Diabetes care during pregnancy.

By: Giovanna Rodriguez, MD
Endocrinologist with Brookwood Baptist Health, Specialty Care Network, located in the Brookwood Medical Plaza, Suite 400

The pregnancy hormones such as estrogen, progesterone, prolactin, human placental lactogen, along with increased levels of cortisol and weight gain during pregnancy affect glucose levels. 
In a pregnant woman with Gestational Diabetes, the cells become ‘insulin resistant’ and the post prandial blood glucose levels stay elevated due to the cell’s inability to absorb the glucose.  The hyperglycemia that ensues crosses the placenta and affects the fetus.  Women with gestational diabetes may have larger babies that may be wedged in the birth canal, sustain clavicular fractures or require c-section.  The baby may also suffer from preterm delivery, respiratory distress, hypoglycemia at birth or even Type 2 diabetes and obesity later in life.

Therefore it is of utmost importance for mothers diagnosed with gestational diabetes to be educated about the condition and to have strict glycemic control.  If referred to an endocrinologist, we target fasting levels below 95 mg/dl, 1-hour postprandial less than 140 mg/dl and/or 2-hours postprandial: 120 mg/dl or less as per American Diabetes Association.  However, since glucoses above 130mg/dl cross the placenta and affect the fetus, some may choose to target less than 120mg/dl one hour post prandial.

Some patients do well after thorough education and strict low carb diets, however some require the initiation of insulin therapy, particularly in the third trimester when the above mentioned hormone levels are highest.

Once patients deliver, the insulin requirements return to pre-pregnancy baseline and patient is able to either stop the diabetes medication completely or require less medications.  The main focus post-partum is to avoid the progression from gestational diabetes to type 2 diabetes. 

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