WHAT IS GESTATIONAL DIABETES?
Gestational diabetes is a type of diabetes first diagnosed during pregnancy (gestation). Like other forms of diabetes, gestational diabetes affects how your cells use sugar (glucose). Gestational diabetes causes high blood sugar that could affect your pregnancy and your baby’s health.
While any pregnancy complication is concerning, there is some good news. During pregnancy you could help control gestational diabetes by eating healthy foods, exercising, and, if necessary, taking medication. Controlling blood sugar could keep you and your baby healthy and prevent a difficult delivery.
If you have gestational diabetes during pregnancy, usually your blood sugar returns to its usual level soon after delivery. But if you have had gestational diabetes, you have a greater risk of getting type 2 diabetes. You will need to get tested for changes in blood sugar more frequently.
Most of the time, gestational diabetes does not cause noticeable signs or symptoms. Increased thirst and more-frequent urination are potential symptoms.
WHEN SHOULD YOU SEE A DOCTOR?
If possible, seek health care early — when you first think about trying to get pregnant — so your health care provider could check your risk of gestational diabetes along with your overall wellness. Once you are pregnant, your health care provider will check you for gestational diabetes as part of your prenatal care.
If you develop gestational diabetes, you might need checkups more often. These are most likely to happen during the last three months of pregnancy when your health care provider will monitor your blood sugar level and your baby’s health.
Researchers do not yet know why some women have gestational diabetes and others do not. Excess weight prior to pregnancy often plays a role.
Generally, various hormones work to keep blood sugar levels in check. But during pregnancy, hormone levels change, making it more difficult for the body to process blood sugar efficiently. This makes blood sugar increase.
Risk factors for gestational diabetes are:
- Being overweight or obese
- Not being physically active
- Having prediabetes
- Having had gestational diabetes during the last pregnancy
- Having polycystic ovary syndrome
- Having an immediate family member with diabetes
- Having previously delivered a baby weighing more than nine pounds (4.1 kilograms)
- Being of a certain race or ethnicity, like Black, Hispanic, American Indian and Asian American
Gestational diabetes that is not carefully managed could lead to high blood sugar levels. High blood sugar could cause problems for you and your baby, including an increased likelihood of needing surgery to deliver (C-section).
Complications that might affect your baby
If you have gestational diabetes, your baby might be at increased risk of:
- Excessive birth weight – If your blood sugar level is higher than the standard range, it could cause your baby to grow too large. Very large babies — those who weigh nine pounds or more — are more likely to become wedged in the birth canal, have birth injuries, or require a C-section birth.
- Early (preterm) birth – High blood sugar might increase the risk of early labor and delivery before the due date. Or early delivery might be recommended because the baby is large.
- Serious breathing difficulties – Babies born early might experience respiratory distress syndrome — a condition that makes breathing difficult.
- Low blood sugar (hypoglycemia) – At times babies have low blood sugar (hypoglycemia) shortly after birth. Serious episodes of hypoglycemia might cause seizures in the baby. Prompt feedings and sometimes an intravenous glucose solution could return the baby’s blood sugar level to normal.
- Obesity and type 2 diabetes later in life – Babies have a greater risk of developing obesity and type 2 diabetes later in life.
- Stillbirth – Untreated gestational diabetes could result in a baby’s death either before or shortly after birth.
Complications that might affect you
Gestational diabetes might also increase your risk of:
- High blood pressure and preeclampsia – Gestational diabetes raises your risk of high blood pressure, as well as preeclampsia — a severe complication of pregnancy that causes high blood pressure and other symptoms that could threaten both your life and your baby’s life.
- Having a surgical delivery (C-section) – You are more likely to have a C-section if you have gestational diabetes.
- Future diabetes – If you have gestational diabetes, you are more likely to get it again during the next pregnancy. You also have a greater risk of developing type 2 diabetes as you get older.
There are no guarantees when it comes to preventing gestational diabetes — but the healthier habits you could adopt before pregnancy, the better. If you have had gestational diabetes, these healthy choices might also reduce your risk of having it again in future pregnancies or developing type 2 diabetes in the future.
- Eat healthy foods – Opt for foods high in fiber and low in fat and calories. Concentrate on fruits, vegetables, and whole grains. Strive for variety to help you achieve your aims without compromising taste or nutrition. Watch portion sizes.
- Keep active – Exercising before and during pregnancy could help protect you from developing gestational diabetes. Aim for thirty minutes of moderate activity on most days of the week. Go for a brisk daily walk. Ride your bike. Swim laps. Short bursts of activity — like parking further away from the store when you run errands or taking a short walk break — all add up.
- Start pregnancy at a healthy weight – If you are planning to get pregnant, losing extra weight beforehand might help you have a healthier pregnancy. Focus on making lasting changes to your eating habits that could help you through pregnancy, such as eating more vegetables and fruits.
- Do not put on more weight than recommended – Gaining some weight during pregnancy is normal and healthy. But gaining too much weight too quickly could increase your risk of gestational diabetes. Ask your health care professional what is the reasonable amount of weight gain for you.
If you are at average risk of gestational diabetes, you will likely have a screening test during your second trimester — between 24 and 28 weeks of pregnancy.
If you are at high risk of diabetes — for example, if you are overweight or obese before pregnancy; you have a mother, father, sibling, or child with diabetes; or you had gestational diabetes during a previous pregnancy — your health care provider might test for diabetes early in pregnancy, likely at your first prenatal visit.
Routine screening for gestational diabetes
Screening tests might vary slightly depending on your health care provider, but generally include:
- Initial glucose challenge test – You will drink a syrupy glucose solution. An hour later, you will get a blood test to measure your blood sugar level. A blood sugar level of 190 milligrams per deciliter (mg/dL), or 10.6 millimoles per liter (mmol/L), is an indicator of gestational diabetes.
A blood sugar level below 140 mg/dL (7.8 mmol/L) is generally considered within the standard range on a glucose challenge test, although this may vary by clinic or laboratory. If your blood sugar level is higher than expected, you will need another glucose tolerance test to determine if you have gestational diabetes.
- Follow-up glucose tolerance testing – This test is identical to the initial test — except the sweet solution will have even more sugar and your blood sugar will be checked every hour for three hours. If at least two of the blood sugar readings are greater than expected, you will be diagnosed with gestational diabetes.
Treatment for gestational diabetes includes:
- Lifestyle changes
- Blood sugar monitoring
- Medication, if required
Managing your blood sugar levels makes it easier for you and your baby to stay healthy. Close management could also help you avoid complications during pregnancy and delivery.
Your lifestyle — how you eat and move — is a crucial part of keeping your blood sugar levels in a healthy range. Health care providers usually do not advise losing weight during pregnancy — your body is working hard to support your growing baby. But your health care provider could help you set weight gain goals based on your weight before pregnancy.
Lifestyle changes include:
- Healthy diet – A healthy diet concentrates on fruits, vegetables, whole grains, and lean protein — foods that are high in nutrition and fiber and low in fat and calories — and limits highly refined carbohydrates, including sweets. A registered dietitian or certified diabetes care and education specialist could help you create a meal plan based on your current weight, pregnancy weight gain goals, blood sugar level, exercise habits, food preferences, and budget.
- Staying active – Regular physical activity plays an essential role in every wellness plan before, during, and after pregnancy. Exercise reduces your blood sugar. As an added bonus, regular exercise could help relieve some common discomforts of pregnancy, including back pain, muscle cramps, swelling, constipation, and trouble sleeping.
With your health care provider’s OK, aim for thirty minutes of moderate exercise on most days of the week. If you have not been active for a while, begin slowly and build up gradually. Walking, cycling, and swimming are good options during pregnancy. Everyday activities like housework and gardening also count.
Blood sugar monitoring
While you are pregnant, your health care team might ask you to check your blood sugar four or more times a day — first thing in the morning and after meals — to ensure your level stays within a healthy range.
If diet and exercise are not enough to manage your blood sugar levels, you might need insulin injections to lower your blood sugar. A small number of women with gestational diabetes require insulin to reach their blood sugar aims.
Some health care professionals prescribe oral medication to manage blood sugar levels. Other health care providers believe more research is required to confirm that oral medications are as safe and as effective as injectable insulin to manage gestational diabetes.
Close monitoring of your baby
A crucial part of your treatment plan is close observation of your baby. Your health care provider might check your baby’s growth and development with repeated ultrasounds or other tests. If you do not go into labor by your due date — or sometimes earlier — your health care provider might induce labor. Delivering after your due date might increase the risk of complications for you and your baby.
Follow-up after delivery
Your health care provider will check your blood sugar level after delivery and again in six to twelve weeks to ensure that your level has returned to within the standard range. If your tests are back in this range — and most are — you will need to have your diabetes risk evaluated at least every three years.
If future tests suggest type 2 diabetes or prediabetes, talk with your health care provider about increasing your prevention efforts or starting a diabetes management plan.
If you or anyone you know is suffering from gestational diabetes, our expert providers at Specialty Care Clinics will take care of your health and help you recover.