Gestational Diabetes is a diagnosis of diabetes during pregnancy. This diagnosis is usually obtained about the 24th week of pregnancy after taking a blood glucose test. A diagnosis of gestational diabetes does not mean the individual is going to become diabetic after pregnancy or was diabetic prior to pregnancy. Gestational diabetes is usually caused by the imbalance of hormones during pregnancy, along with other biological factors such as a decrease in pancreatic production of insulin. I will discuss how the diagnosis is obtained, how it is treated, medication that can be used, ethical and cultural affiliation with gestational diabetes. Finally I will also discuss some controversies surrounding this disease and how it impacts African-American females.
What is Gestational Diabetes?
According to American Diabetic Association (ADA, 2011) gestational diabetes affects about 4% of all pregnant women in the United States, about 135,000 women per year. Scientist currently does not have a cause for gestational diabetes. Elevated blood sugar levels begin when the pregnant mother is unable to make the insulin it needs for pregnancy. When the body is unable to produce enough insulin, the body cannot turn glucose into energy, therefore the glucose builds up in the blood and gets to elevated levels. Scientist speculates that the hormones from the baby's placenta block the action of the mother's insulin in her body. Diabetes is mainly known as dysfunction of the pancreases, where the pancreases cannot produce enough insulin to support the body. Gestational diabetes is different, the pancreases makes the insulin, however it is inhibited by the placenta. After delivery most women reverts to normal glucose tolerance levels (Anderwald et. al., 2011). There are very few noticeable symptoms of gestational diabetes. Only a small percentage of women suffer increased thirst and frequent urination as a sign of gestational diabetes. Pregnant women are urged to have routine examination during pregnancy which will aid in the diagnosis of gestational diabetes or any other medical condition.
How is it diagnosed and who is affected?
Gestational Diabetes is diagnosed using a routine test called the glucose challenge test. The pregnant woman is given 50 grams of glucose to drink and an hour later her blood glucose level is tested. If this test shows elevated blood glucose, which is above 140 milligrams then she is sent for a second test known as the glucose tolerance test, which is a more difficult test of the same nature. Elevated glucose level in this test is a confirmation of gestational diabetes. Typically women that are above 30 years old and are overweight are more likely to have gestational diabetes (U.S. Health, 2011). Women with a strong family history of diabetes or have had a previous pregnancy with gestational diabetes are likely to get gestational diabetes. Women who have given birth in the past to a baby weighing over 9 pounds, and women living in impoverished neighborhoods and have inadequate medical care are also likely to develop gestational diabetes. Women who are at risk for gestational diabetes are advised to decrease dietary intake of iron to help prevent this disease (Bowers et. al., 2011). High levels of dietary intake of iron during the early part of the pregnancy are associated with gestational diabetes for women who are at risk for this disease (Qiu et. al., 2011).
Treatment of Gestational Diabetes
Patients who were diagnosed with gestational diabetes are often given different steps in their treatment program. Pregnant women are often offered educational classes to help them learn about their diagnosis. Most obstetricians want to prevent hospitalization for their pregnant patients, so they recommend that patient get the enough education about their condition to prevent hospitalization. Midwives are often utilized to provide counseling and other forms of health assistance for gestational diabetic patients (Persson et. al., 2011). One of the biggest ways of managing gestational diabetes is proper diet and exercise. Pregnant women are given information about proper pregnancy diets that will decrease blood sugar levels, in some cases without the use of pharmacology and with the use of pharmacology. Women, who are unable to manage their gestational diabetes with proper diet and exercise, use insulin to control their blood sugar. Insulin is the pharmaceutical choice for treatment of gestational diabetes, since it does not pass the placenta. The baby is unharmed by insulin. In recent years there have been other drugs developed that is still being tested and have considered fairly safe for the baby (Coustan, 2007). Glyburide is the leading medication for treating gestational diabetes with the least side effects. A comparison of treatment between insulin and glyburide showed glyburide is more cost effective compared to insulin (Goetzl & Wilkins, 2002).
According to the National Women's Health Information Center (2011) African-American women are at risk for type 2 diabetes and gestational diabetes. They have the most health risk compared to other minority groups in the United Sates. 4.9 million African-American women have undiagnosed and diagnosed diabetes, including gestational diabetes (NDEP, 2010). Many African-American women have diabetes prior to pregnancy. They and are then diagnosed during pregnancy as gestational diabetes, then later diagnosed as type 2 diabetes after they give birth. Gestational diabetes and diabetes impact different cultures differently. Women who have experience gestational diabetes, and are non-Caucasian are at higher risk for developing type 2 diabetes after pregnancy (Razee et. al., 2010). African-American women have the highest risk of being diagnosed with any form of diabetes. The two biggest reasons that put African-American women at risk for different types of diabetes are lack of proper health care and obesity.
Many health care providers refer their gestational diabetic patients to diabetic education classes, which provide the patients with information about lifestyle changes to deter type 2 diabetes and to control gestational diabetes. Education classes teach the women how to eat, how to cook and advise to add exercise to their daily schedules to increase their health. Women are given information about their risk for type 2 diabetes in the future and given information about how they can prevent this from happening with proper diet and exercise.
Women with gestational diabetes are considered high risk pregnancy. They must be monitored carefully and must follow the doctor's orders. There are more frequent follow-ups in the last trimester compared to a normal pregnancy. Women with gestational diabetes are also advised to follow up with their physician after they have given birth to be evaluated for type 2 diabetes. It is important that women who have experienced gestational diabetes lose weight, maintain a regular exercise routine and follow medical advice.
African-American women who have had gestational diabetes and have one parent with a history of diabetes are at extreme risk for type 2 diabetes (Osei, Gailard & Schuster, 1998). Scientist still does not know the importance of parental history with diabetes and gestational diabetes as a risk factor for pathogenesis of diabetes in African-American women. Researchers also believe the metabolic and hormonal milieu during gestational diabetes may cause permanent alterations in the beta-cell function, SI and glucose effectiveness in African-American women, which later leads to type 2 diabetes (Osei, Gailard & Schuster, 1998).
Obstetricians are very torn about treatment methods for gestational diabetes. There is still a high neonatal mortality, which leads to extreme controversy (Kelly et. al., 2005). Women should follow the orders of their obstetrician to ensure the health of their baby. Their daily glucose levels should be carefully monitored. A healthy mother has a greater chance of delivering a healthy baby. There are many different cultural and ethical controversies pertaining to gestational diabetes. Women from different back grounds such as Hispanics and African-Americans are at high risk for gestational diabetes and diabetes. Women of these cultural backgrounds are at risk and should educate themselves on how to protect themselves from this disease. Education is the biggest weapon against fighting diabetes. It is debated that women from these backgrounds are lacking the education about the disease and how to protect themselves from this disease. Many of these women also have limited access to health care.
A study conducted by Frederick et al. (2000) showed that when African-American women were compared to their white counterparts, they had a higher diagnosis rate of gestational diabetes and type 2 diabetes. The same study also found in these women 50% of this risk could be considered potentially modifiable factors. These are risk factors that can be modified by simple lifestyle changes, like losing weight, getting better medical care and more exercise. African-American women have the highest health risks during pregnancy, when compared to other ethnic groups.
Disparities in women's health care and education is a major contributing factor to gestational diabetes in African-American women. A study conducted in Detroit found that 47% of African-American pregnant women were obese or overweight during pregnancy (Kieffer et. al., 2001). The same study shows these women were from a lower socio-economic status and had health disparities.