I am in the seventh month of my second pregnancy.My first pregnancy was normal and produced a healthy baby. Now I have been told that I suffer from gestational diabetes, and it is being treated. I know it puts me at higher risk for getting type-2 diabetes later in life. I worry whether it will affect my fetus and if it will cause harm to my health. – B.T., Beersheba Prof. Yariv Yogev, head of the Lis Obstetrics Hospital at Tel Aviv Sourasky Medical Center, replies: Gestational diabetes involves a rise in sugar levels during pregnancy. The hormone responsible for metabolism of sugars is insulin. When there’s a problem in the production of insulin or the ability to activate it, there is a rise in glucose in the blood, and diabetes appears.Because pregnancy poses special metabolic needs from the developing fetus, the mother’s body has to suit itself to supply all the baby’s needs for growth. As a reaction to these demands, the mother’s metabolism changes, so when she is satiated, there is insulin resistance and a decline of 50 percent to 70% in the efficacy of this hormone, especially during the third trimester of pregnancy. The rise in insulin resistance causes less glucose to enter the tissues, even though the amount of insulin secreted by the pancreas rises. However, it does not succeed in carrying out its job properly, causing a rise in blood sugar in the mother. Most pregnant women successfully cope, but in 8% to 10% of them, a new situation is created, disrupting the carbohydrate balance in the body and causing gestational diabetes.Almost all cases of gestational diabetes are without symptoms and lack the traditional diabetic signs, such as thirst and excessive drinking and urination. As a result, pregnant women undergo special tests, exposing them to a large amount of sugar in liquid to detect the hidden condition. A disruption of sugar balance in the body is expressed by a rise in sugar to high levels after meals, and it remains so for quite a long time afterwards.Diagnosis of gestational diabetes is carried out in two stages. First, the woman is given 50 grams of sugar in water to drink without fasting before between the 24th and 28th week of pregnancy. If her sugar level is over 140 milligrams per deciliter, another test of 100 grams is given after fasting, an hour later, and then two and three hours later to see how quickly the body deals with the sugar.Babies born to women whose gestational diabetes has not been treated are liable to be very big and cause significant complications, such as trauma to the mother from lacerations of the uterus and the cervix, as well as harm to the fetus, such as problems due to its shoulders being stuck in the birth canal. Even if fetuses are large, they often don’t undergo proper development of their lungs at the same pace of their physical growth. If born before the 38th week, they may suffer from respiratory distress. Women with gestational diabetes have a higher risk of preeclampsia, with high blood pressure, edema, protein in the urine shortly before birth and other problems. In addition, women may suffer from urinary infections and vaginal fungi.Another problem that has been proven only recently is overweight in the child years later and even diabetes itself in adolescence.All of this points to the major role that high sugar levels have in the uterus on the fetus and the child’s future – even affecting cognitive development. Thus, if gestational diabetes has been diagnosed, the mother should follow a special diet and, if necessary, should be given pills and even injections of insulin to cope with higher sugar levels. She must undergo regular tests for which she is referred by a specialist in the field or a unit for high-risk pregnancy or gestational diabetes.Eating a low-carbohydrate diet is very important for such women, who should eat three main meals and three small ones daily. It’s important to know that there isn’t a single diet suited to all women in this situation.There is no point asking your doctor for general instructions such as “what is permitted and what is forbidden to eat” or even for an information sheet.A clinical dietitian should recommend a personalized diet based on the mother’s needs, weight and types of food she is used to eating, as well as regular exercise, such as walking for an hour each day if there is no contraindication.Her condition should be followed up until the end of the pregnancy.Many women with gestational diabetes are asked to prick their skin to test sugar levels five or six times a day (after fasting and two hours after starting to eat). Today, there is no need to hospitalize women with gestational diabetes to test and balance their sugar levels – as hospitals are not a natural environment for a pregnant woman and the meals she would get there are different from what she is used to at home. There is also no need to induce labor unless the fetus is heavier than four kilograms; in such a case, a cesarean section is usually recommended so the baby’s shoulders don’t get stuck in the birth canal.The sugar levels of most women with gestational diabetes return to normal after delivery, but some will develop diabetes themselves. To identify this group, they must undergo insulin-resistance tests six weeks after birth. They should be supervised by their personal physician in the long term to prevent them from developing chronic diabetes.Rx for Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 9100002, fax your question to Judy Siegel-Itzkovich at (02) 538-9527, or e-mail it to jsiegel@ jpost.com, giving your initials, age and place of residence.