by Chris Corsi, MD
NOTE: If you have any questions for "Ask the Doctor," please send them to the Voice editorial office. The only questions Dr. Wilson (our regular writer) will be able to answer are the ones used in this column.
Christopher M. Corsi, MD, our guest writer this issue, is an endocrinologist at Western Montana Clinic, in Missoula, Montana.
Q: My wife had “gestational diabetes” when we had our first child--but the doctor says she “isn’t diabetic” now. We want to raise a family--is it safe to have more children? Will they be diabetic? Will she become a “real” diabetic? What do we need to do and watch for?
A: Gestational diabetes has become quite common. We see more of it in certain ethnic groups, in particular Black, Hispanic, and Native American women. In some communities dominated by one of these ethnic backgrounds, the frequency of gestational diabetes has been reported to be as high as 14%.
Pregnancy is diabetogenic. This means that several hormones are produced by the placenta during pregnancy, and the presence of these hormones can lead to insulin resistance. Insulin resistance is the same problem that can lead to type 2 diabetes in non-pregnant individuals. Young women who develop gestational diabetes might already be insulin resistant, and the extra insulin resistance generated by the pregnancy brings on the diabetes. After the pregnancy is completed, most women no longer meet the criteria for having diabetes. However, they have a high risk (up to 50%) of developing diabetes over the next several years.
All of this is important because gestational diabetes is associated with certain problems, including macrosomia (very large babies), which can lead to problems at delivery, and increased need for caesarian section. Babies born to women with gestational diabetes are also at risk for hypoglycemia (low blood sugar) following delivery. Several other concerns make gestational diabetes an increased risk to the developing baby.
That being said, it is possible for a woman to have gestational diabetes with one pregnancy and then not develop gestational diabetes with a subsequent pregnancy. Good diet and exercise, in between the pregnancies, can often help minimize this risk, particularly if they lead to weight loss in an overweight woman. These same interventions can also lower the risk of developing diabetes in the future, but these are not universally accepted for this purpose as yet.
My best advice would be that your wife pay strict attention to diet and exercise. If she is overweight, she should try to gradually lose weight through these lifestyle modifications. If she is to achieve another pregnancy prior to such interventions, she will need to be screened again for gestational diabetes early in that pregnancy. After the two of you have completed your family, these same lifestyle interventions will be important, in order to have your wife avoid developing type 2 diabetes down the road. She should have regular visits with her physician, and have her glucose checked from time to time. A fasting glucose level each year would be the minimum.