Gestational diabetes is a type of diabetes diagnosed during pregnancy. The condition affects the way insulin manages blood sugar circulating in the bloodstream. If not appropriately diagnosed and managed, high blood sugar levels can adversely affect your pregnancy and the health of your baby.
Gestational diabetes is not uncommon. According to the U.S. Centers for Disease Control and Prevention, from 1 in 50 to 1 in 20 pregnant women have gestational diabetes. People with the following conditions are at higher risk of developing gestational diabetes:
- Lacking physical activity
- Being overweight or obese
- Having prediabetes
- Having had gestational diabetes in a previous pregnancy
- Having had a baby weighing 9 pounds or more in a previous pregnancy
- Having a history of heart disease
- Having polycystic ovary syndrome (PCOS)
- Having a family history of diabetes
How is Gestational Diabetes Diagnosed?
Screening for gestational diabetes is commonly performed between 24 and 28 weeks of pregnancy using a glucose challenge test. If the one-hour glucose screening test is normal, gestational diabetes is not present. If the test is abnormal (elevated), patients will need to do a three-hour glucose test: Blood sugar levels are evaluated at fasting, one hour, two hours and three hours after the sugar solution is consumed. The results of this test will determine whether the patient is diagnosed with gestational diabetes. In some cases, gestational diabetes can be diagnosed after the one-hour test if it is markedly elevated.
Anyone with risk factors for gestational diabetes should talk to their doctor about an additional early glucose test during the first trimester. Diagnosing gestational diabetes as soon as possible in pregnancies at high risk is beneficial for managing the condition early to improve outcomes for the mother and the baby.
What Should I Do If I Have Been Diagnosed With Gestational Diabetes?
First, do not panic. You are right to be concerned about your health and the health of your baby, but there are ways to control this condition to help ensure a healthy pregnancy. Here are some tips:
1. Get regular exercise. Aim for 150 minutes of moderate-intensity exercise per week. Exercise helps keep blood sugar levels in a healthy range. It is helpful to walk 10 to 15 minutes after each meal to help metabolize sugars.
2. Watch what you eat. Be sure to eat regular meals throughout the day – you are pregnant! Try to focus on healthy foods, such as complex carbohydrates, selected fruits, vegetables, fiber, lean protein and healthy grains. Balance is important: Aim for 30% to 40% complex carbohydrates, 20% protein and 30% to 40% healthy fats. Pregnant patients with gestational diabetes may benefit from consultation with a nutritionist.
3. Learn how to check your blood sugar levels. Monitoring your levels is important to make sure your medication and lifestyle changes are working.
4. Some patients require medication to manage their gestational diabetes. Insulin is the recommended treatment when medication is needed. This is a prescription medication, usually prescribed and managed by an OB-GYN, endocrinologist or maternal-fetal medicine doctor. It is common to require adjustments in insulin dose as the pregnancy progresses.
How Could Gestational Diabetes Affect My Baby?
Babies born to moms with gestational diabetes may develop health problems. They may be born large or prematurely. Some babies may have birth trauma because of increased fat tissue, including shoulder dystocia (shoulder gets stuck) and/or broken bones or damaged nerves, as well as compromised oxygen supply to the brain. They may have breathing problems at birth, low blood sugar levels, jaundice (yellowing of the skin) and low levels of calcium and magnesium. These babies may be at higher risk for developing type 2 diabetes in the future, and they may be at increased risk of becoming overweight or obese.
In rare cases, gestational diabetes can lead to stillbirth.
How Could Gestational Diabetes Affect My Health?
Having gestational diabetes during pregnancy can increase the risk of requiring a cesarean section. Patients with gestational diabetes also are at increased risk of preeclampsia, which is high blood pressure after 20 weeks of pregnancy. Preeclampsia can lead to other future complications, such as heart attack or stroke. Women with gestational diabetes also are at increased risk of developing type 2 diabetes in the future.
How Could Gestational Diabetes Affect My Prenatal Care and Delivery?
Women with poorly controlled gestational diabetes are at higher risk for stillbirth. Additional monitoring, including nonstress tests that check the baby’s heart rate and movement, are recommended, typically starting at 32 weeks of pregnancy. These tests are performed once or twice weekly, depending on the level of control of blood sugars and other risk factors.
An ultrasound is often done during the third trimester to find out an estimated fetal weight of the baby. (A cesarean delivery may be recommended if the fetal weight is too high.) We know that babies of mothers with poorly controlled diabetes may have more fat tissue, which could increase the risk of birth trauma.
The timing of delivery depends on how well blood sugars are managed and whether medication is used to manage blood sugars. Our goal is for moms to have a healthy baby, as close to full term as possible.
Is There Any Special Testing or Treatment I Should Do After Gestational Diabetes?
All women with gestational diabetes should complete a glucose challenge test between four and 12 weeks postpartum. This test will help identify who is at higher risk of developing diabetes after pregnancy.
A follow-up examination with a primary care physician is recommended. The doctor will monitor patients for diabetes and heart disease. Anyone diagnosed with diabetes postpartum should work to manage the condition before becoming pregnant again.
Maintaining a healthy lifestyle before and during pregnancy can help reduce the risk of gestational diabetes, and managing your blood sugar levels if you have gestational diabetes is vital to ensuring a healthy pregnancy.
If you have concerns about gestational diabetes, reach out to your OB-GYN, and if you had gestational diabetes in a previous pregnancy, keep in touch with your medical team for monitoring.
Jessica Bullard, MD, is a board-certified OB-GYN with the Mid-Atlantic Permanente Medical Group. She sees patients at the Kaiser Permanente Manasses Medical Center.
