A significant upsurge in the number of pregnant Utah women with gestational diabetes has far surpassed the increase in the number of births over the past decade, leading state health officials to warn that the condition poses risks for baby and mom.
Gestational diabetes shows up as an elevated glucose level and other symptoms of diabetes in a woman who didn't have diabetes before her pregnancy. And it disappears after the baby is born. Usually, it is caused when pregnancy-related hormones affect hormones in the insulin that the women produce.
Pregnant women who are overweight or older have a greater chance of developing gestational diabetes, which appears in as many as 5 percent of women during pregnancy. The number of women with gestational diabetes has doubled over the past decade, though the number of births increased by only 24 percent. With the increase in gestational diabetes has come increased pregnancy and delivery complications.
Compared to women who did not have gestational diabetes, mothers who did had twice the rate of pregnancy-related high blood pressure, higher rates of Cesarean-section delivery, higher rates of preterm birth. They more often gave birth to a baby who weighed more than 9 pounds. The babies are also prone to hypoglycemia — low blood sugar — right after delivery.
In a diabetic mother, blood sugar has been consistently high so the baby has a lot of insulin in its system. That insulin level stays high right after birth, but mom's sugar is no longer available, leading to a baby with low blood sugar.
Children of mothers who had diabetes during the pregnancy have a higher risk of developing diabetes and obesity when they get older, said Brenda Bodily, information specialist in the Diabetes Prevention and Control Program in the Utah Department of Health.
Other risk factors for gestational diabetes include a family history of diabetes or simply being a member of a racial or ethnic minority. Risk also increases for women who have previously given birth to a very large infant, had a stillbirth or had a child with a birth defect. Excess amniotic fluid also is a risk factor.
Treatment options include a special diet, exercise, daily glucose monitoring and insulin injections.
The department found the increase in gestational diabetes by looking at birth certificates that note the condition. Among other things, they found that Hispanic and Native American women had higher rates of gestational diabetes, said Brenda Ralls, a research consultant in the state health department. Native Americans were twice as likely, while Hispanics were 1.5 times as likely. What was not clear, she said, was why those populations were more prone to the condition.
"Maybe their diets are different enough or their genetic makeup different enough," Ralls said. "We just don't know."
The long-term ramifications for the baby can be serious, Ralls said. Babies born to mothers with diabetes, whether pre-existing or gestational, have a two- to five-times higher risk of developing the disease either as children or adults. In families in which the mother had diabetes in some pregnancies and not others, those exposed to the diabetes are at higher risk, compared to their siblings.
When women have high glucose levels in pregnancy, Ralls said, it seems to settle on the shoulders of the baby, making them broader, which also increases the probability of a C-section.
While some doctors routinely test for gestational diabetes during pregnancy, others do not. Health officials say that women with symptoms or risk factors should request testing during pregnancy. Symptoms include blurred vision, tingling or numbness in hands or feet, excessive thirst, frequent urination, sores that heal slowly and being tired much of the time.
People can find a screening location by calling the Health Resource Line at 1-888-222-2542 or go online for information at www.health.utah.gov/diabetes.
Gestational diabetes complications
Pregnancy and delivery complications have increased along with the rise in the rate of gestational diabetes. Compared to women who did not have gestational diabetes, mothers who did:
Had twice the rate of pregnancy-related high blood pressure.
Had higher rates of caesarean-section delivery.
Had higher rates of preterm birth.
More often gave birth to a baby who weighed more than 9 pounds.