Gestational Diabetes

What causes gestational diabetes?

Gestational diabetes occurs when your body can’t make the extra insulin needed during pregnancy. Insulin, a hormone made in your pancreas, helps your body use glucose for energy and helps control your blood glucose levels.

During pregnancy, your body makes special hormones and goes through other changes, such as weight gain. Because of these changes, your body’s cells don’t use insulin well, a condition called insulin resistance. All pregnant women have some insulin resistance during late pregnancy. Most pregnant women can produce enough insulin to overcome insulin resistance, but some cannot. These women develop gestational diabetes.

Being overweight or having obesity is linked to gestational diabetes. Women who are overweight or have obesity may already have insulin resistance when they become pregnant. Gaining too much weight during pregnancy may also be a factor.

Having a family history of diabetes makes it more likely that a woman will develop gestational diabetes, which suggests that genes play a role.

 

Who is at risk for gestational diabetes?

Anyone can get gestational diabetes during pregnancy. But certain factors can increase your risk.

They include:

• Heart disease.
• High blood pressure.
• Having obesity or overweight before pregnancy.
• Personal history of GD (in previous pregnancies).
• Family history of Type 2 diabetes.
• Polycystic ovary syndrome (PCOS).
• Advanced maternal age.
• Prediabetes (history of higher-than-normal blood glucose).

People over the age of 25 who are of South and East Asian, Hispanic, Native American or Pacific Island descent are also at a higher risk.

 

What are the symptoms of gestational diabetes?

There are usually no obvious warning signs of gestational diabetes. Symptoms are mild and often go unnoticed until your pregnancy care provider tests you for gestational diabetes.

If you do have symptoms, they may include:

• Frequent urination.
• Excessive thirst.
• Tiredness.
• Nausea.

 

What are complications of unmanaged gestational diabetes?

Being unable to keep your blood sugar levels in a healthy range can lead to complications for both you and the fetus.

Gestational diabetes increases your risk of:

• C-section (if the fetus gets too big).
• Preeclampsia (high blood pressure during pregnancy).
• Miscarriage or Stillborn

People with gestational diabetes are slightly more likely to have Type 2 diabetes later in life.

 

How does gestational diabetes affect my baby?

If you have gestational diabetes, your baby’s more at risk for:

• Increased birth weight (fetal macrosomia).
• Breathing problems at birth.
• Hypoglycemia. This can cause seizures in newborns.
• Obesity.
• Premature birth.
• Type 2 diabetes later in life.

 

When does a healthcare provider test for gestational diabetes?

Your healthcare provider tests for gestational diabetes around weeks 24 to 28 of your pregnancy. Most healthcare experts believe this is the best time to get the most accurate results. But your provider may screen you for gestational diabetes a little earlier, especially if you have risk factors for the condition.

 

How is gestational diabetes diagnosed?

Your healthcare provider will test your blood sugar during pregnancy with a blood test. Often, the first test is a “screening,” which means it identifies people who are more likely to have gestational diabetes. If you don’t pass the screening, your provider will order a second blood test which is more comprehensive.

• Glucose challenge test: You may have the glucose challenge test first. Another name for this blood test is the glucose screening test. In this test, a health care professional will draw your blood 1 hour after you drink a sweet liquid containing glucose. You do not need to fast for this test. Fasting means having nothing to eat or drink except water. If your blood glucose is too high—140 or more—you may need to return for an oral glucose tolerance test while fasting. If your blood glucose is 200 or more, you may have type 2 diabetes.
• Oral Glucose Tolerance Test (OGTT): The OGTT measures blood glucose after you fast for at least 8 hours. First, a health care professional will draw your blood. Then you will drink the liquid containing glucose. You will need your blood drawn every hour for 2 to 3 hours for a doctor to diagnose gestational diabetes.
  
  High blood glucose levels at any two or more blood test times—fasting, 1 hour, 2 hours, or 3 hours—mean you have gestational diabetes. Your health care team will explain what your OGTT results mean.
  
  Your health care professional may recommend an OGTT without first having the glucose challenge test.

 

How is gestational diabetes managed?

If you have gestational diabetes, you’ll need more frequent checkups during your pregnancy.

Your pregnancy care provider will want to:

• Monitor the growth of the fetus. This typically involves having a few extra ultrasounds where they’ll make sure the fetus isn’t getting too large.
• Review your blood sugar ranges. Most of the time, this involves discussing how often your blood sugar is high or low and looking at general trends in your blood sugar levels.

To keep track of your blood sugar at home, you’ll need a tool called a glucose meter. You’ll need the monitor itself, as well as needles (or lancets) and test strips. Taking your blood sugar involves pricking the tip of your finger with the lancet and then wiping the blood on a test strip. Then, you insert the test strip into the meter. After a few seconds, the device will display a number. This is your blood sugar level. Your nutritionist or diabetes educator will go over how to use the device. It may take a few days to get the hang of it, but your provider is always available to help you if you need it.

You’ll have to record your meals and blood sugar readings on paper, on an app or whatever way your provider wants you to. Then, your pregnancy care provider will review your readings at regular intervals (often weekly or biweekly). Sometimes, your provider will need to adjust your food (like decreasing the amount of carbs you eat) to keep your glucose levels well managed. The combination of tracking your blood sugar levels and eating diabetes-friendly food is usually enough to manage gestational diabetes.

Some people need medication such as insulin to manage gestational diabetes. This usually involves injecting insulin into your stomach, thigh or buttocks every day or multiple times a day. How frequently you need to inject insulin depends on many factors. Your healthcare provider will teach you how to inject insulin, when to take it and how much to take. If you need to use insulin to manage diabetes, it’s important to take it exactly as your provider prescribes.

 

Blood sugar levels

You typically record your glucose levels right when you wake up (before eating anything) and then about one hour after each meal. For example, you may take your blood sugar upon waking up at 6:15 a.m. Then, if you eat breakfast at 7 a.m., you’d take your blood sugar level around 8 a.m. You record the numbers in whatever way you and your provider have agreed on.

The American College of Obstetricians and Gynecologists typically recommends the following ranges for blood glucose levels:

• Before a meal: 95 milligrams (mg)/dL or less. (Mg/dL stands for milligrams per decilitre.)
• One hour after a meal: 140 mg/dL or less.
• Two hours after a meal: 120 mg/dL or less.

As always, everyone is unique, and these are only guidelines. Your pregnancy care provider will discuss what your blood sugar range should be.

 

What shouldn’t you eat with gestational diabetes?

You can help manage gestational diabetes by eating nutritious foods that don’t cause your blood sugar to rise to unsafe levels.

Try to:

• Avoid processed foods and sugary drinks.
• Choose a healthy balance of proteins, carbohydrates, fiber and fat for each meal.
• Eat smaller meals more often.
• Schedule your meals at the same time each day.

Some people with gestational diabetes find that small tweaks to what they usually eat are all that’s necessary to maintain normal blood sugar levels. Still, some find that they have to make more changes. It’s important to keep in mind that some people may be able to eat certain foods without a large impact on blood sugar, but you may not be able to. Remind yourself that everyone is different and unique.

 

Does drinking water lower blood sugar with gestational diabetes?

Hydration is important during pregnancy, especially if you have gestational diabetes. But there are no studies that show drinking water alone will directly lower blood sugar.

Staying hydrated does help your body regulate your blood sugar, though. It helps dilute your blood, which makes it easier for your kidneys to get rid of excess sugar. Water can also help your body use insulin more effectively, which also contributes to regulating blood sugar.

 

How can I exercise safely with gestational diabetes?

Physical activity can help you reach your target blood glucose levels. If your blood pressure or cholesterol levels are too high, being physically active can help you reach healthy levels. Physical activity can also relieve stress, strengthen your heart and bones, improve muscle strength, and keep your joints flexible. Being physically active will also help lower your chances of having type 2 diabetes in the future.

Talk with your health care team about what activities are best for you during your pregnancy. Aim for 30 minutes of activity 5 days of the week, even if you weren’t active before your pregnancy. If you are already active, tell your doctor what you do. Ask your doctor if you may continue some higher intensity activities, such as lifting weights or jogging.

 

How can you reverse gestational diabetes while pregnant?

You can’t reverse gestational diabetes once you have it. Your provider will test you for diabetes after your baby is born (usually between six and 12 weeks postpartum) to see if you still have it.

 

How can gestational diabetes be prevented?

If you are thinking about becoming pregnant and are overweight, you can lower your chance of developing gestational diabetes by losing extra weight and increasing physical activity before you become pregnant. Taking these steps can improve how your body uses insulin and help your blood glucose levels stay normal.

Once you are pregnant, don’t try to lose weight. You need to gain some weight for your baby to be healthy. However, gaining too much weight too quickly may increase your chance of developing gestational diabetes. Ask your doctor how much weight gain and physical activity during pregnancy are right for you.

 

How worried should I be about gestational diabetes?

Gestational diabetes is a common condition and healthcare providers have a good idea of how best to manage and treat it. You’ll still have a healthy pregnancy and a healthy baby if you have gestational diabetes. Work with your healthcare provider to make sure you understand your treatment plan and how you can keep your blood sugar levels healthy.

Take time to understand the possible complications of not managing gestational diabetes. Your baby has a very good chance of being born healthy, but you must take steps to manage the condition. If your blood sugar levels are high several readings in a row, don’t wait to contact your provider. Let them know that your blood sugar levels are repeatedly high so they can adjust your foods or medication and help you. Gestational diabetes is manageable, but there’s a level of responsibility you must take to ensure your pregnancy is healthy.

 

Will gestational diabetes go away after pregnancy?

Your blood sugar levels should come down after you give birth, when your hormone levels return to normal. Your pregnancy care provider will test you for gestational diabetes after your baby is born to confirm it’s gone (usually around six to 12 weeks postpartum).

But about 50% of people with gestational diabetes develop Type 2 diabetes later in life. Eating the right foods for your body and getting physical activity can help lower your risk. Your healthcare provider may recommend blood glucose tests every few years to watch for diabetes, especially if you have one or more risk factors.

 

Does having gestational diabetes make a pregnancy high risk?

Yes, having gestational diabetes may make your pregnancy high risk. Healthcare providers consider a pregnancy high risk when either you or the fetus (or both) has health conditions that increase your chances of having a pregnancy complication.

 

Will my baby be healthy if I have gestational diabetes?

Yes. Most babies born are born healthy. There are some steps you can take to manage gestational diabetes during pregnancy to give your child the best start in life. Attending all your prenatal appointments and managing diabetes the best you can during pregnancy are the two best things you can do.

 

What can I do to make living with gestational diabetes easier?

Make diabetes management part of your daily routine. Create a schedule and stick to it.

Try to:

• Check your blood glucose levels at the same time each day.
• Choose three days each week to get 30 minutes of light exercise.
• Plan small, balanced meals ahead of time.
• Talk with your healthcare provider or a diabetes educator about other tips for daily diabetes management.

 

When should I see my healthcare provider if I have gestational diabetes?

Even if you’re being careful to manage your condition, there may be situations where you need to call your pregnancy care provider.

Contact your provider if you have gestational diabetes and:

• You’re having trouble managing blood sugar levels. This means your blood sugar levels are higher than the range your provider gave you for several readings in a row. They may want to adjust your diabetes management plan.
• Your blood sugar is consistently low. Having low blood sugar can be a bad thing, too. Your provider may have ideas to help your blood sugar stay in a healthier range.
• You have an illness that prevents you from following your management plan. For example, you may have food poisoning or be vomiting for another reason. Being unable to eat will affect your blood sugar levels.

 

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