If you are suffering from high blood sugar, you may need specialized care for gestational diabetes from about 20 to 24 weeks until you deliver. Gestational Diabetes is a highly manageable condition with proper care and a good treatment plan. Your obstetrician may act quickly to arrange for other team members to participate in your pregnancy care. This will ensure that your blood sugars are brought under control as soon as possible. Early intervention will help reduce the risks of complications.
There are a number of team specialists your doctor may refer you to if you need specialized care for gestational diabetes and pregnancy. Read further about the different team members that may be put together for your plan of care.
Specialized Care for Gestational Diabetes and Pregnancy
The following are members of the care team used for cases of gestational diabetes. In mild cases, your obstetrician may be able to manage you. Some states have special gestational diabetes programs for expecting moms, where they can see all of the specialists in one place. In more moderate to severe cases, you may see all of the listed specialists or more than one.
Gestational diabetes meets the criteria for considering your pregnancy a “high-risk pregnancy.” What this means is that you will be monitored more closely. Expect to have a few more appointments than in an uncomplicated pregnancy. Your doctor may have you check-in every other week from your second trimester until delivery. The good news is the majority of women with gestational diabetes go on to have a very healthy pregnancy.
Here is a list of the different providers for gestational diabetes:
Your personal obstetrician
Your personal obstetrician will manage all of your pregnancy needs that occur in a normal pregnancy. Between 24 and 28 weeks your obstetrician will screen you for gestational diabetes. They also monitor your urine for increased glucose your entire pregnancy so they can catch it as early as possible.
If you have a mild case that can be controlled with diet and exercise, you may not need any further can than he or she can provide. However, you may still be sent to a diabetic educator to learn more about diabetes and come up with a diet plan.
Your doctor will most likely send you to a diabetic educator. They specialize in diabetic teaching about the condition in general. They are also trained to work with gestational diabetes and how that affects your body and your growing baby. They will work with you in the office, you may watch some videos, and they will give you printed information to refer to at home.
You will sit down with them and tell them your eating habits, your likes and dislikes, and if you have any food sensitivities or allergies. They will help you come up with a meal plan to ensure that you get just the right amount of nutrients to fuel your body and help your baby develop properly. It will also help you prevent excess weight gain and reduce the risk of having a large baby. Your diet plan may be re-evaluated and worked with throughout the remainder of your pregnancy based on your blood sugar trends.
They will teach you how to check your blood sugar and give you a schedule of when they need to be checked. If you are managing your condition with diet only or using long acting insulin, you may only need to check in the morning and before bed. If you are on short-acting insulin before meals you will need to check your blood sugar five times daily; when you wake up, before each meal, and at bedtime. Your educator will give you a log to write them down. It is very important to keep track of every blood sugar and show them to your doctor and your diabetic care team at each visit.
Your diabetic educator will teach you how to use diabetic medications. They will teach you how to put your medication into the syringe and give yourself an injection. This is usually done with sterile saline into a piece of fruit the first few times so you can get the feel.
They also teach you what to do in the event of blood sugars that are too high or too low. They instruct you to keep hard candies to suck on for mild low blood sugars, eat a meal with protein and carbs, or teach you how to show your family how to use diabetic rescue glucose in case you cannot help yourself. With good teaching, most people are able to bring their blood sugar up easily.
They will also talk to you about exercise. They can give you some exercises that will help keep your blood sugar stable. You will also be taught to take your blood sugar before and after exercise and eat a snack to prevent crashes (extreme lows), since when you exercise you burn off excess glucose.
You may need to see the educator only one time, or a few times. If you have a more severe case, you may see them monthly or even more often.
Maternal Fetal Medicine Specialist
A maternal fetal medicine specialist is an obstetrician with special training to more closely monitor your baby’s development. They counsel you on your past health history, any genetic conditions, can order extra testing, and do high-level ultrasounds.
A maternal fetal medicine doctor is most often used when your obstetrician is concerned about the health of your baby during high-risk pregnancies. They are most often used when expectant mothers have pre-existing conditions that complicate the pregnancy. These can be; advanced maternal age, obesity, infectious disease (HIV, Hepatitis C), a genetic condition, Type 1 or 2 diabetes, Hypertension, kidney disease, autoimmune conditions, or heart conditions, If you have any of these, you may be referred right away for an evaluation and specialized ultrasound.
In the last trimester of your pregnancy, you may be sent for high level ultrasounds to monitor the size and growth of your baby. You may only need one, but if the specialist finds your baby is too large for dates, they may have you come back and repeat the test o a schedule. They may also have you go into labor and delivery in your last few weeks for a “fetal non-stress” test to monitor the baby’s heart rate and movement patterns.
If your blood sugars are out of control or you suffer from Type 1 or 2 diabetes, you may need to see an endocrinologist for further care. They take care of the hormonal issues with diabetes and can order further testing or treatments. You may only need a few visits and they can consult with your doctor over the phone if you run into problems.
High Risk Pregnancy Care
Maternal Fetal Medicine
American Association of Diabetes Educators