During pregnancy the body goes through many changes and requires more insulin, which helps with control of blood sugar levels. Such changes sometimes leave a woman vulnerable to developing gestational diabetes — a type of…
During pregnancy the body goes through many changes and requires more insulin, which helps with control of blood sugar levels. Such changes sometimes leave a woman vulnerable to developing gestational diabetes — a type of the disease that occurs only during pregnancy.
Screening for gestational diabetes — where commonly there aren’t any obvious signs or symptoms of the condition — is routinely done between 24 and 28 weeks of pregnancy. But some women who are at higher risk may be tested for preexisting diabetes at the first prenatal visit.
According to the National Institute of Diabetes and Digestive and Kidney Diseases, the chance of developing gestational diabetes is increased for those who:
The timing of gestational diabetes screening has to do with when gestational diabetes can first be detected, says Dr. Adam Borgida, a maternal-fetal medicine specialist and chief of obstetrics and gynecology at Hartford Hospital in Connecticut. It’s also a critical window to intervene and reduce complications during the pregnancy, including having a larger baby, which can raise risk to mom and the child during delivery, as well as issues like preeclampsia, or high blood pressure during pregnancy.
“It’s just before the most fetal growth is occurring,” says Borgida, a professor of obstetrics and gynecology at the UConn School of Medicine. “So you can have a better impact on preventing some the adverse outcomes of gestational diabetes if it isn’t controlled.”
Typically routine screening for gestational diabetes in the U.S. involves taking one or two (the second as needed) screening tests.
The first is what’s called the glucose challenge test. You don’t need to fast for this test. You’ll drink a sweet liquid with glucose in it, and your blood will be drawn one hour later to test your blood-glucose levels. If that’s 140 or higher, you’ll likely be asked to return for a second test: the oral glucose tolerance test. However, if it’s especially high — 200 or more, you may have Type 2 diabetes, NIDDK notes. And if your reading is above 190, you may be diagnosed with gestational diabetes without undergoing further testing.
For those who need to come back for the glucose tolerance test, this requires fasting for at least eight hours. A blood-glucose measure is taken before drinking more sugary liquid, then typically blood is drawn again to check blood-sugar levels at one, two and three hours thereafter.
If two or more of the readings show you have high blood glucose levels, you’ll be diagnosed with gestational diabetes.
What to Do If You Have Gestational Diabetes
A diagnosis of gestational diabetes — while already dealing with all the changes pregnancy brings — can be overwhelming initially. Fortunately, clinicians say, there are steps that can be taken to properly manage the disease and lower risk for gestational diabetes complications.
As with those diagnosed with preexisting diabetes, the goal is the same for women found to have gestational diabetes, Bordiga says; that involves doing what’s necessary to keep blood-sugar levels optimal. “We’re looking for very good glucose-control,” he says.
To achieve that and properly manage gestational diabetes, you should take these steps:
— Lower your carb intake.
— Be active.
— Monitor your weight.
— Take insulin — or medication — if necessary.
Lower your carb intake.
This is probably the most important measure to take when you have gestational diabetes. Carbs convert to sugars, which make your blood sugar surge. You’ll want to work closely with a registered dietitian nutritionist or another clinician who has training and expertise in developing a meal plan specifically for gestational diabetes. It’s not about cutting out all carbs, but instead taking a measured approach to moderate consumption and spread them across your day, while also checking blood sugar levels as directed.
“A lot of women of child-bearing age have never received nutritional or lifestyle counseling, because they’re generally healthy, and the gestational diabetes is often the first condition they’ve ever had,” says Dr. Ellen Seely, director of the clinical research, endocrinology, diabetes and hypertension division at Brigham and Women’s Hospital in Boston, and professor of medicine at Harvard Medical School. “So we can’t take for granted that people know what to do to have a healthy lifestyle.”
Take a sensible approach to managing gestational diabetes. Rather than drastically cutting calories or other components of your diet, follow a sustainable plan. Among other things, that favors eating cruciferous veggies like broccoli and leafy greens and choice proteins like fish and eggs, along with healthy fats.
While it’s worth talking to your doctor about what exercises are — and aren’t — a good fit for you during pregnancy, you’re usually safe to break a sweat. The American Congress of Obstetricians and Gynecologists recommends exercising 30 minutes a day, and strength training two or three times a week. And low-impact exercise like walking can improve blood-sugar control.
What you should gain during pregnancy varies depending on your weight pre-pregnancy. The Institute of Medicine recommends women at a normal, healthy weight gain 25 to 35 pounds in pregnancy, while women who are overweight (25 to 29.9 body mass index) should gain 15 to 25 pounds and women who are obese (30 and greater BMI) gain 11 to 20 pounds.
Take insulin if necessary.
Women with gestational diabetes need to monitor their glucose levels continuously, and if diet and exercise don’t control those levels well enough, they’ll have to take insulin. Based on the latest data, insulin injections are a first line medical therapy to help control blood sugar, notes Dr. Leo Brancazio, chair of the department of obstetrics and gynecology at West Virginia University School of Medicine.
As an alternative, medication is sometimes recommended, though insulin is typically the first choice. “Usually nowadays if the patient can’t take insulin or refuses to give herself injections, we have them try the metformin,” Brancazio says.
After the Delivery
Fortunately, research finds that with close monitoring and taking steps to manage gestational diabetes, women who have gestational diabetes can have a safe, healthy pregnancy.
Still, additional follow-up is recommended after delivery. That includes having blood sugar checked again at the post-partum visit, experts say.
Some women have pre-existing diabetes going into the pregnancy and didn’t know it. “We don’t know exactly how many, because it depends what screening criteria you use — but there’s going to be some women who actually have Type 2 diabetes, and even Type 1 diabetes, that is only picked up during pregnancy,” Seely points out.
What’s more, for the majority of women who had gestational diabetes and will have normal blood sugar after pregnancy, it’s still a critical time to think about extending lifestyle changes forward into that future.
About 50 percent of women who have gestational diabetes will actually go on to develop Type 2 diabetes, according to the Centers for Disease Control and Prevention. But the agency notes there things you can do to prevent that. That includes losing weight, as needed, and continuing with healthy lifestyle improvements which, research shows, can prevent or delay the onset of Type 2 diabetes for a woman who had gestational diabetes.