What to expect when you're expecting (207 page)

Frequent and very copious urination (as distinguished from the also frequent but usually light urination of early pregnancy)

Fatigue (which may be difficult to differentiate from pregnancy fatigue)

Sugar in the urine (detected at a routine practitioner visit)

What can you and your practitioner do?
Around your 28th week, you’ll be given a glucose screening test (see
page 297
) and, if necessary, a more elaborate three-hour glucose tolerance test. If these tests show you have GD, your practitioner will likely put you on a special diet (similar to the Pregnancy Diet) and suggest exercises to keep your GD under control. You may also need to check your glucose levels at home using a glucose meter or strips. If diet and exercise alone aren’t enough to control your blood sugar level (they usually are), you may need supplementary insulin. The insulin can be given in shots, but the oral drug glyburide is being used more and more often as an alternative treatment for GD. Fortunately, virtually all of the potential risks associated with diabetes in pregnancy can be eliminated through the careful control of blood sugar levels achieved by good self- and medical care. For more on diabetes control, see
page 519
.

You’ll Want to Know …

There’s little reason for concern if your GD is well controlled. Your pregnancy will progress normally and your baby shouldn’t be affected.

Can it be prevented?
Keeping an eye on your weight gain (both before and during pregnancy) can help prevent GD. So, too, can good diet habits (eating plenty of fruits and vegetables, and whole grains, keeping refined sugar intake down, and making sure you’re getting enough folic acid) and regular exercise (research shows that obese women who exercise cut their risk of developing GD by half). Continuing these preventive steps after the baby’s born also significantly reduces the risk of diabetes occurring later in life.

Keep in mind, too, that having GD during pregnancy puts you at greater risk of developing type 2 diabetes after pregnancy. Keeping your diet healthy, staying at a normal weight, and, even more important, continuing to exercise after the baby is born (and beyond) significantly cuts that risk.

What is it?
Preeclampsia (also known as pregnancy-induced hypertension or toxemia) is a disorder that generally develops late in pregnancy (after week 20) and is characterized by a sudden onset of high blood pressure, excessive swelling (edema), and protein in the urine.

If preeclampsia goes untreated, it could progress to eclampsia, a much more serious condition involving seizures (see
page 562
). Unmanaged preeclampsia can also cause a number of other pregnancy complications, such as premature delivery or intrauterine growth restriction.

How common is it?
About 8 percent of pregnant women are diagnosed with preeclampsia. Women carrying multiple fetuses, women over 40, and women with high blood pressure or diabetes are at greater risk of developing preeclampsia. If you’re diagnosed with preeclampsia in one of your pregnancies, you have a 1 in 3 chance of developing the condition in future pregnancies. That risk is higher if you are diagnosed with preeclampsia in your first pregnancy or if you develop preeclampsia early in any pregnancy.

What are the signs and symptoms?
Symptoms of preeclampsia can include any or all of the following:

Severe swelling of hands and face

Swelling of the ankles that doesn’t go away after 12 hours of rest

Sudden excessive weight gain unrelated to eating

Headaches that don’t respond to over-the-counter pain relievers

Pain in the upper abdomen

Blurred or double vision

A rise in blood pressure (to 140/90 or more in a woman who has never before had high blood pressure)

Protein in the urine