Gestational diabetes paper by jtrotte4


									                               Gestational Diabetes 1

    Gestational Diabetes

    Gestational Diabetes

       Jordan Trotter

The University of Tennessee

Nutrition 493, Dr. Kavanaugh
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       There are a variety of health issues that plague American citizens. Due to the fast paced

society, Americans are eating on the run and are not conscientiously monitoring their sugar

intake. The United States has considerable difficulty controlling blood sugar today, and this is

evident in the numerous reported cases of Type I and Type II diabetes. The bodies of those

diagnosed with Type I diabetes do not produce insulin. They must take insulin in some form

such as in an injection or a pill. According to the American Diabetes Association, “Type I

diabetes affects between 500,000 and 1 million Americans…Approximately 17 million

Americans have Type II Diabetes” (2005, p.13, 4). Victims of Type II Diabetes produce insulin,

but for some reason, their bodies do not utilize the insulin properly and are resistant. These two

forms of diabetes are the most common, but there is a third type known as gestational diabetes.

This disease affects 2-14% of all pregnant women, and appears around the 24th week of

pregnancy. If a woman has high blood sugar while pregnant, she is diagnosed with gestational

diabetes. Gestational diabetes can simply be defined as high blood sugar in an expectant mother.

(1990, p. 3). Although Gestational Diabetes Mellitus (GDM) has a simple definition, it is a

complex disease that alters a mother’s health, affects fetal and infant development, but can be

prevented and treated with the use of medication and a good diet.

        The American Diabetes Association says, “Gestational diabetes develops when a

woman’s pancreas is unable to produce enough insulin to cover her body’s needs during

pregnancy” (2005, p. 14,15). According to Goer et al. (1991), the disease is defined as a

“carbohydrate intolerance of variable severity with onset or first recognition during the present

pregnancy.” There are factors that influence this carbohydrate intolerance such as the placenta

during pregnancy. “The placenta enables the optimal transfer of nutrients to the fetus and uses

hormonal messages to influence maternal physiology. As fetal demand for glucose increases
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gradually throughout pregnancy, the mother's sensitivity to insulin is reduced” ( 2004, p. 62).

When hyperglycemia peaks above the common threshold, the mother is then diagnosed with

gestational diabetes. U.S. experts believe the disease is related to fluctuating hormone levels,

such as in the hormone Placental Lactogen. This hormone reduces pancreatic functioning in the

mother (2006, p. 8).

       Although hyperglycemia and chaotic hormone levels directly involve the mother, the

disease affects both mother and child. The effects can be long lasting, and certain ethnicities

and body types are more at risk than others. Mothers are affected in a variety of ways and for

different reasons. “Gestational diabetes affects 2-5% of pregnant women in the United States”

(2006, p. 8). Those mothers with the highest risk are those who are overweight or obese before

or during pregnancy (Henriksen, 2006). Other definite risk factors for mothers are older

maternal age, a family history of diabetes, being of an ethnicity with a high prevalence rate, or

complications in previous pregnancies (2005, p. 15). Hyperglycemia has a higher risk factor for

some mothers more than others. These women with an increased risk include those who had

high blood sugar in previous pregnancies, had babies larger than nine pounds, were overweight

before pregnancy, or were of Native American heritage (1990, p. 5).

       There are numerous reasons why mothers and infants are the two people groups affected

by gestational diabetes. An upsetting reason is the rise of obesity in mothers. Dr. Tore

Henriksen states, “A change in body composition also implies alterations in physiology and

metabolism in corresponding proportions of the population. Thus, [obese] women of

childbearing age are becoming “diabetic,” with a more “metabolic syndrome-like” metabolism”

(2006). These women are becoming “diabetic” because their intake is increasing and their

energy expenditure is decreasing. According to Gillen et al (2002, p. 135), the consumption of
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sugar is increasing worldwide, and carbohydrate consumption correlates directly with insulin

resistance. This increase in sugar intake in these overweight women causes their bodies to

become insulin resistant, and their pancreas, therefore, stops working (2006, p. 8). Studies of the

mother’s own birth weight have shown that mothers with a large birth weight do have an

increased risk of gestational diabetes in their first pregnancy (King, 2003, p. 24-5). As

previously stated, energy intake increases but energy expenditure decreases in most of the

mothers affected with GDM. A lack of exercise is known to increase chances of GDM in

mothers, which is the reason it is critical to be active before and during pregnancy (2004, p. 18).

       There are daunting risks involved for mothers and infants affected with GDM.

According to Alive: Canadian Journal of Health and Nutrition, “Women with GDM have a

higher risk for diabetes in their next pregnancy and a 40 % greater chance of developing type 2

diabetes later in life” (2004, p. 18). Maternal hypertension preeclampsia and fluid retention is a

large risk for mothers with GDM. The American Diabetic Association states, “Preeclampsia is

frequently accompanied by swelling, often in the hands and face, headache, blurred vision, and

pain in the upper stomach (2005, p. 18). Gillen et al. (2002, p. 135) states that mothers with

GDM are more likely to have babies with higher birth weight; therefore, caesarean sections are

more common in mothers with GDM. Many hazards are possible with C-sections such as risk of

infections, longer hospital stays, and longer recovery time. Urinary tract infections are more

common in mothers with GDM, along with Ketonuria, a sickness in which the mother’s placenta

is not supplying the baby with enough nutrients. There are symptoms involved with GDM that

allow mothers to know they are at risk. The most common symptom in mothers is high blood

sugar. If a mother’s blood sugar is above 140 mg/dl, she may have gestational diabetes (2005, p.

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       The infant is subject to dangerous risks, as well. GDM infants often suffer from

Macrosomnia, or “a baby that is larger than normal for its developmental age” (Anonymous,

2005, p. 17). Goer et al. (1991, p. 21) says that there are subsequent risks for Macrosomnia

infants including a “resultant increase in operative deliveries, birth injuries and birth asphyxia.”

Infants are susceptible to hypoglycemia, because the lack of nutrients received from their

mother. They are at risk of contracting Jaundice (hyperbilirubinemia) and Respiratory Distress

Syndrome (RDS). Also, because the babies are of higher birth weight, they become more

susceptible to premature birth. When born prematurely, the lungs may not be fully developed,

which results in RDS (2005, p. 17,8). Infants of mothers with GDM have an increased risk of

prenatal death, congenital abnormalities, hypocalcaemia (low serum levels in the blood), and

polycythemia (Goer, Jones, Weston, Rose, Gillmor, & Hunter, 1991). Polycythemia is a disease

in which the proportion of blood volume to red blood cells increases. The threat of a future

diagnosis of diabetes in the infant is augmented.

       Although the risks involved with GDM are grim, there are many preventative measures to

protect mothers and infants from contracting this disease. Quality nutrition is crucial in women

of childbearing age. Alive: Canadian Journal of Health and Nutrition elucidate, “To maintain a

healthy weight and keep blood sugar levels normal, it is essential for women before, during, and

after pregnancy to have a healthy lifestyle (2004, p. 18). Excellent nutrition means having a

well-balanced diet. This is a diet low in simple sugars found in refined grains, cookies, and

sweets. Carbohydrate intake should be monitored closely along with a moderate intake of fats,

and an increased intake of fruits and vegetables (2004, p. 18). Key nutrients are carbohydrates,

fats, and proteins. Carbohydrates, for a healthy woman, should compose 40-45% of her diet.

Proteins should make up 20-25% of her diet, and 30-40% of her diet should consist of fats. High
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fiber intake is critical because it allows blood glucose to rise gradually after a meal. An increase

of folic acid and calcium is imperative, as well, for the health of the baby. Healthy weight gain

is vital for expectant moms. Twenty-five to thirty-two pounds are considered appropriate weight

gain for healthy moms. Moms should gain between two and four pounds in the first 3 months

and one pound per week after that. Weight gain pattern is more important than the number of

pounds gained. Healthy weight gain along with exercise will help ensure a healthy, GDM-free

infant (2005, p. 29, 30). Exercise increases the insulin sensitivity of muscles and glucose uptake

into muscular cells, resulting in a lower glycemic index (2004, p. 62). If a mother is diagnosed

with GDM, exercise lowers blood glucose by helping body cells become more sensitive to

insulin, overcoming insulin resistance. The mother should consult her doctor about exercise if

on insulin and pregnant (2005, p. 38, 40).

       If diagnosed with GDM, many treatments and therapies are available to help the mother

and infant cope in a healthy and effective way. In most cases, gestational diabetes can be treated

by diet alone. An abundance of fruits and vegetables along with consulting a registered dietician

are helpful. If the mother is obese, cutting calorie intake by a third can reduce the risk of high

blood sugar and triglycerides (2006, p. 8). There are special tests that mothers can utilize to

monitor blood sugar and monitor their health. The Oral Glucose Tolerance test is a standard test

given to those with GDM (Goer, Jones, Weston, Rose, Gillmor, and Hunter, 1991). The

Hemoglobin A1C test monitors blood sugar over a period of two months prior to taking the test.

The doctor may want this test to be conducted once a month. An ultrasound shows the size of

the baby, and monitors Macrosomnia. Amniocentesis looks at the respiratory health of the baby

in order to protect the infant from RDS (1990, p. 19). A health care provider may even

recommend insulin injections or medications. Glyburide is an oral diabetes medication that was
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found in a study conducted in 2000 to work well in diabetic women and not cross the placenta,

affecting the infant (2006, p. 8).

       Gestational Diabetes Mellitus is a grim diagnosis for any mother and her infant.

Although the risks for mothers and infants are great, there are many preventative measures and

treatments an expectant woman can practice in order to maintain good healthy for herself and her

baby. By maintaining a well-balanced diet with exercise, women give themselves the upper

hand in the battle against GDM. In order to keep mothers and infants safe, it is imperative for

women to educate themselves about GDM and take every precaution to ensure a pregnancy free

from GDM and its serious complications.
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