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Posted: February 27th, 2023
Gestational diabetes management.
Gestational diabetes is a type of diabetes that affects some women during pregnancy. It occurs when the body cannot produce enough insulin to regulate blood glucose levels. Gestational diabetes can have negative effects on both the mother and the baby, such as increased risk of preeclampsia, macrosomia, preterm birth, congenital anomalies, and neonatal complications. Therefore, it is important to manage gestational diabetes effectively to ensure a healthy pregnancy and delivery.
Management of gestational diabetes involves lifestyle changes, blood glucose monitoring, and medication if needed. Lifestyle changes include following a healthy eating plan that focuses on fruits, vegetables, whole grains, lean protein, and low-fat dairy products, and limits refined carbohydrates and sweets. A registered dietitian or a certified diabetes care and education specialist can help create a personalized meal plan that meets the nutritional needs of the mother and the baby, and helps control blood glucose levels. Physical activity is also recommended for women with gestational diabetes, as it can improve insulin sensitivity and lower blood glucose levels. Moderate-intensity exercise, such as brisk walking, swimming, or cycling, for at least 30 minutes a day, five days a week, is generally advised, unless there are medical contraindications. However, physical activity should be done with caution and under the guidance of a health care provider, as it may affect blood glucose levels and require adjustments in medication or food intake.
Blood glucose monitoring is essential for women with gestational diabetes, as it helps them assess the effectiveness of their treatment plan and make necessary changes if needed. Blood glucose levels should be checked at least four times a day: before breakfast and one hour after each meal. The target blood glucose levels for women with gestational diabetes are:
– Before breakfast: less than 95 mg/dL (5.3 mmol/L)
– One hour after meals: less than 140 mg/dL (7.8 mmol/L)
Some health care providers may recommend more frequent or different blood glucose testing depending on the individual situation.
Medication may be required for some women with gestational diabetes who cannot achieve adequate blood glucose control with lifestyle changes alone. The most common medication used for gestational diabetes is insulin, which is injected under the skin using a syringe, pen, or pump. Insulin does not cross the placenta and is safe for the baby. The dose and type of insulin are determined by the health care provider based on the blood glucose levels and the stage of pregnancy. Insulin therapy may require frequent adjustments as the pregnancy progresses and the insulin needs change. Some oral medications, such as metformin or glyburide, may also be used for gestational diabetes in some cases, but their safety and efficacy are not as well established as insulin. Therefore, they should be used with caution and only under the supervision of a health care provider.
Women with gestational diabetes should receive regular prenatal care and screening for possible complications, such as high blood pressure, fetal growth abnormalities, or fetal distress. They should also receive education and support from a multidisciplinary team that includes an obstetrician, an endocrinologist or diabetologist, a nurse educator, a dietitian, a pharmacist, and a social worker. The goal of gestational diabetes management is to achieve normal blood glucose levels throughout pregnancy and deliver a healthy baby.
References:
– American Diabetes Association. 14. Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes—2021 [Internet]. Diabetes Care 2021;44 (Supplement_1):S200–S210 [cited 2023 Oct 27]. Available from: https://diabetesjournals.org/care/article/44/Supplement_1/S200/30761/14-Management-of-Diabetes-in-Pregnancy-Standards
– Mayo Clinic. Gestational diabetes – Diagnosis & treatment [Internet]. Mayo Clinic [cited 2023 Oct 27]. Available from: https://www.mayoclinic.org/diseases-conditions/gestational-diabetes/diagnosis-treatment/drc-20355345
– National Institute of Diabetes and Digestive and Kidney Diseases. Managing & Treating Gestational Diabetes [Internet]. NIDDK [cited 2023 Oct 27]. Available from: https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/gestational/management-treatment
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