Polycystic Ovarian Syndrome & Gestational Diabetes
Diagnosis of Gestational Diabetes in PCOS
Women with PCOS have an increased risk of developing Gestational Diabetes Mellitus, regardless if they are overweight or not. Insulin levels significantly increase in the second and third trimesters of pregnancy as a normal part of pregnancy; the majority of women with PCOS already have high insulin levels. If not well managed, Gestational Diabetes Mellitus can cause significant problems during pregnancy and labor for mom and baby. The good news is that diet and exercise modifications can help to prevent Gestational Diabetes Mellitus. Here are some of the most effective ways to reduce your chances of developing Gestational Diabetes Mellitus during your pregnancy.
Screening for Gestational Diabetes in PCOS
All women are monitored for gestational diabetes with a routine blood sugar screening at 24 to 28 weeks. Since PCOS can result in higher blood sugar due to insulin resistance, women with the condition are often screened for gestational diabetes earlier in the pregnancy.
There are two different ways to screen for gestational diabetes – the glucose challenge test and glucose tolerance testing. Both methods require that you drink a sugary solution, though the amount differs depending on which test the doctor is using.
The glucose challenge test requires only a single blood draw at one hour after you drink the solution. You do not need to fast before this test. However, this test alone is not sufficient to diagnose gestational diabetes. If the test is abnormal, you’ll need to have the glucose tolerance testing.
During the glucose tolerance test, you’ll again drink the sugary solution (though you’ll need to drink more of it), with four blood draws: one before drinking the solution, and at one, two and three hours after finishing it. You will need to fast before taking this test.
If any of the tests show an elevated blood glucose level, you will be diagnosed with gestational diabetes. Some doctors will skip the glucose challenge test and use only the glucose tolerance testing.
Does PCOS Increase My Risk of Gestational Diabetes?
While it is a fact that women with Polycystic Ovarian Syndrome have a higher risk of developing gestational diabetes during pregnancy, is your PCOS the only cause of this condition? PCOS and pregnancy create the perfect storm for gestational diabetes because many women with PCOS are insulin resistant and being pregnant increases glucose intolerance in the body.
Women who don’t have PCOS also develop gestational diabetes which makes it logical to assume that other causes and factors do come into play. The processes that occur during a normal pregnancy can also raise blood sugar without any influencing factors. During pregnancy, your baby is connected to your blood supply through the placenta, which produces hormones that can impair the way insulin interacts with your cells. This can raise your blood sugar. As your pregnancy progresses the placenta puts out an increasing volume of insulin-blocking hormones, which can in the later trimesters develop into gestational diabetes. A few extra risks and factors can tip the blood sugar see-saw of pregnancy onto the gestational diabetes side even without considering PCOS.
Other factors and conditions that can increase the risk of gestational diabetes beyond Polycystic Ovarian Syndrome or rising blood sugar are
- Age: Women older than age 25
- Personal history: your risk of gestational diabetes is higher if you had gestational diabetes in a previous pregnancy or had a baby over nine pounds.
- A prediabetic condition before pregnancy
- Obesity: women with a body mass index of 30 or higher
- Ethnicity: Asian, black, American Indian, or Hispanic women have a greater risk of gestational diabetes
- Family history: Your risk of gestational diabetes increases if a close family member has Type 2 diabetes
If you do develop gestational diabetes during pregnancy due to PCOS or other risk factors, you can experience other complications beyond those stemming from Insulin Resistance and a rise in blood sugar.
Other complications from Gestational Diabetes
High blood pressure: This condition can develop during pregnancy especially if you have PCOS. Women with PCOS have a higher risk for pregnancy-induced hypertension.
Preeclampsia and eclampsia: These are very serious conditions that can threaten the lives of both the mother and baby. They are characterized by high blood pressure, swelling in the extremities, and in severe cases seizures.
Gestational diabetes: Gestational diabetes resolves itself when the baby is born but once you have had this condition you are at higher risk of having it again in future pregnancies.
Type 2 diabetes: If you experience gestational diabetes your risk for developing Type 2 diabetes later in life is higher. PCOS can also increase this risk because Insulin Resistance plays a role in both PCOS and diabetes. A proactive approach involving healthy life choices such as following a balanced diet and exercising daily following the birth can be instrumental to prevent the development of diabetes.
What effect does gestational diabetes have on the baby?
Most women with gestational diabetes and PCOS have perfectly healthy babies despite potential pregnancy problems. However, complications of gestational diabetes can be passed on to your baby if you don’t manage the condition while you are pregnant.
Issues that can affect your baby are:
Excessive birth weight (macrosomia):? Your baby might grow too large if the extra glucose in your bloodstream passes through the placenta. The baby’s pancreas will make extra insulin, thus triggering the growth. This is a concern for both mother and child because a C-section might have to be performed and the baby could end up with injuries associated with its birth or become stuck in the birth canal.
Hypoglycemia: Babies born to women with gestational diabetes can develop low blood sugar after the birth which in turn can cause seizures. An IV of glucose solution is often administered to these babies to normalize the blood sugar level.
Preterm birth: Because premature labor is a risk when a mother has gestational diabetes, sometimes an early delivery is induced when the baby is growing too large.
Respiratory distress syndrome: Babies with this condition have immature lungs that require assistance to breath effectively. Sometimes respiratory distress syndrome is the result of an early delivery but it also can be linked to a mother with gestational diabetes.
Jaundice: When the liver is unable to break down bilirubin a yellowish cast to the skin and the whites of the eyes can occur. This condition is not serious but it does need to be treated.
Type 2 diabetes: This complication can occur later in life. When gestational diabetes is left untreated it can cause serious harm to the baby either before or soon after birth.
Gestational Diabetes Management in PCOS
Gestational diabetes can be treated with a combination of lifestyle changes (in mild blood sugar abnormalities) or medication. Your doctor will probably have you measure your blood sugar periodically through the day; once in the morning when you wake up and after each meal is typical, though you’ll want to follow your doctor’s instructions. Lifestyle modification include cutting out processed and refined sugars and fried or fatty foods. Your diet should include mostly fruits, vegetables, lean proteins and whole grains. With your doctor’s okay, light to moderate exercise should be included in your daily routine.
If lifestyle changes aren’t enough to regulate your blood sugar, your doctor may prescribe a pill to control your blood sugar or even insulin.