Diabetes Mellitus GESTATIONAL AND PREGESTATIONAL DIABETES OTHER TYPES OF DIABETES

GESTATIONAL AND PREGESTATIONAL DIABETES

Written by StopDiabetes

What are some connections between diabetes and pregnancy?

One connection between diabetes and pregnancy is pregestational diabetes. This is when a woman already has insulin-dependent diabetes and becomes pregnant (see below). The most well-known connection between diabetes and pregnancy is a condition called gestational diabetes. In the United States, it occurs in about 4 to 9 percent of pregnant women (the percentage varies depending on the study). Worldwide, it has been reported by some studies to occur in about 19 percent of pregnant women.

What is gestational diabetes?

Gestational diabetes occurs when a pregnant woman develops high blood glucose levels, even if she did not have diabetes before pregnancy. This type of diabetes generally develops during the woman’s second trimester and usually disappears after the baby is born. According to the American Diabetes Association, this condition is also thought to raise the mother’s and child’s risk for developing type 2 diabetes later in life.

Why do some pregnant women develop gestational diabetes?

Although not all studies agree, most research seems to indicate gestational diabetes may be caused by the hormones in the fetus’s placenta. This connection between the mother and fetus, which supplies the nutrients the baby needs, may block the action of the mother’s insulin throughout the body. If left untreated, gestational diabetes can result in very large babies and possibly the need for a caesarean delivery.

What is the O’Sullivan test?

The O’Sullivan test is a one-hour glucose-tolerance test (GTT) that is given to pregnant women to screen for gestational diabetes. It is most often performed between the 24th and 28th weeks of pregnancy.

What is pregestational diabetes?

Pregestational diabetes is used to describe the condition of a woman who already has insulin-dependent diabetes and becomes pregnant. Like gestational diabetes, pregestational diabetes can have consequences for the woman’s infant, especially if the mother’s blood glucose levels are not controlled during pregnancy.

What percentage of pregnant women develop pregestational or gestational diabetes?

Although studies vary, it is estimated that gestational diabetes affects around 4 to 9 percent of pregnant women, or 4 to 9 of every 100 women who become pregnant in the United States. It is also estimated that gestational diabetes is 100 times more common than pregestational diabetes. There are also ethnic and racial groups that are at higher risk for gestational diabetes. It is thought that the Pima Indians of Arizona have 40 percent chance of having gestational diabetes, or a tenfold higher risk than the general population. Other groups are also at an increased risk, including African Americans, obese women, women who are at an older maternal age at pregnancy, women with a family history of diabetes, women whose babies are large for their gestational age, and women with a prior history of gestational diabetes during other pregnancies.

Do any groups have a lower risk of developing gestational diabetes?

Yes, it has been estimated that teenage pregnant women have a lower risk—about one-fourth lower—of developing gestational diabetes than pregnant women age 35 or older. In addition, certain studies have indicated that Asian, Asian American, and Filipino women seem to have a lower risk of developing gestational diabetes, but more studies are needed to confirm the results.

How can having pregestational diabetes affect a woman’s unborn child?

If a mother who has insulin-dependent diabetes has uncontrolled blood glucose, excess glucose is often transferred to the fetus. Because of this, the baby’s system secretes an increased amount of insulin, which can cause an increase in tissue and fat deposits in the baby. According to Stanford Children’s Health, these deposits can increase the risk of birth defects, especially during the development of the fetus’s heart, brain, spinal cord, and gastrointestinal system. In many cases, too, the infant of a mother with pregestational diabetes is often larger than expected for the gestational age.

Can a woman develop diabetes by becoming pregnant?

No, there is no research that supports the idea that pregnancy causes a woman to develop diabetes, but there is the possibility of developing gestational diabetes. However, some research indicates that if a woman has had gestational diabetes, she may be at a higher risk for developing type 2 diabetes later in life. Other research seems to indicate that breastfeeding a child will lower the mother’s risk of developing type 2 diabetes. But overall, no true connection between becoming pregnant and developing diabetes has been shown.

In what way does gestational diabetes differ from pregestational diabetes in terms of the fetus?

According to Stanford Children’s Health, pregestational diabetes (if the mother has uncontrolled blood glucose levels) has been associated with birth defects in certain organs of the fetus as they form. Gestational diabetes generally does not cause birth defects. This may be because women who develop gestational diabetes develop it later in their pregnancy. Thus, most women will have normal blood glucose levels during the first trimester when the fetus’s organs are forming.

What is the White Classification?

The White Classification of Diabetic Pregnancies classifies the risks associated with a woman who is pregnant and has diabetes. It was presented by American physician and researcher Priscilla White (1900–1989), who, in 1924, joined the practice of Elliot Joslin and began caring for pregnant women who had diabetes. (She was also one of the founders of the Joslin Diabetes Center in Boston; for more information about Joslin, see the chapter “Introduction to Diabetes,” and for more about the center, see the chapter “Resources, Websites, and Apps.”) White’s system was based on a pregnant woman’s age at the onset of diabetes, the duration of the disease, and whether the woman had any vascular complications. The class system White presented in 1949 included Class A, meaning the diagnosis of the diabetes is based on a glucose-tolerance test and deviates slightly from the normal levels. Class B means the pregnant woman has had diabetes less than ten years, with the onset at age 20 or older, and no vascular disease. The diabetes and associated diseases increases as the classes continued down the alphabet. For example, class F means the pregnant woman with diabetes has nephritis, or inflammation of the kidneys.

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