To Inject or Not To Inject

Labib Ghulmiyyah MD, FACOG
Assistant Professor, Clinical Obstetrics & Gynecology Residency Program
Director Maternal-Fetal Medicine, AUBMC

It is a well known fact that high blood sugar can cause a baby to grow unnaturally large, a most common problem with gestational diabetes or diabetes that develops during a pregnancy. And a baby that is too big can cause problems during delivery and even cause the baby problems at birth. Complications that can occur to the baby are the possibility of breathing difficulties, jaundice or low blood sugar. High blood pressure is also common in women with gestational diabetes.

However, most women with gestational diabetes can give birth to healthy babies. The key is to keep blood sugar levels under control. 

You are probably wondering how can this be done?

Most women can control their gestational diabetes by strictly following a diabetes meal plan, being more active and consulting a diabetes educator or a dietician, as they are experts in nutrition and meal planning. Controlling blood glucose may require daily tracking of glucose levels, eating healthy foods, exercising regularly, and sometimes, taking medication. As a mother with gestational diabetes, you will probably need more frequent prenatal care visits to monitor your health and the health of your baby. In doing so, you will reduce risks and complications that may arise. Later in the pregnancy, you should also be doing special tests for the baby’s well being in order to make sure everything is ok.

Gestational diabetes can usually be controlled through diet and exercise, but if that doesn’t work pharmacologic therapy may be required to control blood glucose levels. Until recently, pharmacologic therapy was limited to insulin, a drug that is injected under the skin (in the fat). (Health care providers or diabetes educators can teach you how to give yourself insulin shots).

The use of oral medication was not common throughout the history of diabetes treatment, with a few attempts in the 1960s to popularize it. In 2000, a new study conducted in the United States revived the interest in oral medications. The daily sugar levels as well as the well being of mothers and babies did not differ significantly between those taking the injections of insulin and those taking the oral medication.

Having said that, insulin injections are still considered to be the standard treatment today although it is now accepted that oral medication might be an alternative option for some patients.

In both cases, if you are prescribed medication, you need to keep monitoring your blood glucose level as recommended by your health care provider. They will review your glucose log to make sure that the medication is working.

Bear in mind that changes in your medications may be needed to help keep your blood glucose level in the normal range. There is the unfortunate possibility that gestational diabetes may cause long-term health effects in women, and they are at higher risk of having diabetes in the future, as are their children.

Women with gestational diabetes will need to have regular diabetes testing after pregnancy. Their children will also need to be monitored for diabetes risks. Control is the key before, during and after the pregnancy!

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