Gestational diabetes is a term used to describe diabetes or abnormal glucose tolerance discovered during pregnancy. While many women enter pregnancy with a diagnosis of diabetes (whether on medication or not), gestational diabetes is used to describe diabetes that is diagnosed in the second half of pregnancy. Insulin resistance is common during pregnancy, and the result of hormonal changes as well as increased body weight essentially causes there not to be an effective dose or uptake of insulin. As such, serum glucose levels rise in this setting and can continue to rise as pregnancy hormones and body weight continue to increase.
Gestational diabetes is caused by an inadequate level of insulin combined with the cell’s inability to take insulin into the cell properly (insulin resistance). Risk factors for gestational diabetes include a family history of type 2 diabetes, a previous pregnancy with gestational diabetes, delivery of a large infant previously, and increased sugar in the urine. Diagnosis is made by elevated blood glucose levels. While the majority of the problems and risks are assumed by the fetus during the pregnancy period, over 30 (and as high as 50) percent of individuals with a history of gestational diabetes will go on to develop non -insulin (type 2) diabetes on their own within 10 years.
The highest risk of gestational diabetes include older age at pregnancy, overweight, a history of previous abnormal glucose metabolism or tolerance tests, a sedentary lifestyle, and coexisting high blood pressure or metabolic syndrome. Women with a condition known as polycystic ovary syndrome also have higher risks. Women who are diagnosed with gestational diabetes are considered to have high risk pregnancies and are generally followed in a specialty obstetrics clinic along with a diabetes nurse educator and a dietician.
There are maternal complications to gestational diabetes. There are increased risks to spontaneous abortion, an increased risk of premature delivery, increased frequency of eclampsia (high blood pressure and kidney problems), premature labor, and a higher likelihood of Cesarean section. Needless to say, in some women insulin will have to be started in order to control blood sugars, and that can have effects on the mother if the dosage is not well applied. Most women after delivery will be able to discontinue the insulin and go back to their previous state of health. It goes without mentioning that newborns are all subject to similar risks, including congenital malformation, larger babies, stillbirths, and other complications.
While there was a time when insurance applications were universally postponed until a pregnancy was completed, most cases can now be considered at the same rates at which they would have been issued if there was not a pregnancy in process. In gestational diabetes however, the underwriter looks for good control of blood sugars and watches for any other complications that can develop, such as high blood pressure or kidney problems. Some cases will be postponed if complications develop until the baby is delivered. When insulin is used or blood sugars prove to be hard to control, there is always the consideration that gestational diabetes is a risk factor for not only type 2 diabetes in the future but for a risk of diabetes with subsequent pregnancies. A case may indeed be postponed until delivery, but applicants can be offered preferred rate consideration if 5-10 years have passed since the last episode of gestational diabetes and general health remains otherwise good.
Robert Goldstone, MD, FACE, FLMI
Goldstone, board certified internist and endocrinologist, is vice president and chief medical officer for Pacific Life and Pacific Life and Annuity. He has extensive brokerage and life insurance experience, having been medical director at both MetLife Brokerage and Transamerica Occidental Life. Goldstone is board certified in insurance medicine and the inaugural recipient of the W. John Elder Award for Insurance Medicine Journalism Excellence. He was also honored as a fellow of the prestigious American College of Endocrinology and has written monthly for Broker World since 1990. Goldstone can be reached by telephone at 949-420-8390. Email: firstname.lastname@example.org.