Gestational diabetes

Close monitoring of the mother and the foetus should continue throughout the pregnancy. Self-monitoring of glucose levels allows the woman to participate in her care. Foetal monitoring to assess the foetal size and well-being may include ultrasound exams and non-stress tests. A non-stress test is a very simple painless test for you and your baby. An electronic foetal monitor (a machine that hears and displays your baby's heartbeat) is placed on your abdomen. When a baby moves, its heart rate normally rises between 15 and 20 beats above its regular heart rate. Your health-care provider can look at the pattern of your baby's heartbeat in relationship to its movements and determine whether the baby is doing well. Your health-care provider will look for three accelerations of 15 beats per minute over the baby's normal heart rate, occurring within a 20-minute period.

Dietary management provides adequate calories and nutrients required for pregnancy and to control blood glucose levels. Patients should receive nutritional counselling from a dietician.

If dietary management does not control blood glucose levels and keep them within the recommended range, insulin therapy should be initiated. Self-monitoring of blood glucose is required for effective treatment with insulin.

Prognosis There is a slight increased risk of foetal and neonatal death with gestational diabetes, but this risk is lowered with effective treatment and surveillance of the mother and foetus. High blood glucose levels often resolve after pregnancy. However, women with gestational diabetes should be monitored postpartum and at regular intervals to detect diabetes early. Up to 30% to 40% of women with gestational diabetes develop overt diabetes mellitus within 5 to 10 years after delivery. The risk may be increased if the risk factor of obesity is present.

Complications

• Low blood glucose or illness in the newborn
• Increased incidence of newborn deaths
• Development of diabetes later in life.