What Is Gestational Diabetes
Gestational diabetes is a kind of diabetes that some women get during pregnancy. Its a condition in which your body has too much sugar in the blood.
When you eat, your body breaks down sugar and starches from food into glucose to use for energy. Your pancreas makes a hormone called insulin that helps your body keep the right amount of glucose in your blood. When you have diabetes, your body doesnt make enough insulin or cant use insulin well, so you end up with too much sugar in your blood. This can cause serious health problems, like heart disease, kidney failure and blindness.
Most pregnant women get tested for GDM at 24 to 28 weeks of pregnancy. Most of the time it can be controlled and treated during pregnancy. If its not treated, GDM can cause problems for you and your baby. It usually goes away after you have your baby. But if you have GDM, youre at increased risk of developing diabetes later in life.
In the United States, 7 out of every 100 pregnant women develop gestational diabetes. Youre more likely than other women to have GDM if youre African-American, Native American, Asian, Hispanic or Pacific Islander.
How Will I Know If I Have It
You can expect your doctor to assess your risk for GDM at your first prenatal visit.
If you are at high risk, you’ll have a blood test for GDM as soon as possible. If your test is negative, you’ll repeat the test about week 24-28.
If you are not at high risk, you should also get screened about week 24-28.
To test for gestational diabetes, your doctor may order a test known as the glucose challenge test. You do not need to fast for this. If you fail the test, you will have an oral glucose tolerance test. You will fast for a certain period beforehand . This two-step approach is commonly used.
After you’re diagnosed, your doctor or midwife will want to watch your health and your baby’s health closely for the rest of your pregnancy.
Living With Gestational Diabetes
A diagnosis of gestational diabetes requires a lifestyle change. You have to eat healthy, count carbohydrates and be active. Patients check their blood sugars four to six times per day. If the blood sugars are unable to be controlled with diet and activity, they are treated with insulin.
Your blood sugar levels can be harder to control as pregnancy progresses, because your insulin resistance continues to build.
Having gestational diabetes means more frequent appointments for non-stress testing, and we recommend you do fetal kick counts at home to make sure your baby is moving normally, Elizabeth said. You will also need detailed ultrasounds to monitor fetal growth and check for birth defects.
Women with gestational diabetes will require a non-stress test up to twice a week. You will be hooked up to a monitor for usually about 30 minutes. The test allows your care provider to monitor the health of the placenta and how the baby is doing.
We monitor the baby closely as pregnancy develops because of the risk of stillbirth, Elizabeth said.
Some women 10-20% of them will need insulin to reach their blood sugar targets. Some might need it just overnight. Some might need insulin doses all day long.
There is no way to cheat the system, Elizabeth said. Treating gestational diabetes appropriately is so important for a healthy mom and a healthy baby.
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Who Is At Risk Of Gestational Diabetes
Between 3% and 8% of pregnant women develop gestational diabetes. It is usually detected around weeks 24 to 28 of pregnancy, although it can develop earlier. Being diagnosed with gestational diabetes can be both unexpected and upsetting. It is important to reach out and get support and help with managing it.
Some women are at increased risk of developing gestational diabetes. This includes women who:
- are over 40 years of age
- thrush .
Can Gestational Diabetes Cause Problems During Pregnancy
Yes. If not treated, GDM can cause pregnancy complications, including:
Gestational diabetes also can cause health complications for your baby after birth, including:
- Breathing problems, including respiratory distress syndrome . This is a breathing problem caused when babies dont have enough surfactant in their lungs. Surfactant is a protein that keeps the small air sacs in the lungs from collapsing.
- Jaundice. This is a medical condition in which a babys eyes and skin look yellow. A baby has jaundice when his liver isn’t fully developed or isnt working well.
- Low blood sugar
- Obesity later in life
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Causes And Risk Factors Of Gestational Diabetes
Similar to type 2 diabetes, gestational diabetes develops when the body is no longer able to respond effectively to insulin a condition called insulin resistance.
When the body’s cells don’t properly absorb glucose, the simple sugar builds up in the bloodstream, resulting in elevated levels of glucose on blood tests.
Gestational diabetes is caused by the effects of placental hormones, says Kevin Borst, DO, an endocrinologist at Cleveland Clinic in Ohio. These can increase insulin resistance in susceptible individuals. It is not fully understood why some women dont tolerate these hormones well and ultimately develop gestational diabetes.
These hormones include:
- Human placental lactogen
- Placental insulinase
What’s more, other changes during pregnancy such as eating more, exercising less, and having larger fat deposits can contribute to insulin resistance.
- Prediabetes
- Previously having an unexplained stillbirth or miscarriage
Still, some women without any of these risk factors may go on to develop gestational diabetes due to their intolerance of the placental hormones, Dr. Borst explains.
If You Have Gestational Diabetes How Can You Help Prevent Getting Diabetes Later In Life
For most women, gestational diabetes goes away after giving birth. But having it makes you more likely to develop type 2 diabetes later in life. Type 2 diabetes is the most common kind of diabetes. If you have type 2 diabetes, your pancreas makes too little insulin or your body becomes resistant to it .
Heres what you can do to help reduce your risk of developing type 2 diabetes after pregnancy:
- Breastfeed. Breastfeeding can help you lose weight after pregnancy. Being overweight makes you more likely to develop type 2 diabetes.
- Get tested for diabetes 4 to 12 weeks after your baby is born. If the test is normal, get tested again every 1 to 3 years.
- Get to and stay at a healthy weight.
- Talk to your provider about medicine that may help prevent type 2 diabetes.
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How Can I Avoid Getting Gestational Diabetes
- Eat right: Choose grains that release sugar slowly instead of refined flour that gets digested fast. Carbohydrates that are quickly digested lead to a spike in sugar levels in your blood and that puts pressure on your body to produce insulin. Some good options are unrefined flour , brown rice, bran, oats or millet.
- Exercise: Exercising is how your body uses the sugars that are digested. If you don’t use the sugars that you take in, even if they are from healthy sources, it can lead to an imbalance. There are many kinds of gentle exercise that are safe in pregnancy. Some good examples are yoga, pilates, walking and swimming.
- Watch your weight gain: If you’re a healthy weight before getting pregnant, with a BMI between 18.5 and 23, you’ll put on between 10 and 12.5 kg during your pregnancy. This is normal and healthy. The higher above 23 your BMI is before conceiving, the more at risk you are for gestational diabetes. Speak to your doctor about what weight gain is right for you according to your BMI. You might start by losing weight in your first trimester, that is quite normal and nothing to worry about. As your morning sickness improves, and you start gaining weight, try to keep it within the range your doctor recommends.
Problems Of Gestational Diabetes In Pregnancy
Blood sugar that is not well controlled in a woman with gestational diabetes can lead to problems for the pregnant woman and the baby:
An Extra Large Baby
Diabetes that is not well controlled causes the babys blood sugar to be high. The baby is overfed and grows extra large. Besides causing discomfort to the woman during the last few months of pregnancy, an extra large baby can lead to problems during delivery for both the mother and the baby. The mother might need a C-Section to deliver the baby. The baby can be born with nerve damage due to pressure on the shoulder during delivery.
C-Section
A C-section is an operation to deliver the baby through the mothers belly. A woman who has diabetes that is not well controlled has a higher chance of needing a C-section to deliver the baby. When the baby is delivered by a C-section, it takes longer for the woman to recover from childbirth.
High Blood Pressure
When a pregnant woman has high blood pressure, protein in her urine, and often swelling in fingers and toes that doesnt go away, she might have preeclampsia. It is a serious problem that needs to be watched closely and managed by her doctor. High blood pressure can cause harm to both the woman and her unborn baby. It might lead to the baby being born early and also could cause seizures or a stroke in the woman during labor and delivery. Women with diabetes have high blood pressure more often than women without diabetes.
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Staying Aware Of Increased Cardiovascular Risk After The Pregnancy
While gestational diabetes usually resolves after delivery, women who have experienced it have a 68% higher risk of developing cardiovascular disease later in life than women who didnt have gestational diabetes. This risk is there whether the pregnancy was last year or 40 years ago. Women should be aware of their increased risk and be sure their healthcare providers are aware of their medical history.
The Riverside Womens Heart Center specializes in caring for women with this increased risk. To learn more about the cardiovascular risks from a high-risk pregnancy or to make an appointment at the Riverside Womens Heart Center, please visit www.riversideonline.com/womensheart.
What Should I Do After My Blood Sugars Return To Normal Postpartum
- Continue to test your blood sugar! Test 2 hours after your largest meal a couple times per week. This is important data that will give you a heads up if your blood sugar starts trending up or you are just not tolerating the carbohydrate content in a particular meal.
- Limit processed carbs. Just because your blood sugars come down doesn’t mean you should eat all the junk. Generally avoid processed carbohydrate foods it will result in better blood sugar control long term.
- Focus on eating a nutrient rich whole foods diet. This is simple and will benefit your health on many levels. Those who eat a whole foods diet generally do not develop diabetes, simple as that.
- Move you body. Working out improves insulin sensitivity. If gestational diabetes indicates some level of insulin sensitivity you will want to do what you can to improve your response to insulin. Doing something as gentle as walking post-meal you can reduce your blood sugar without relying on insulin. This is a great tool and should be utilized!
- Get your A1c tested annually. Even if you are young getting your A1c tested each year is important. Those who miss these annual appointments sometimes miss the pre-diabetes diagnosis and jump straight to diabetes. Prediabetes is scary but it is still early enough to make changes to prevent a chronic disease. Prevention is key.
What strategies did you use to control blood sugar during and after pregnancy? Leave your comments below.
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How Much Carbohydrate Should I Eat To Control Blood Sugar
This is going to be very individual. Things like height and weight, carbohydrate tolerance, activity level, whether you are carrying multiples and countless other factors can affect how much carbohydrate you will want to intake.
As a general rule, most pregnant women with gestational diabetes can tolerate somewhere between 100-200 grams of carbohydrates daily. Some organizations will suggest 175 grams of carbohydrate as a minimum for pregnant women. This is not something I agree with.
Often times women will continue to experience elevated blood sugars eating 175 grams of carbohydrate or higher. In this case, I would recommend lowering carbohydrate by 15 grams per day until you can achieve desired blood sugar goals.
Will Your Baby Need Special Care After Birth
Your baby may need special care after birth. This is because your baby is at risk of having low sugar levels soon after birth, and thus he may have to undergo blood glucose testing. In case the results are abnormal, your doctor will be monitoring your baby closely.
Your doctor may recommend feeding your baby soon after birth to prevent low blood sugar levels. However, in extreme cases, the doctor may recommend intravenous glucose to get your babys blood sugar levels under control.
Depending on how the labour and delivery went, the doctor may keep your baby in a neonatal intensive care unit for some time to take special care of your baby under the following conditions:
- Your baby is born prematurely.
- Your baby has breathing difficulty.
- Your baby has low blood sugar or hypoglycaemia.
- Your baby has other common birth-related complications such as jaundice.
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Treatment For Gestational Diabetes
You can do a lot to manage your gestational diabetes. Go to all your prenatal appointments and follow your treatment plan, including:
- Checking your blood sugar to make sure your levels stay in a healthy range.
- Eating healthy food in the right amounts at the right times. Follow a healthy eating plan created by your doctor or dietitian.
- Being active. Regular physical activity thats moderately intense lowers your blood sugar and makes you more sensitive to insulin so your body wont need as much. Make sure to check with your doctor about what kind of physical activity you can do and if there are any kinds you should avoid.
- Monitoring your baby. Your doctor will check your babys growth and development.
If healthy eating and being active arent enough to manage your blood sugar, your doctor may prescribe insulin, metformin, or other medication.
Diagnosing And Treating Gestational Diabetes
Your doctor will ask you to schedule a glucose challenge test around 24 or 28 weeks of pregnancy. During your appointment, youll drink a glucose solution and be asked to wait one hour in the office. After one hour, you will have a blood sugar test. Your doctor will let you know if results are abnormal and if another test is needed.
The follow-up test, a glucose tolerance test, is also given in your doctors office. Youll need to fast overnight. Then, arriving in your doctors office you will have your blood drawn. After the first blood test, you will drink a glucose solution. Your blood will then be checked once an hour over three hours. A gestational diabetes diagnosis is given if two of the three blood draws have higher than normal blood sugar levels.
Your health care provider will discuss a treatment plan thats right for you if you do have gestational diabetes. That may include:
- More frequent doctor appointments to check your blood sugar levels
- Healthy eating
- Limiting refined sugar and carbohydrates
- Monitoring blood sugar at home
If you are having a hard time managing your gestational diabetes, you may need insulin. Your doctor will help decide whats right for you.
For support in managing your diet if you have gestational diabetes, please visit Riverside Diabetes Services to learn more about educational programs taught by Riversides Certified Diabetes Educators.
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Management Care And Treatment
Gestational diabetes can often be managed with healthy eating and regular physical activity. However, some women may need medication and/or insulin injections to help manage gestational diabetes.
If you have recently been diagnosed with gestational diabetes or have a family member with gestational diabetes, view information on managing gestational diabetes.
There Are Several Risk Factors But It Is More Likely If You:
1. Are overweight or gained excessive weight during pregnancy
2. Have a family history of diabetes
3. Are older than 25
4. Are of Native American, Black, Pacific Islander, Hispanic, South or East Asian, or Indigenous Australian background
5. Have had gestational diabetes during previous pregnancies
6. Gave birth to a baby weighing more than 9 pounds or had a stillborn
7. Have high blood pressure
8. Are a smoker
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How Does Gestational Diabetes Affect Any Future Pregnancies
If you have had gestational diabetes, you are more likely to have it again in future pregnancies. For that reason, a test for gestational diabetes will be performed early in any future pregnancy. If this test gives a negative result within the recommended range, then another pregnancy OGTT will be done again later in the pregnancy to make sure your blood glucose levels are still in the recommended range.
How Gestational Diabetes Can Impact Your Baby
We don’t know what causes gestational diabetes, but we have some clues. The placenta supports the baby as it grows. Hormones from the placenta help the baby develop. But these hormones also block the action of the mother’s insulin in her body. This problem is called insulin resistance. Insulin resistance makes it hard for the mother’s body to use insulin. She may need up to three times as much insulin.
Gestational diabetes starts when your body is not able to make and use all the insulin it needs for pregnancy. Without enough insulin, glucose cannot leave the blood and be changed to energy. Glucose builds up in the blood to high levels, called hyperglycemia.
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