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February 21, 2004

Gestational Diabetes

Question from Pune, India:

In June 2003, my wife and I decided to stopped using birth control to have a baby. My wife conceived very promptly and we first diagnosed it with a visual strip. Within a few days, she had a fever and stress and she underwent some tests. Her sugar level was found to be at 407 mg/dl [22.5 mmol/L]. She was admitted for a complete diagnosis and her sugar was brought down using some pills. It was then recommended that she take metformin for some time and monitor her blood sugar levels at regular intervals. We contacted a gynecologist to decide of the risk factors involved. In her opinion, it would be very risky to continue with the pregnancy as her sugar levels were very high during the initial 15 days of her pregnancy so we decided to terminate the pregnancy. She continued with metformin for a month and, after that, her sugars were under control, mostly in the range of 60 mg/dl [3.3 mmol/L] to 100 mg/dl [5.6 mmol/L] using a glucometer. She now consumes her regular diet, including sweets, but her blood sugar level does not increase, even though she is no longer thaking any medication. We were told by the gynecologist that it was not gestational diabetes since it had occurred in the very early stages of pregnancy, while gestational diabetes occurs in the later stages. Meanwhile, her sugar levels were very much under control for the past four months without any medication. This is not going to happen in the case of a normal diabetic patient. I believe that the increase in sugar levels was somehow related to the pregnancy, even if it may not be classified as gestational diabetes. Now, we are again planning for another pregnancy and would like to know what precautions we need to take. Would the sugar levels again rise after conceiving? Should she be put on insulin injections before conceiving?

Answer:

I have no explanation for such a high glucose value, but it was clearly not normal. Being at such an early point in the pregnancy, it technically does not qualify for gestational diabetes. With her fever and hyperglycemia, I am wondering if she had acute pancreatitis that has since resolved. It is interesting that her blood sugar values are all normal now. I am guessing that whatever happened has resolved and you can proceed with trying for another pregnancy. Testing for diabetes early in the pregnancy and then at the usual 24-28 week point would be useful. If her blood sugars become elevated, then either oral hypoglycemic agents may be used or insulin.

OWJ