Diabetes in Pregnancy:

Diabetes in pregnancy can be either preexisting from before pregnancy (Type 1 or 2), or pregnancy induced. Pregnancy induced diabetes is known as Gestational Diabetes Mellitus or GDM.

Gestational Diabetes Mellitus (GDM):

GDM occurs from carbohydrate intolerance during pregnancy. It can affect 5-15% of women during pregnancy. Risks for GDM may include Obesity prior to pregnancy, twin pregnancies (multiples), strong family history of diabetes, GDM in a previous pregnancy, Prediabetes, and polycystic ovarian syndrome (PCOS).  Some ethnic groups are at higher risk to develop GDM. GDM testing is done routinely between 24 and 28 weeks however, earlier testing may be needed if any risk factors are present.

Testing for GDM:

Patients will routinely take a glucose screening between 24 and 28 weeks. This is a one-hour test following a 50-gram load of glucose. If you do not pass the 50-gram screening, you will need to follow up with a 3-hour diagnostic test unless the one-hour test was significantly high. Confirmation of GDM with the 3 hour test usually requires 2/4 abnormal values. Recent guidelines support the use of 1/4 abnormal values to apply the diagnosis of GDM. Some providers may use a 2-hour 75-gram glucose tolerance test. This is a one-step pass or fail test and is not commonly used in the United States.

GDM Management:

Once GDM is diagnosed, dietary recommendations are provided. Patients will start to check and record their blood sugars using a glucometer four times daily (fasting and two hours after meals).

If diet is not adequate to control sugar levels, medication will be necessary. In general, first line medications include oral medications such as Metformin or Glyburide. If these are not adequate, insulin may be added or a complete conversion to insulin may be needed. Some patients may need insulin as their first line of medication to achieve the best control.

Serial ultrasound evaluation is done to assess your baby’s growth every 3 weeks. Fetal well-being testing in the form of Biophysical (BPP) or Non stress testing with amniotic fluid check (modified BPP) is usually started in the third trimester. If a patient is well controlled on diet, fetal testing is scheduled weekly after 34 weeks. Patients who require medications, either pills or insulin to control their sugars will have fetal testing started earlier and more frequently.

Preexisting Diabetes Mellitus (DM):

Almost 6% of the US population has Diabetes Mellitus. Diabetes can either be Type I(DM-I) also known as Juvenile or Insulin Dependent diabetes, or Type II (DM-II) also known as adult onset or Non-Insulin dependent diabetes.

Diabetes is becoming more prevalent among women of reproductive age. DM is more difficult to control during pregnancy because of higher levels of hormones that worsen carbohydrate intolerance.

Preexisting DM Management in pregnancy:

The management of preexisting DM in pregnancy, either Type I or Type II includes strict blood sugar control with diet, monitoring blood sugar levels, and taking medication. Most Type II diabetics and all Type I mothers need Insulin to regulate their blood sugars. Most Type I diabetics are managed in conjunction with their Endocrinologists. Type I and Type II DM patients should have a detailed ultrasound at 20 weeks and a Fetal Echocardiogram around 22 weeks. In some cases, an early genetic ultrasound may be appropriate in patients who conceived with a high Hemoglobin A1C.

During the pregnancy, serial ultrasound evaluation is done to assess your baby’s growth, in addition to tests which measure your baby’s well-being such as the Biophysical Profile (BPP) or Non-Stress Test (NST).  Tests for fetal well being are started around 30 weeks and are usually twice weekly.

MFAMA has a comprehensive diabetes program that includes:

• Nutrition and dietary counseling.
• Blood sugar evaluation and management. Patients will provide their blood sugar log on a weekly basis through a convenient email address and will bring their sugar log to all visits.
• Comprehensive medical management with oral medications and insulin.
• Serial ultrasound evaluation
• Detailed anomaly
• Fetal echocardiogram
• Routine fetal testing with Biophysical profiles.
• Our diabetes program is inclusive of all diabetics, including Type I, Type II, Gestational diabetics, pre-diabetics and some patients with insulin resistance and Polycystic ovary syndrome (PCOS).