Cardiovascular Risks In Women With Prior Gdm
The question arises whether and how to evaluate CVD risk markers in women with glucose abnormalities persisting after pregnancies with GDM. Inflammatory processes are now known to contribute to atherosclerosis . Research continues on the role of lipoproteins, cytokines, oxidative stress, loss of nitric oxide bioactivity in the vessel wall , and effects of angiotensin and aldosterone . Addition of LDL subfractions to the standard lipid profile may help in predicting risk of CVD events . Assays of inflammatory markers for potential clinical use include white blood cells, soluble adhesion molecules, cytokines , and acute-phase reactants . C-reactive protein is a correlate of obesity in women with GDM . The American Heart Association/Centers for Disease Control Scientific Statement concluded that class IIA evidence supported use of hsCRP as the best inflammatory marker currently available . Other inflammatory markers should not be measured for the determination of coronary risk in addition to hsCRP. Measurement of hsCRP using standardized assays should be done twice , optimally 2 weeks apart, fasting or nonfasting in metabolically stable patients. If hsCRP level is > 10 mg/l, the test should be repeated and the patient examined for sources of infection or inflammation. Otherwise, hsCRP levels are categorized as low risk , average risk , and high risk .
Who’s At Risk Of Gestational Diabetes
Any woman can develop gestational diabetes during pregnancy, but you’re at an increased risk if:
- your body mass index is above 30 use the healthy weight calculator to work out your BMI
- you previously had a baby who weighed 4.5kg or more at birth
- you had gestational diabetes in a previous pregnancy
- 1 of your parents or siblings has diabetes
- you are of south Asian, Black, African-Caribbean or Middle Eastern origin
If any of these apply to you, you should be offered screening for gestational diabetes during your pregnancy.
If You Have Gestational Diabetes How Can You Help Prevent Getting Diabetes Later In Life
For most women, gestational diabetes goes away after giving birth. But having it makes you more likely to develop type 2 diabetes later in life. Type 2 diabetes is the most common kind of diabetes. If you have type 2 diabetes, your pancreas makes too little insulin or your body becomes resistant to it .
Heres what you can do to help reduce your risk of developing type 2 diabetes after pregnancy:
- . Breastfeeding can help you lose weight after pregnancy. Being overweight makes you more likely to develop type 2 diabetes.
- Get tested for diabetes 4 to 12 weeks after your baby is born. If the test is normal, get tested again every 1 to 3 years.
- Get to and stay at a healthy weight.
- Talk to your provider about medicine that may help prevent type 2 diabetes.
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Gestational Diabetes And Your Health After Your Baby Is Born
Your healthcare provider will check your blood sugar level after you deliver. For most women, blood sugar levels go back to normal quickly after having their babies.
Six to twelve weeks after your baby is born, you should have a blood test to find out whether your blood sugar level is back to normal. Based on the results of the test, you will fall into one of three categories.
|Impaired Glucose Tolerance or Pre-iabetes||
The test also checks your risk for getting diabetes in the future. Women who have had gestational diabetes have a 40 percent higher chance than women who have not had gestational diabetes of developing type 2 diabetes later in life.
Getting checked for diabetes is important because type 2 diabetes shows few symptoms. The only way to know for sure that you have type 2 diabetes is to have a blood test that reveals a higher-than-normal blood sugar level. You should also tell your healthcare provider right away if you notice any of these things:
- Increased thirsty
- Feeling constantly or overly tired
- Losing weight quickly and/or without reason
Can I breastfeed even though I have gestational diabetes?
Am I going to develop diabetes in the future?
Plan your next pregnancy
Increased Risk Of Developing Type 2 Diabetes
If youve had gestational diabetes, you have up to a 1 in 2 chance of developing type 2 diabetes in the next 5-10 years. You are also at higher risk of developing type 2 diabetes for the rest of your life.
There are other risk factors for type 2 diabetes, which include:
- being over 40 years
- having a close relative with diabetes
- being overweight or obese
- being of south Asian, Chinese, African Caribbean or black African origin
- having polycystic ovary syndrome
Type 2 diabetes is a lifelong condition that can affect your everyday life. If you develop the condition, you will need to keep an eye on your health and have regular check-ups. This is because it can lead to serious problems such as:
- loss of feeling and pain causing problems with sex
- foot problems like sores and infections
- vision loss and blindness.
This may sound worrying, but there is a lot you can do to reduce your risk of developing the condition. This includes:
- eating well
- being the right weight for your height
- stopping smoking.
A healthy lifestyle will not just reduce your risk of type 2 diabetes, it will also make you less likely to develop all sorts of other health problems. These include cancer, heart disease, stroke, depression, arthritis and even dementia.
- a weight-loss programme or group
- a registered dietitian or exercise specialist
- a type 2 diabetes prevention programme
- local NHS Stop Smoking Services
- other local services to help you move more and eat better.
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Gestational Diabetes Causes And Risk Factors
Gestational diabetes develops when your body isnt able to produce enough of the hormone insulin during pregnancy. Insulin is necessary to transport blood glucose into the cells. Without enough insulin, you can build up too much glucose in your blood, leading to a higher-than-normal blood glucose level and perhaps gestational diabetes.
The elevated blood glucose level in gestational diabetes is caused by hormones released by the placenta during pregnancy. The placenta produces a hormone called the human placental lactogen , also known as human chorionic somatomammotropin . Its similar to growth hormone , but it actually modifies the mothers metabolism and how she processes carbohydrates and lipids. HPL actually raises maternal blood glucose level and makes a woman’s body less sensitive to insulinless able to use it properly. If the body doesnt use insulin as it should, then the blood glucose levels will rise. The HPL hormone increases the blood glucose level so that the baby can get the nutrients it needs from the extra glucose in the blood.
At 15 weeks, another hormonehuman placental growth hormonealso increases and causes maternal blood glucose level to rise. This hormone is also supposed to help regulate the mothers blood glucose level to be sure that the baby gets the right amount of needed nutrients.
While doctors arent clear about why some women develop gestational diabetes and others don’t, there are several risk factors that make it more likely to occur:
Management Of Igt After Pregnancy
How should the clinician manage the woman with prior GDM and IGT identified after pregnancy? Certainly weight loss or weight maintenance medical nutrition therapy and 3060 min exercise daily at least 5 days per week should be applied . The 2-h 75-g GTT should be repeated at some interval, since it can revert to normal or abnormal spontaneously. For women with persisting IGT after a good effort of medical nutrition therapy and planned physical activity, clinical trials support the clinician adding pharmacotherapy . Acarbose delays carbohydrate absorption and helps with postprandial glucose control, but side effects limit usage . Metformin decreases hepatic glucose production and lipid oxidation, improves peripheral tissue insulin sensitivity and helps with weight loss . Thiazolidinediones as peroxisome proliferatoractivated receptor- agonists increase insulin sensitivity and may improve lipid balance and cardiovascular and renal function . Metformin and glitazones may help take the load off the overworked pancreatic -cells . As noted above, it is important to identify and control type 2 diabetes before a subsequent pregnancy. This may justify continued follow-up in the gynecological setting of women with the potential to become pregnant, or close collaboration with other physicians.
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Why Does Gestational Diabetes Occur
Your body goes into hypermobility, which means your body doesnt store blood sugar normally. Sometimes a womans cells dont even have a gene that allows them to make the hormone insulin.
There are several genes that cause type 2 diabetes, Says Dr. Sandra Guerrero, MD, director of maternal fetal medicine at New York-Presbyterian/Columbia University Medical Center. There is no deficiency of these genes.
It is those that are lacking, and which women usually inherit from their mothers, that cause most cases of type 2 diabetes.
In other words, you cannot get gestational diabetes because you have a gene that allows it, but you are more likely to develop type 2 diabetes later.
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Symptoms Of Gestational Diabetes
Gestational diabetes does not usually cause any symptoms.
Most cases are only discovered when your blood sugar levels are tested during screening for gestational diabetes.
Some women may develop symptoms if their blood sugar levels gets too high , such as:
- needing to pee more often than usual
- a dry mouth
But some of these symptoms are common during pregnancy and are not necessarily a sign of gestational diabetes. Speak to your midwife or doctor if you’re worried about any symptoms you’re experiencing.
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How Much Carbohydrate Should I Eat To Control Blood Sugar
This is going to be very individual. Things like height and weight, carbohydrate tolerance, activity level, whether you are carrying multiples and countless other factors can affect how much carbohydrate you will want to intake.
As a general rule, most pregnant women with gestational diabetes can tolerate somewhere between 100-200 grams of carbohydrates daily. Some organizations will suggest 175 grams of carbohydrate as a minimum for pregnant women. This is not something I agree with.
Often times women will continue to experience elevated blood sugars eating 175 grams of carbohydrate or higher. In this case, I would recommend lowering carbohydrate by 15 grams per day until you can achieve desired blood sugar goals.
What Is Gestational Diabetes
Gestational diabetes is a medical condition in which your blood sugar levels become elevated during pregnancy. This condition affects as many as 10% of pregnant women each year in the US.
Those who are able to manage their blood sugars through diet and exercise are considered class A1. Those who require insulin or oral medications to reduce blood sugar are consider class A2.
Generally, blood sugars will return to normal around 6 weeks after giving birth. This is not always the case. Some women do not experience a reduction in blood glucose post partum and are then diagnosed with type 2 diabetes.
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How Can I Reduce My Risk Of Type 2 Diabetes
Women who have gestational diabetes have a high chance of developing type 2 diabetes at some point later in their lives. However, type 2 diabetes can be prevented. The following steps can reduce your risk:
- maintain a healthy eating plan
- maintain a healthy weight for your height
- do regular physical activity
- have regular follow-up blood tests every one to three years to check your blood glucose levels, especially if you may have further pregnancies.
Talk to your doctor about follow-up blood tests to check for diabetes. The frequency of the tests will depend on your risk for developing diabetes.
How Is Gestational Diabetes Diagnosed
Most women are diagnosed using a pathology test, which requires blood samples to be taken before and after a glucose drink. This is known as a pregnancy oral glucose tolerance test . These tests are usually performed between 24 and 28 weeks into the pregnancy, or earlier if you are at high risk.
A pregnancy oral glucose tolerance test involves:
- fasting overnight
- having a blood test in the morning
- having a drink containing 75 grams of glucose
- having a blood test one hour after having the drink
- having a blood test two hours after having the drink.
Gestational diabetes is diagnosed if any of these blood tests show that your blood glucose is raised.
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What Are The Symptoms Of Gestational Diabetes
Gestational diabetes doesn’t cause any symptoms. Thats why its important to get tested for it if you are at high risk.
If your blood sugar levels are very high, you may have these symptoms:
You urinate more than normal
You are hungrier or thirstier than normal.
You have blurred vision
You have nausea and vomiting
You lose weight even though you are hungrier
Possible Complications For The Baby
Unlike type 1 diabetes, gestational diabetes generally occurs too late to cause birth defects. Birth defects usually originate sometime during the first trimester of pregnancy. The insulin resistance from the contra-insulin hormones produced by the placenta does not usually occur until approximately the 24th week. Women with gestational diabetes mellitus generally have normal blood sugar levels during the critical first trimester.
The complications of GDM are usually manageable and preventable. The key to prevention is careful control of blood sugar levels just as soon as the diagnosis of diabetes is made.
Infants of mothers with gestational diabetes are vulnerable to several chemical imbalances, such as low serum calcium and low serum magnesium levels, but, in general, there are two major problems of gestational diabetes: macrosomia and hypoglycemia:
Blood glucose is monitored very closely during labor. Insulin may be given to keep the mother’s blood sugar in a normal range to prevent the baby’s blood sugar from dropping excessively after delivery.
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What Causes Gestational Diabetes Mellitus
Although the cause of GDM is not known, there are some theories as to why the condition occurs.
The placenta supplies a growing fetus with nutrients and water, and also produces a variety of hormones to maintain the pregnancy. Some of these hormones can have a blocking effect on insulin. This is called contra-insulin effect, which usually begins about 20 to 24 weeks into the pregnancy.
As the placenta grows, more of these hormones are produced, and the risk of insulin resistance becomes greater. Normally, the pancreas is able to make additional insulin to overcome insulin resistance, but when the production of insulin is not enough to overcome the effect of the placental hormones, gestational diabetes results.
What Are The Risks Factors Associated With Gestational Diabetes Mellitus
Although any woman can develop GDM during pregnancy, some of the factors that may increase the risk include the following:
Overweight or obesity
Family history of diabetes
Having given birth previously to an infant weighing greater than 9 pounds
Prediabetes, also known as impaired glucose tolerance
Although increased glucose in the urine is often included in the list of risk factors, it is not believed to be a reliable indicator for GDM.
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How Can I Keep Myself Healthy And Prevent Having Diabetes In The Future
There are several lifestyle changes you can make to help your body use insulin better. These changes may help keep you from getting gestational diabetes with your next pregnancy. A healthy lifestyle can also prevent or delay getting type 2 diabetes.
Eat Well: Eat healthy well-balanced meals. It is best to eat 3 small- to medium-sized meals, with snacks in between. Be careful about how much you eat at each meal. Use a smaller plate and split a meal when you eat out. Fill at least half your plate with fruits and vegetables of different colors. Eat 2 to 3 servings of low-fat or fat-free dairy a day. At least half of your grains should be whole grains. Be careful about how much fat you are eating. Drink water or unsweetened drinks instead of sugary drinks like soda and juice, which have lots of sugar and calories.
Stay Active: Exercise at least 30 minutes most days of the week. Your goal is to get your heart rate up and to sweat. Find activities you enjoy. Walk, swim, bike, or dance. You can stay motivated by changing what activities you do. Also, find a friend who will exercise with you. Exercising with a friend or in a class will help you keep exercising regularly.
National Institute of Diabetes and Digestive and Kidney Disease: Information about gestational diabetes.
United States Department of Agriculture: Information on eating healthy and losing weight.
Monitoring Blood Glucose Levels
Monitoring your blood glucose levels is essential. It gives you a guide as to whether the changes you have made to your lifestyle are effective or whether further treatment is required.
A diabetes nurse educator can teach you how and when to measure your blood glucose levels. They will discuss the recommended blood glucose levels to aim for.
Your doctor or diabetes educator can help you link in with the National Diabetes Services Scheme for cheaper blood glucose strips. Regular contact with your diabetes educator or doctor is recommended.
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How Is It Diagnosed
While most women with gestational diabetes have no obvious symptoms, some experience extreme hunger, thirst, or fatigue. Since these symptoms are also common during typical pregnancies, Dr. Esakoff says it’s essential to get proper screening.
“We have patients who take care of themselves, are in excellent shape, watch their diet, and they still get it,” says Dr. Esakoff. So you should definitely get tested around 24-28 weeks.”
Tests include a 1-hour glucose tolerance test, and if it’s positive, a follow-up 3-hour test to confirm the diagnosis.