Gestational Diabetes During Pregnancy
Has your doctor diagnosed you with gestational diabetes (GD or GDM), a form of diabetes that appears only during pregnancy? While it might feel overwhelming at first, it turns out that this pregnancy complication is much more common than you might think. In fact, up to 9.2 percent of pregnant women have GD, according to a 2014 analysis by the Centers for Disease Control and Prevention (CDC). Know that with careful monitoring and treatment, it can be managed, and you can have a safe and healthy pregnancy.
WHAT CAUSES GESTATIONAL DIABETES?
Gestational diabetes usually starts between week 24 and week 28 of pregnancy when hormones from the placenta block insulin — a hormone produced by the pancreas that regulates the body’s metabolism of fats and carbs and helps the body turn sugar into energy — from doing its job and prevent the body from regulating the increased blood sugar of pregnancy effectively. This causes hyperglycemia (or high levels of sugar in the blood), which can damage the nerves, blood vessels and organs in your body.
WHO’S MOST AT RISK FOR GESTATIONAL DIABETES?
While researchers aren’t certain why some women get gestational diabetes while others don’t, they do know that you may be at an increased risk if:
- You are overweight. Having a BMI of 30 or more going into pregnancy is one of the most common risk factors for gestational diabetes because the extra weight affects insulin’s ability to properly keep blood sugar levels in check.
- You have a higher level of abdominal fat. Recent research published in the American Diabetes Association’s journal Diabetes Care found that women who had higher levels of tummy fat in the first trimester of pregnancy may be more likely to be diagnosed with gestational diabetes later.
- You are older. Doctors have noted that women over the age of 35 have a significantly higher risk of developing GD.
- You have a family history. If diabetes runs in the family, you may be more at risk of GD. Women who are African-American, Hispanic, Asian or Native American are also statistically more likely to receive a GD diagnosis.
- You have a personal history of GD. If you had gestational diabetes during a previous pregnancy, research suggests you’re more likely to have it again in a subsequent pregnancy.
- You received a pre-diabetes diagnosis. If your blood sugar levels are slightly elevated before pregnancy, you may be at higher risk of GD.
- You have been put on bed rest. Some research has shown that because you’re inactive on bed rest, you’re more likely to put on more pregnancy weight and, therefore, more likely to develop GD.
WHAT ARE THE SYMPTOMS OF GESTATIONAL DIABETES?
Most women with have gestational diabetes have no symptoms, though a few may experience:
- Unusual thirst.
- Frequent urination in large amounts (distinguished from the also frequent but usually light urination of early pregnancy).
- Fatigue (which may be difficult to differentiate from normal pregnancy fatigue).
- Sugar in the urine (detected during a routine practitioner visit).
HOW IS GESTATIONAL DIABETES DIAGNOSED?
You’ve probably noticed by now that your doctor asks for a urine sample at every office visit. That’s in part to check for sugar in your urine, which can be a sign of gestational diabetes (though one positive screening doesn’t necessarily mean you have GD).
In addition, the U.S. government now recommends that all pregnant women be screened specifically for gestational diabetes. Around week 28 of pregnancy, your practitioner will give you a glucose screening test, where you’ll drink a sugary liquid and have your blood drawn an hour later. If your bloodwork picks up high sugar levels, your doctor will have you take a three-hour glucose tolerance test to determine whether you have gestational diabetes.
HOW DOES GESTATIONAL DIABETES AFFECT ME AND MY BABY?
With proper treatment and regular monitoring by your practitioner, gestational diabetes can be managed and is not harmful to either you or your baby. But if excessive sugar is allowed to circulate in a mother’s blood and then enter the fetal circulation through the placenta, the potential problems for both mother and baby are serious. Women who have uncontrolled GD are at risk for having a too-large baby (a condition called macrosomia), making delivery more difficult and C-section more likely. They are also at risk for pre-eclampsia and stillbirth. And because gestational diabetes is considered a pregnancy complication, pregnant women who have it may be more likely to be induced since most doctors won’t let their pregnancies progress past their due dates.
Uncontrolled diabetes could also lead to potential problems for the baby after birth, such as jaundice, breathing difficulties and low blood sugar levels. Later in life, he or she may be at an increased risk for obesity and type 2 diabetes. But it’s important to remember: These potential negative effects don’t apply to moms who get the help they need to keep their blood sugar under control.
WHAT YOU CAN DO TO PREVENT GESTATIONAL DIABETES?
If your only risk factors for gestational diabetes are a family history of the disease and/or advanced maternal age, there may be nothing more you can do to prevent your chances of developing the condition. But if you’re overweight, don’t eat a well-balanced diet or don’t routinely exercise, adopting a few healthy habits can make a big difference. And with enough repetition, they’ll eventually require less conscious effort to maintain. The following steps can have a big impact on reducing your risk of developing both gestational diabetes and type 2 diabetes, both before you conceive and during your pregnancy:
- Stay active. Working out under the guidance of your practitioner — even starting with just a 15-minute walk after lunch and dinner — allows your body to burn glucose even without the insulin your body should normally produce. It’s a great way to keep your blood sugars in check, and you’ll probably love the way you feel once you get motivated to move.
- Eat a healthy diet. Making changes to your diet now not only protects you and your baby during pregnancy, it also helps you to develop better eating habits for life. Consume a well-balanced diet loaded with a variety of fruits and vegetables; lean, healthy protein; and complex carbs. Also, aim to limit your fat intake to 30 percent of your total daily calories, and try to avoid sugary, processed foods. Think high-fibre, low-fat options (whole grains, low-fat dairy, meat, legumes and fish), and watch your portions.
- Keep an eye on the scale. With the help of your practitioner, try to maintain a normal weight and BMI: That means aim to gain the right amount of weight during pregnancy and lose the extra pounds after.
HOW IS GESTATIONAL DIABETES TREATED?
Fortunately, virtually all of the potential risks associated with diabetes in pregnancy can be eliminated by carefully controlling your blood sugar levels. If you’re diagnosed with GD, doctors and researchers recommend the following:
- Monitor your blood sugar level several times a day. Check first thing in the morning to get your fasting rate and then an hour after you eat each meal to make sure your blood sugar stays in a healthy range (suggested by your doctor). Most doctors suggest that you buy a diabetes kit, which includes needles to prick your finger and a little machine that reads your blood sugar. Don’t worry, the finger prick doesn’t hurt, and it’s the most accurate way to tell how your body is processing various foods. It’s empowering when you make healthy food choices and your blood sugar reading is good — you’re taking an active role in your own health (and, of course, your child’s).
- Meet with a dietitian. She can help you review healthy food options and make a meal plan. Many women stick to their “gestational diabetes” diet of well-balanced meals long after birth.
- Keep a food log. After each meal, write down everything you ate along with your blood glucose number. This helps you to better understand what foods are spiking your glucose levels so you can avoid them.
- Get moving. Go for a walk or take the stairs after a meal to lower your glucose levels.
Diet and exercise are often enough to control gestational diabetes — but if they don’t, your doctor may suggest that you take supplementary insulin to control it. It can be given in shots, though the oral drug glyburide (a diabetes medication that helps the pancreas produce insulin) is being prescribed more and more often for GD.
Your doctor may suggest additional fetal monitoring in your third trimester, including nonstress tests, to make sure your baby’s heart rate and movements are normal.
WHAT HAPPENS TO YOU AFTER PREGNANCY?
Research has shown that women with gestational diabetes have a 50 percent chance of developing type 2 diabetes — which is why it’s so important to make those healthy habits routine during pregnancy and keep a check on your health even after your pregnancy is over. Here are a few ways to stay healthy post-birth:
- Keep up with doctor visits. Make sure your primary care physician and/or OB-GYN reevaluate you after your postpartum visit — at six weeks and then again every year — to check for continued problems with glucose and HgbA1C (glycated haemoglobin) levels.
- Talk to a nutritionist. She’ll help you to develop a diet you can maintain that will help to control your glucose levels.
- Continue to aim to eat healthy every day. Try to avoid sugars and refined carbohydrates that spike your blood sugar and can contribute to the development of type 2 diabetes. Remember, sugar and simple carbs are everywhere — so make sure to read labels carefully (a nutritionist can help you to understand key ingredients to watch out for). Instead, opt for unprocessed foods like vegetables, low-fat meats, dairy and whole grains.
- Breastfeed for as long as possible. Breastfeeding has been found to decrease your risk of developing type 2 diabetes after GD. That’s because breastfeeding improves glucose metabolism and insulin sensitivity, cutting the risk of developing diabetes down the road by half — and the longer you breastfeed, the lower your risk becomes.
- Fit in fitness. Although it’s hard to stay active with a baby who requires all of your attention (and more!), tries to fit in as much doctor-approved exercise as possible to help you lose the pregnancy pounds and keep your weight in check.
WHAT HAPPENS TO YOUR BABY AFTER BIRTH?
Babies who are born to mothers with gestational diabetes should be tested for low blood sugar (hypoglycemia), even if they have no symptoms, with a simple blood test after birth. This happens immediately after delivery, while you and baby are still in the hospital.
After birth, it’s essential to keep the focus you had during pregnancy on a healthy lifestyle for your whole family — you may find that it helps you stick to your resolutions as well. Teach your child good eating and exercise habits early on: A recent study showed that children born to women with gestational diabetes were six times more likely to develop either diabetes or pre-diabetes compared to those kids born to moms who did not have this condition. To help avoid a type 2 diabetes diagnosis for your child, aim to ensure that he:
- Eats nutritious meals both as a baby and when he gets older.
- Gets plenty of exercises as he grows.
- Maintains a healthy weight.