Nicholas Wulf

Wulf

Being pregnant comes with its highs and lows. There’s the blissful anticipation of welcoming your bundle of joy to the world, but also the misery of morning sickness, swollen ankles and your little one constantly pushing on your bladder.

Another undesirable effect is gestational diabetes. While common in pregnant women, it can also be dangerous for both mom and baby if not addressed properly. And, it can have long-term effects, with 70 percent of women developing type-2 diabetes later on in life.

Causes & Diagnosis

Gestational diabetes differs from type-1 or type-2 diabetes, in that it occurs secondary to physiology shifts during pregnancy—due to a hormone the placenta makes that renders a woman’s insulin less efficient.

The American College of Obstetrics and Gynecology Screening recommends screening at week 24-28.

“It’s a fairly simple test. We send you home with a ‘sugary drink’ that contains about 50 grams of glucose. It’s basically like drinking a soda,” explained Dr. Nicholas Wulf, obstetrician gynecologist at Columbus Women’s Healthcare. “You drink that about 45 minutes before your appointment, then one hour after you drink it, we test your blood sugar with a simple blood draw. We like to see blood sugar levels less than 140.”

This first test is considered a “screening” test. If a woman’s levels are too high, the next step is to do a diagnostic three-hour glucose tolerance test that’s conducted in a lab. The sugary drink is increased to 100 grams, and testing occurs at the one-, two-, and three-hour marks.

“If you fail that, which is failing two out of four of the values, you are diagnosed with gestational diabetes,” said Dr. Wulf.

Reducing Risk

Previously, women were only screened if they held certain risk factors, such as a prior diagnosis, twin gestations, moms who are at extremes of age (both very young moms and older moms), being overweight, and inactive lifestyles. That has since changed.

“In about 2014, we found that risk factors alone would leave out about 50 percent of women diagnosed with gestational diabetes,” noted Dr. Wulf.

Women can reduce their risk by engaging in regular exercise—ideally 30 minutes in the morning before eating—and proper nutrition. If a woman has had a prior diagnosis, Dr. Wulf advised screening earlier than the 24-28-week timeline.

“For the women we screen early, if they pass their test, great. We still always go on to screen them at that 24-28 week regardless,” he shared. “If they fail the test early on, then we might go ahead and just start some counseling.”

Treatment Options

Once a woman has been diagnosed with gestational diabetes, the first plan of action is to get her in with a diabetic educator who can advise on nutrition—specifically, carbohydrate consumption. Physical activity is also advised, at least 30 minutes five days a week. According to Dr. Wulf, about 90 percent of women are able to control their gestational diabetes with diet and lifestyle changes alone.

For those women who still struggle, medications are available.

“Insulin is really the gold standard, as far as medications go, to control blood sugars. Some women are not able to use insulin, so we do have oral medications that also work very well,” assured Dr. Wulf.

Gestational Diabetes Complications

The biggest risk in women with gestational diabetes is that they are at increased risk for other complications in pregnancy, such as preeclampsia or C-section. These women are also at an increased risk for having a large baby, leading to shoulder dystocia. Babies born to mothers with gestational diabetes are more likely to require NICU admission.

Focus on Healthy Mom & Baby

Gestational diabetes typically goes away post-delivery, but women are tested at about six weeks after delivery to assess their condition. However, Dr. Wulf cautioned women that relief of the condition shouldn’t be a motivator to not take care of themselves prior to, during and post-pregnancy.

“Anything you can do to prevent complications during pregnancy is what we want to focus on. Eating a proper diet, continuing to be active during pregnancy, those are important things. For women who have had gestational diabetes in the past, it’s important you get screened at your yearly exam to make sure you don’t become an overt diabetic as well,” he said.

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