Managing Pregnancy and Gestational Diabetes
You're in your 24th to 28th week of pregnancy, and your doctor wants to test you for diabetes. If you feel fine, you may wonder why he or she ordered the test. About 5 percent of all pregnant women who did not have diabetes before becoming pregnant will develop persistent high blood sugar while they're expecting, according to the National Institute of Child Health and Human Development (NICHD). This is known as gestational diabetes, and you can have it without having obvious symptoms.
Gestational diabetes can be controlled. But you need to take the disease seriously. Left untreated, gestational diabetes can harm your baby and lead to problems during childbirth.
Hormonal changes and weight gain are part of a normal pregnancy. For at least three out of every 100 pregnant women, these changes cause a rise in blood sugar, resulting in gestational diabetes.
What is gestational diabetes?
Diabetes is a condition in which there is a problem with the way your body makes or uses insulin. Insulin is the hormone that enables your body's cells to use glucose, or blood sugar, for energy. In gestational diabetes, the placenta that nourishes the baby produces hormones that can block the body's ability to use insulin, a condition called insulin resistance. To make up for this, the body needs to produce more insulin. Sometimes a woman's body just can't make enough. So, the glucose level in her blood stays high, and she develops gestational diabetes, the NICHD says.
Gestational diabetes usually develops later in pregnancy, when the baby's body weight is increasing and after the baby's organ systems have been formed. For most women, gestational diabetes goes away after the pregnancy ends, but the risk for developing it with future pregnancies is higher. Occasionally, a pregnancy will uncover pre-existing type 1 or type 2 diabetes, which will continue after the pregnancy.
Address Your Risk
You have a high risk of developing gestational diabetes during pregnancy if two or more of the following are true:
- You had gestational diabetes during a previous pregnancy.
- You had a very large baby or a stillbirth with a previous pregnancy.
- A past test showed you had abnormal blood-sugar levels.
- You are overweight.
- You are African-American, Hispanic, Native American, or Pacific Islander.
- You are 26 years old or older.
- You have a family history of diabetes.
- You have pre-diabetes
It is standard for every pregnant woman to be tested for gestational diabetes, regardless of risk factors or family history. The most common test used in the United States is to drink a sugary liquid and get a blood test one hour later. If this shows a high level, a second, confirmatory test is done.
Health effects
Gestational diabetes does not cause birth defects. Most women with gestational diabetes have healthy, full-term babies. If gestational diabetes is not adequately treated, the extra blood glucose in the mother's blood crosses the placenta, raising the baby's blood sugar. The baby's body makes extra insulin to store the extra blood sugar as fat.
The infants of mothers with uncontrolled gestational diabetes usually are heavier, sometimes more than 9 pounds. These large babies can make delivery more difficult, with possible birth trauma or the need for cesarean section. In addition, the extra insulin in the baby's body can cause very low blood glucose levels at birth. These babies also have higher risk for breathing problems.
Keeping your weight gain at the level recommended by your health care provider and keeping your blood glucose under control during pregnancy will help you have a normal weight baby. Larger babies are more likely to be obese during childhood and develop type 2 diabetes later on, the NICHD says.
Women with gestational diabetes are more likely to have high blood pressure problems, such as preeclampsia, which can increase the chance of premature birth.
If you have had gestational diabetes, you are more likely to develop type 2 diabetes later in life, especially if you were obese before getting pregnant, according to the FDA.
What are the possible complications for the baby?
The complications of gestational diabetes are usually manageable and preventable. The key to prevention is careful control of blood sugar levels just as soon as the diagnosis of gestational diabetes is made.
Infants of mothers with gestational diabetes are vulnerable to several chemical imbalances, such as low blood calcium and low blood magnesium levels, but, in general, there are two major problems of gestational diabetes:
- Macrosomia refers to a baby that is considerably larger than normal. All of the nutrients the fetus receives come directly from the mother's blood. If the maternal blood has too much glucose, the pancreas of the fetus senses the high glucose levels and produces more insulin in an attempt to use this glucose. The fetus converts the extra glucose to fat. Even when the mother has gestational diabetes, the fetus is able to produce all the insulin it needs. The combination of high blood glucose levels from the mother and high insulin levels in the fetus results in large deposits of fat, which causes the fetus to grow excessively large. This results in a higher risk of forcep delivery, birth trauma, and cesarean section.
- Hypoglycemia refers to low blood sugar in the baby immediately after delivery. This problem occurs if the mother's blood sugar levels have been consistently high, causing the fetus to have a high level of insulin in its circulation. After delivery, the baby continues to have a high insulin level, but it no longer has the high level of sugar from its mother, resulting in the newborn's blood sugar level becoming very low. The baby's blood sugar level is checked after birth, and if the level is too low, it may be necessary to give the baby glucose intravenously.
You should have a diabetes test six weeks after giving birth. Women who have had gestational diabetes may have an increased risk of developing adult-onset type 2 diabetes.
Prevention and management
Although you can't change your family history or age, before you become pregnant, you should try to maintain a body mass index (BMI) in the normal range — 25 kg/m² or less. Once you are pregnant, getting adequate physical activity and increasing your weight only as much as your doctor recommends can help keep blood glucose levels normal and prevent a large newborn.
Talk with your doctor before starting an exercise program or a diet during pregnancy. If you're diagnosed with gestational diabetes, work with your doctor to control your blood glucose by following the meal and exercise plan he or she recommends. If these two things don't help, your doctor may prescribe regular insulin injections to help protect your health and your child's.
How is gestational diabetes treated?
Treatment for gestational diabetes focuses on keeping blood glucose levels in the normal range through some or all of the following methods:
- Exercising, such as walking or swimming
- Daily blood glucose monitoring
- Insulin injections
- Following a special diet with the help of your doctor to include foods like fruit, vegetables, and whole-grain crackers, cereal, and bread.
- Prescribed medications
Left untreated, gestational diabetes can cause problems for you and your baby. You run the risk of developing high blood pressure during pregnancy. Those with gestational diabetes have an increased risk of developing type 2 diabetes later in life.
Fortunately, treating gestational diabetes can help prevent these problems. Many women with gestational diabetes can keep their blood sugar under control by adopting healthy eating and exercise patterns:
- Know that what you eat, how much you eat, and how often you eat all affect blood-sugar levels.
- Eat three small meals and one to three snacks a day.
- Choose smaller portions of healthy foods, such as fruits, vegetables, whole grains, and low-fat dairy products.
- Limit sweets.
- Control blood sugar by walking or swimming.
- Try to be active with moderate-intensity activity for 30 minutes or more, at least five days a week.