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Pregnant and diabetic

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Jill Miller, a Los Angeles mother-to-be, is nervously awaiting the results of a test her obstetrician gave her to check her blood sugar levels in her 26th week of pregnancy. As an expectant first-time mother over 35, the public relations executive knows she has an increased risk of developing gestational diabetes and has already tried to get her sweet tooth under control in order to keep her pregnancy weight down.

“I have been trying to curb my sugar intake by avoiding our candy-filled snack closet at the office, but am finding it difficult to give up my nearly nightly dose of ice cream,” she says.

Miller is relieved when her glucose test comes back normal. But the experience has made her feel “more sensitive about what I’m eating now than I did before I was pregnant.”

Gestational diabetes affects about 4 percent of all pregnant women in the United States each year, according to the American Diabetes Association. But across the country, health care providers and dietitians specializing in diabetic care are reporting a rise in the number of women being diagnosed with the condition.

Some of the increased incidence comes from women like Miller who are delaying child-bearing until their 30s or 40s — considered old age in maternity years.

While women over 30 are more likely to develop glucose intolerance during pregnancy because of their age, doctors say the real culprit is the obesity epidemic.

“Far and away, the biggest risk in developing gestational diabetes is obesity,” says Dr. Patrick Catalano of the department of reproductive biology at Case Western Reserve University School of Medicine in Cleveland. “We’re seeing more women with it.”

Paula S. Yutzy, a registered nurse at The Diabetes Center at Mercy Hospital in Baltimore, also says her clinic is seeing more cases of gestational diabetes. “It’s because more of the women are obese,” she says.

When a woman becomes pregnant, she may need up to three times the normal amount of insulin, a hormone made by the pancreas, to meet her growing baby’s needs. At the same time, other hormones produced by the placenta can also increase a woman’s resistance to insulin. Gestational diabetes occurs when she can’t produce enough extra insulin. Sugars build up in her blood and are passed on to the baby.

Unfortunately, there are no warning signs with gestational diabetes. That’s why since the 1960s, nearly all women in the United States are screened for the condition about two-thirds through the pregnancy — between 26 and 28 weeks.

If untreated, it can lead to “fat” babies. Larger babies may need to be induced early, leading to more difficult deliveries, birth injuries or Caesareans.

Moreover, the babies’ lungs and livers may not be as mature as their size would imply and they are more likely to have jaundice and breathing problems.

“Big and mature [aren’t] the same thing,” says Yutzy.

Long-term risks
Gestational diabetes usually disappears with the birth of the child, but it’s a red flag for possible problems down the line for both the mother and the child.

About 50 percent of women who have gestational diabetes develop type 2 diabetes, the most common form of the disease, within five years of giving birth, studies show.

Recent research also indicates that gestational diabetes may be a contributor to adolescent obesity, says Catalano.

In a report to be published next month in the Journal of Obstetrics and Gynecology, Catalano and other researchers examined the fat mass of infants born to women with gestational diabetes. They found that even though the babies’ birth weights may be normal, their bodies have more fat.

“These kids are at risk, too. Is it due to lifestyle, diet and activity or something programmed while they’re inside the mother’s womb?” he asks.

Because of potential problems for the child, Catalano believes high-risk women — those who have a family history of diabetes, had gestational diabetes in a previous pregnancy or are overweight — should be checked earlier than normal.

Dietary change, exercise
Most women with gestational diabetes can control their blood sugar with dietary change and exercise, although extreme cases require insulin shots. Women are advised to eat moderate-sized meals and avoid empty calories like desserts.

For women who look forward to pregnancy as the one time they can ease up on calorie-counting, having to restrict their diets may be a disappointment. But in this case, the diet isn’t to lose weight.

Elaine Magee, a registered dietitian and author of “Tell Me What to Eat if I Have Diabetes,” says women don’t have to give up carbs and sugar completely if they have gestational diabetes. In fact, they should make sure they’re getting enough calories to sustain a health pregnancy.

“The key is careful distribution of carbs per day and eating more whole grains, fruits, vegetables and beans,” she says.

Pregnant women should avoid strict low-carb diets like the Atkins Diet, experts say.

“A lot of it is just a little diet tweaking and exercise and they’re fine,” says Ann Fittant, a dietitian at the Joslin Diabetes Center at Swedish Medical Center in Seattle. “Pregnant women are very motivated; they’ll do anything to have a healthy baby.”

Dr. Steven Thomas, medical director of the Women and Infants Center at Desert Regional Medical Center in Palm Springs, Calif., says just simple walking after meals can help get gestational diabetes under control.

“What’s underestimated is that exercise can dramatically lower blood sugars,” he says.