The specialist: Dr. Carol Levy, treatment of gestational diabetes

As the director of clinical trials operations at Mount Sinai, Dr. Carol Levy is an endocrinologist who specializes in diabetes and pregnancy. Over the past 15 years, she has treated more than 1,000 women with gestational diabetes.

Who’s at risk

Doctors estimate that 5% to 10% of pregnant women have gestational diabetes, a condition that causes elevated glucose levels during pregnancy.

“The placenta produces hormones that make the body not respond as well to insulin, the hormone that normally lowers blood sugar,” says Levy. “As a result, the glucose levels become elevated — but in pregnancy even moderately elevated glucose levels can be harmful to the baby.”

All pregnant women produce extra insulin to overcome the placenta’s hormones, but women with gestational diabetes can’t make enough. As the placenta grows bigger and bigger, it becomes harder to make enough insulin to compensate.

“Ob-gyns test women for gestational diabetes typically between weeks 25 and 28 of pregnancy, because that’s when the placenta gets much bigger and makes more hormones,” says Levy. “The test is done by giving the woman a sweet sugary drink called ‘glucola’ and then testing her glucose levels after a certain interval to see if they are elevated.”

Doctors recommend that almost all pregnant woman be tested for gestational diabetes.

“Women are considered at higher risk if they are over age 25, are obese, Hispanic, African-American or Asian, or have a family or personal history of any diabetes,” says Levy. “These include the general risk factors for type 2 diabetes.”

Twin pregnancies are also at higher risk because there are two placentas, thus producing more hormones.

One misconception is that eating sugary meals during pregnancy causes gestational diabetes.
“Patients come in and say, ‘I’m such a failure, I ate a piece of cake last week,’ ” says Levy. “But it’s not what you ate last week — you can’t change your genetics or your age.”

Signs and symptoms

Gestational diabetes is invisible and silent to most patients. “Most women will not have any signs and symptoms, which is what makes screening so important,” says Levy. “Glucose levels that might not be of concern outside of pregnancy become associated with serious risks during pregnancy.”