How does having gestational diabetes mellitus affect my pregnancy and my baby?

          Most women who develops diabetes mellitus during pregnancy go on to have healthy babies. Dietary changes and exercise may be enough to keep your blood glucose levels under control, though sometimes medication is needed too.
          It's important to keep your blood glucose levels in check because poorly controlled diabetes mellitus can have serious short- and long-term complications for you and your baby.
          If your blood glucose level is too high, too much glucose will end up in your baby's blood. When it happens, your baby's pancreas needs to produce more insulin to process extra glucose. All these excess glucose and insulin can cause your baby to put on extra weight, particularly in the upper body.
This can lead to what's called macrosomia. A macrosomic baby may be too large to enter the birth canal Or the baby's head may enter the canal but then his shoulders may get stuck. In this situation, called shoulder dystocia, your practitioner will have to use special maneuvers to deliver your baby. Delivery can sometimes result in fractured bone or nerve damage, both of which heal without permanent problems in about 99 percent of babies. (In very rare cases, the baby may suffer brain damage with lack of oxygen during this process.) What's more, the maneuvers needed to deliver a broad-shouldered baby can lead to injuries to the vaginal area or require a large episiotomy for you. Because of these risks, if your practitioner suspects that your baby may be overly large, she may recommend that you give birth by cesarean section. Fortunately, only a minority of women with well-controlled gestational diabetes mellitus ends up with overly large babies.
In addition, babies who have excessive fat stores as a result of high maternal glucose levels during pregnancy often continue to be overweight in childhood and adulthood.
          Shortly after birth, your baby may have low blood glucose (hypoglycemia) because his body will still be producing extra insulin in response to your excess glucose. This is much more likely if your blood glucose levels were high during pregnancy and especially during labor.
Your delivery team will test your baby's blood glucose at birth and continue to check it as needed by taking a drop of blood from his heel. Feeding your baby as soon as possible after birth, preferably by breastfeeding can help prevent or treat hypoglycemia.
          In severe cases of hypoglycemia, though, he'll be given intravenous glucose solution. Testing your baby's blood glucose level and providing an intravenous glucose if necessary can prevent serious problems such as seizures, coma, and brain damage that might result if the condition were to go unnoticed.
          Your baby may also be at higher risk for breathing problems at birth, particularly if your blood glucose levels aren't well controlled or you deliver early (the lungs of babies whose mothers have diabetes mellitus tend to mature a bit later). The risk of newborn jaundice is increased, too.
If your blood glucose control is especially poor, your baby is at risk for polycythemia (an increase in the number of red blood cells) and hypocalcemia (low calcium  in the blood), and your baby's heart function could be affected as well.
          Some studies have found a link between severe gestational diabetes mellitus and an increased risk of stillbirth in the last two months of pregnancy. And, finally, women with gestational diabetes mellitus are at increased risk for developing preeclampsia, particularly those who are obese before pregnancy or whose blood glucose levels are not well controlled.
What will I need to do if I have gestational diabetes mellitus?
You'll need to keep diligent track of your glucose levels, using a home glucose meter or strips. To keep those levels where they should be, you'll want to:
Eat a well-planned diet. The ADA recommends getting nutritional counseling from a registered dietitian who'll help you develop specific meal and snack plans based on your height, weight, and activity level.
Your diet must have the correct balance of protein, fats, and carbohydrates, while providing the proper vitamins, minerals, and calories. To keep your glucose levels stable, it's particularly important that you don't skip meals, especially breakfast, and that you avoid sugary items like candy, cookies, cakes, and soda.
          This may sound daunting, but it's not so hard once you get the hang of it. And don't think of yourself as being on a special or restrictive diet. The principles of the diabetic diet are good ones for everyone to follow. Think of this as an opportunity to create healthier eating habits for yourself and your whole family. If everyone in the house is eating the same foods, you won't feel as deprived.
          Exercise. Studies show that moderate exercise also helps improve your body's ability to process glucose, keeping blood glucose levels in check. Many women with gestational diabetes mellitus benefit from 30 minutes of aerobic activity, such as walking or swimming, each day. Ask your practitioner what level of physical activity would be beneficial for you.
          Take insulin if necessary. If you're not able to control your blood glucose well enough with diet and exercise alone, your provider will prescribe insulin shots for you to give yourself as well. About 15 percent of women with gestational diabetes mellitus need insulin. Recently, some practitioners have been prescribing oral medications instead of injections for some cases of gestational diabetes mellitus.

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