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October 21, 2004

Gestational Diabetes, Hyperglycemia and DKA

Question from Washington, DC, USA:

I had gestational diabetes in my last pregnancy, found at 26 weeks, that was controlled by diet. My one hour glucola test was 186 mg/dl [10.3 mmol/L]. I am terrified that I may have caused birth defects already since it is so early in the pregnancy and I have been craving and eating many more carbohydrates than usual to control my constant nausea (increased carbohydratess starting around four weeks ago). At this blood sugar level, how much risk of birth defects can there be following four weeks of increased carbohydrate intake? Is the essential organogenesis done mostly before six weeks or after? I am confused, because I thought it was common for meat and vegetables to be unappealing during morning sickness, and bland, carbohydrate heavy foods, which are common comforts for morning sickness, to be the worst thing for me to eat.

Answer:

Do not completely blame your diet for the elevated blood sugar. Your blood sugar level also depends on how you produce and respond to insulin. You have no control over that factor. It might still be worthwhile doing the three hour 100 gram glucose test. Even with a significantly elevated one hour test, some women have a normal result on the follow-up three hour test. Just because the one hour value was high, it does not mean that you have been hyperglycemic during the entire pregnancy. Nevertheless, it is unusual to see hyperglycemia this early in pregnancy due to gestational diabetes. I am suspicious that you may have had at least some degree of insulin resistance, if not overt hyperglycemia, prior to the pregnancy. Having a doctor check a hemoglobin A1c value may be useful in determining if you have, in fact, had some degree of longstanding hyperglycemia. If the hemoglobin A1c value is normal than it would reduce the risk of abnormalities in the baby that may be associated with diabetes.

The first eight weeks of the pregnancy are most critical for organ development. However, each organ system is not at risk constantly during that time. For example, the spine is formed between days 21 and 28 post-conception and the heart is completed at six to seven weeks from conception. It will be important to have a good ultrasound evaluation of the baby as it grows to help look for any problems. The odds are still well in your favor of the baby being fine.

OWJ