We are beginning to feel these obese babies are at higher risk for [Type II] diabetes themselves and, ultimately, all the complications of obesity.
Can anything be done to prevent gestational diabetes?
If it is the mom's first pregnancy, and she is diagnosed with gestational diabetes, then nothing can be done about it - she has been diagnosed. But when she has a second child, weight loss [before pregnancy] can help.
Once a diagnosis is made, what is the treatment?
We take a multidisciplinary attack. The first stop is the dietitian who talks to the moms about balancing their calories over the day. Rather than three big meals a day, they eat three smaller meals and three snacks. Some women can control their gestational diabetes with diet alone.
A diabetes educator will collect background data to see if they may have underlying diabetes. We teach them how to use a glucometer, and the moms check their blood sugar four times a day.
What else does the treatment include?
Let's say we have a mom who has done all that [described above] and her blood sugar looks fine, and the baby is growing normally; we may keep her on the diet and keep checking the baby. If the blood sugar stays high, we can use an oral pill or put her on insulin.
What if the baby is not growing normally?
If the baby is already big, we will move to put the moms on insulin. At 30 to 32 weeks, we have time to intervene with the macrosomic babies so they won't be 9-, 10-, 11-pounders. That is the good thing about screening at 24 weeks.
What do you say to your patients if they are diagnosed with gestational diabetes?
What I tell my moms is if you don't have underlying diabetes, gestational diabetes is not that much of a problem as far as the mom goes: It really is all about the baby. For the babies, besides having the risk of injuries at delivery, it means being at risk for metabolic issues, neonatal jaundice and blood-sugar abnormalities. We are talking about trying to get healthy babies who go home with Mom. That is what the work with gestational diabetes is all about.
