点击显示 收起
By Suzanne Schlosberg
Gestational diabetes: a threat to mom and baby
At my 26-week OB appointment, I drank a bottle of extra-sweet soda imagine Mountain Dew spiked with pancake syrup and an hour later, submitted my arm for a blood test. I was being screened for gestational diabetes and, as a gym regular and healthy eater (except for those first-trimester French-toast binges), I wasn't worried. But the next day I learned that my blood sugar exceeded the cutoff level, and I'd need a more precise test involving an overnight fast, four blood draws and a soda twice as sweet as the first. This time I was worried. What were the chances that I could actually have gestational diabetes? If so, what would what mean for me and the twins I was carrying? How concerned should I be
These are hot-button questions in the medical community. High blood sugar during pregnancy, what doctors call gestational diabetes mellitus (GDM), now affects 5 percent to 8 percent of expectant women, up from 4 percent about 20 years ago. Doctors have known for decades that GDM puts women at risk for having large babies and Cesarean sections; new studies indicate it may have long-term consequences and that it poses risks at lower blood-sugar levels than previously thought. The good news is that proper treatment reduces these risks. A diagnosis might sound scary, says Danielle Symons Downs, Ph.D., an assistant professor of kinesiology at Pennsylvania State University in University Park, "but for a woman who takes it seriously and makes lifestyle changes, it could be the best thing to happen to her and her offspring."?
Gestational diabetes develops when hormones from the placenta compromise a
woman's ability to use the insulin produced by her pancreas.
Though most women compensate by producing extra insulin to break down glucose
(blood sugar) for energy, some can't; their excess glucose
builds up in the blood and passes through the placenta. "In some
pregnancies with GDM, the baby sucks up the mother's glucose and grows
bigger than it should," Downs explains. "In others, the baby is
underdeveloped and has a low birth weight."
After delivery, mom's blood sugar levels typically revert to normal, but
according to a study of nearly 10,000 mother-child pairs,
this may not be the end of the story. Researchers at Kaiser Permanente Center
for Health Research in Portland, Ore., and Hawaii, found
that the higher a mother's blood sugar during pregnancy, the more likely her
baby would be overweight by age 7. "Quite a few studies
have shown that if you're overweight at ages 5 to 7 you're much more likely to
be overweight as an adult," says endocrinologist Teresa
Hillier, M.D., the study's lead author. Hillier found an increased risk of
childhood obesity even among GDM babies who weren't born large.
"To me, that suggests something has been metabolically changed that allows
the baby to more easily store fat," she says.
Hillier found the risks were reduced when mothers were treated with diet
changes and increased exercise and, if that was insufficient,
by adding medication, typically insulin. When women remained untreated, their
baby's risk of being overweight or obese at ages 5 to 7
was nearly twice as high, "but the children of women who were treated for
GDM had no greater risk of overweight or obesity compared
with children of mothers with normal blood sugar during pregnancy," she
says. "This suggests that treating moms during pregnancy gives
their babies a fighting chance for a normal metabolism."
Doctors' debate
But who should receive treatment? Despite the new research, there's no consensus on the threshold for gestational diabetes or even whether mild cases warrant intervention. "We don't know the level of glycemia [high blood sugar] that truly poses a risk to the fetus," says Mark Landon, M.D., vice chairman of the department of OB/GYN at Ohio State University Medical Center in Columbus, who is studying the effectiveness of treating mild GDM.
The world's top gestational diabetes researchers will convene later this year to analyze the research and possibly lower the blood-sugar levels that indicate a diagnosis. "There's a good chance [lowering the threshold] will result in more women being identified," says Boyd Metzger, M.D., a professor of medicine and endocrinology at Northwestern University and lead investigator of a GDM study involving 23,000 pregnant women in nine countries. "We found that some problems occurred even in ranges previously considered normal for pregnant women," he adds. Among Metzger's results: moms-to-be with the highest blood-sugar levels were four to six times more likely to deliver large babies than women with the lowest levels.
It's not just babies who may be affected over the long term. Among women diagnosed with GDM, 50 percent will develop type II diabetes within 5 to 8 years; 70 percent to 85 percent will develop the disease during their lifetimes, Metzger says. A GDM diagnosis can serve as an early warning, motivating at-risk women to make permanent lifestyle changes. "Even if treatment only delays diabetes by 10 or 15 years, that's huge," he says.
Limiting sweets and eating smaller, more frequent meals and more fruits and vegetables, is typically the first line of treatment, but exercise can help. Downs is researching how much and what type of physical activity works best. Though gestational diabetes is often associated with overweight, sedentary women, she notes that only 50 percent to 60 percent of women diagnosed with GDM are overweight. Age is a factor women over age 25 are at greater risk due to declining pancreas function and there's a big genetic component.
"You could be healthy, thin and still get GDM because of a genetic predisposition," says Downs, noting that "Bachelorette" Trista Sutter was forced to deliver a month early partly because of complications due to gestational diabetes. Downs herself, a marathon runner with a family history of diabetes, came within two blood-sugar points of a GDM diagnosis during her first pregnancy at age 31. In her second pregnancy, she passed the screening tests with flying colors, attributing her better blood-sugar levels to "being more stringent with my diet and maintaining a moderate-intensity exercise plan."
More than 75 percent of women who "fail" the one-hour glucose challenge, as I did, end up passing the three-hour glucose-tolerance screening, the one with the unbearably sweet soda. I didn't have gestational diabetes, but the testing experience was a reminder to keep cranking on the elliptical trainer and eating my vegetables.
Suzanne Schlosberg is a writer in Bend, Ore., and the mother of twin boys,
Ian and Toby.
Original Publication Date:?April 2008