How Is Preexisting And Gestational Diabetes Mellitus Diagnosed And Treated?
Preexisting Diabetes Mellitus needs to be under excellent control prior to conception, as an elevated Hemoglobin A1C above 8.5 is associated with a 25% chance of a severe heart defect. Ophthalmology consultation, baseline labs, and an EKG are required as soon as pregnancy is confirmed.
Gestational Diabetes is caused by a hormone, human Placental Lactogen, produced in pregnancy that counteracts Insulin, the hormone that keeps your blood sugar under control. It is screened for by drinking a sugar drink, then checking your blood sugar sixty minutes later. In more high risk patients this test is done at the beginning of pregnancy as well as at 24 – 28 weeks.
Blood sugar control with diabetes in pregnancy is much more stringent then when you are not pregnant. Your blood sugar needs to be checked four times a day, fasting upon waking up (goal < 100), then two hours after each meal (goal < 120). Even chronic diabetics are referred to a diabetes educator for a refresher course and your insurance helps cover the cost of a blood sugar meter and OB Home Health to come to your home and provide the necessary instruction.
Fetal monitoring will be similar to that for high blood pressure patients. If your blood sugar is well controlled, your pregnancy will be uneventful and the result will be a beautiful girl or boy. If your blood sugar is not well controlled, you can have a ten-pound baby, growth restricted baby or worse your baby’s heart can suddenly stop.