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June 11, 2002

Gestational Diabetes

Question from Rhode Island, USA:

I am now expecting my fourth child. During my third pregnancy, I developed gestational diabetes (GDM) at about five weeks, along with preeclampsia that necessitated early delivery of my child, and I had gestational diabetes with at least one previous pregnancy (but it is unknown if I had it with either my first or second pregnancies). After the births of my first and third children, I had normal fasting blood glucoses, but occasionally ran high post-prandial values, and my A1cs have been less than 6%. This time, my blood sugars rose before I even knew I was expecting, and it was my unexplained rise in fasting blood glucose that prompted me to test for pregnancy. My fasting blood glucose are now running in the high 90s [mg/dl, 5 mmol/L], and my post-prandial have levels go up to 170 mg/dl [9.4 mmol/L] at 2 hours. (I bet I'm not going to be able to avoid insulin this time.) I recently which correlated early onset of GDM and preeclampsia. Does this extremely early onset of GDM in the fourth pregnancy mean that I am likely to end up with severe preeclampsia again? Is there any thing I can do to ward off preeclampsia again? Would keeping my blood glucoses in meticulous control help any?

Answer:

If your blood glucose was elevated before 24 weeks gestation, then it is possible that you may have preexisting type 2 diabetes. Repeating the hemoglobin A1c may help to confirm this. Certainly testing after pregnancy will be important.

Diabetes and preeclampsia are associated, but the exact cause of preeclampsia is not known. Your chances of having preeclampsia are increased due to the diabetes and having had preeclampsia in a prior pregnancy. However, this does not mean that you will definitely develop preeclampsia again.

Nothing has been proven to be effective in preventing preeclampsia. Keeping your blood sugars under good control will help.

OWJ