During pregnancy, some women face issues with higher than normal blood sugar that could put mother and child at risk. Specifically, 2% to 10% of pregnancies, according to the Centers for Disease Control and Prevention, are affected by gestational diabetes — a type of diabetes that develops during pregnancy.
What’s Gestational Diabetes?
During pregnancy, the body makes special hormones and undergoes other changes, like weight gain, that affect cells’ ability to use insulin and contribute to insulin resistance. And while all pregnant women have some insulin resistance during late pregnancy, most can produce enough insulin to overcome insulin resistance. But some cannot. These women develop gestational diabetes, which is typically determined through routine screening done at 24 to 28 weeks gestation.
[See: Best Hospitals for Maternity Care.]
What Causes Gestational Diabetes?
The condition occurs when the body isn’t able to make enough of the hormone insulin — which helps regulate blood sugar. Changes during pregnancy, such as an increase in hormone production and weight gain, can cause insulin resistance, leading the body’s cells to use insulin less effectively. More insulin is needed as a result.
The reasons some women develop gestational diabetes aren’t fully understood, but there do appear to be some factors that can increase your risk for developing the condition.
Risk factors:
— Being overweight.
— Family history of Type 2 diabetes.
— Previous pregnancy with a diagnosis of gestational diabetes.
— Gave birth to a baby weighing over 9 pounds.
— Are more than 25 years old.
— Have a hormone disorder called polycystic ovary syndrome (PCOS).
— Are an African American, Hispanic or Latino, American Indian, Alaska Native, Native Hawaiian or Pacific Islander person.
Weight is often a factor, although experts are finding that many of the cases are due to pre-existing above target blood sugar levels. With the rise in obesity in women of reproductive age, they may be entering the pregnancy withType 2 diabetes.
Women who have a body mass index, or BMI, above 30 — which is considered obese — are more likely to develop gestational diabetes, says Dr. Athena Philis-Tsimikas, corporate vice president of Scripps Whittier Diabetes Institute in San Diego. Experts advise taking steps starting when trying to become pregnant to reach a healthy body weight, or to lose weight as needed.
Race or ethnicity is another risk factor for gestational diabetes.
“We know the Hispanic population (and) African-American and Asian-American (women) have higher risk and can go on to develop it even at somewhat leaner BMIs,” Philis-Tsimikas says.
A family history of Type 2 diabetes can also raise the risk for having diabetes while pregnant.
“There’s a lot of different factors that play into it — your genetic predisposition, your weight at the time of conception, your age,” as well as if a woman is expecting multiples (twins or more),” says Dr. Margarita DeVeciana Haugh, a former professor of obstetrics and gynecology at Eastern Virginia Medical School in Norfolk and a high-risk maternal fetal medicine physician. “All those things kind of work together to determine a woman’s risk when she gets pregnant that she’s going to develop glucose intolerance during her pregnancy.”
Generally speaking, women who’ve had a previous pregnancy with gestational diabetes are very likely to develop it again, says Philis-Tsimikas, especially those who are overweight. However, even women who aren’t overweight or don’t have other clear-cut risk factors can develop gestational diabetes, and experts say there’s no perfect way to assess risk.
Symptoms of Gestational Diabetes
It’s common for there to be no overt signs of gestational diabetes. If you do have symptoms, they may be mild, such as:
1. Being thirstier than normal.
2. Requiring to urinate more often.
3. Being more tired than usual or feel extra-tired after eating.
“Women that are spiking blood sugars after they eat carbohydrate-laden meals are more likely to come crashing down two or three hours after they’ve had a meal and feel extremely tired, sluggish, gain weight faster,” says DeVeciana Haugh. But it’s hard to distinguish those symptoms from other normal changes during pregnancy.
The same goes with the tendency for those with gestational diabetes to have to urinate more frequently — as is the case for others who may be developing Type 2 diabetes. “That’s one of the classic symptoms — polyuria, where a person will pee more,” DeVeciana Haugh says. “But a lot of pregnant women will tell you, ‘Well, I pee all the time anyway.'”
It’s typically the case that women don’t experience any gestational diabetes symptoms. With other types of diabetes, there are obvious symptoms, like you’re thirsty or you have to pee a lot, says Dr. Kelli Culpepper, an OB-GYN in private practice in Dallas who is affiliated with Medical City Dallas Hospital. “Those things don’t happen in gestational diabetes,” she says. The lack of outward signs characteristic of GDM is all the more reason experts emphasize the importance of routine screening.
How Gestational Diabetes Is Diagnosed
Because even assessing known risk factors for gestational diabetes misses many who go on to develop it, screening is now essentially universal. Gestational diabetes typically develops around 24 weeks gestation, so you can expect to be tested between the 24th and 28th week of pregnancy.
“Virtually everyone is screened unless you have no risk factors for gestational diabetes, and virtually everyone in the United States has some risk factors for diabetes,” 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.
Those who are at higher risk, based on a family history of diabetes or other factors, may be advised to get tested earlier, during the first visit after becoming pregnant.
There’s ongoing debate over the best approach to testing: Some experts say performing a single gestational diabetes test is the best way to check for the condition. Most providers in the U.S. currently use a two-test system, which is endorsed by the American College of Obstetricians and Gynecologists.
Typically, screening for gestational diabetes involves taking a glucose challenge (or glucose screening) test, which involves drinking a liquid with glucose, then having blood drawn an hour later to check one’s blood sugar level. You won’t need to fast before undergoing this test.
If it’s higher than normal (or exceeding 140 milligrams per deciliter), a follow-up glucose tolerance test that requires fasting for at least eight hours is commonly advised. But a particularly high blood glucose level, above 190 mg/dL, can lead to a gestational diabetes diagnosis without the need for further testing; while those with a blood glucose level of 200 or more may have Type 2 diabetes. The glucose tolerance test involves doing a blood test to check blood sugar before and then multiple times after drinking a sugar-rich solution. It’s typically a three-hour test. Based on blood-glucose levels (which may vary based on the amount of glucose consumed), a clinician will determine if a patient has GDM.
“It’s a pretty intense process,” says Dr. Elaine Duryea, an assistant professor of maternal-fetal medicine at UT Southwestern Medical Center in Dallas and the medical director of the Maternal-Fetal Medicine Clinic at Parkland Health and Hospital System. “With that test, if she has two or more abnormal values, we diagnose her with gestational diabetes.”
Once a diagnosis is made, the next steps, are to determine how best to manage gestational diabetes. That’s critical to reduce the risk of complications associated with the disease for mother and child.
[READ: Exercising During Pregnancy]
Treatment of Gestational Diabetes
A healthy pregnancy is always the goal — and it’s certainly not out of reach for a woman diagnosed with gestational diabetes.
Eating well, exercising and maintaining a healthy weight can all lower a woman’s risk of developing gestational diabetes — and the impact and importance of doing so goes beyond prevention.
Diet and physical activity
“Any lifestyle modification that improves a woman’s health prior to pregnancy is going to lessen her risk for developing diabetes when she gets pregnant — or if she does get diabetes, improve her chances of being able to control it with just diet and exercise, rather than have to take a medication for it,” DeVeciana Haugh says.
In fact, for many women with gestational diabetes, lifestyle changes alone are sufficient to manage blood sugar.
“We upfront focus on lifestyle management — so that is working on dietary intake and increased activity,” says Tracie L. Jackson, a registered dietitian and Diabetes Program Coordinator at Children’s Hospital and Medical Center in Omaha. “From the diet standpoint, it mainly focuses on more moderate amounts of carbohydrates evenly spread throughout the day over the course of three meals and snacks, kind of as needed.”
Diet is a central component of managing GDM. A healthy eating plan not only involves keeping careful tabs on what portion of one’s diet is carbs, protein and fat, but also the timing of meals and snacks is a critical part of the eating plan for someone diagnosed with GDM. While specialists who regularly treat patients with diabetes, namely endocrinologists, advise on appropriate diet, experts also extol the benefits of consulting with a registered dietitian to develop a game plan.
However, it’s not drastically cutting carbs, which are a crucial energy source.
“This isn’t a time to go on a crash diet. It’s not time to over-restrict. It’s time to focus on healthy nutrition for pregnancy,” Jackson emphasizes. “Choices for carbohydrates include more of your whole fruits, whole grains and low-fat dairy. So it’s not just don’t eat any carbohydrate. Consider the quantity that you’re eating, and choose carbohydrates from foods that are going to give you the nutrients you need to build a healthy baby.”
At the same time, “pregnancy is not a free-for-all,” says Culpepper. In terms of what one eats, that amounts to just adding about 300 to 400 extra calories a day, she says.
It’s important to work closely with your health care team to develop a gestational diabetes management strategy tailored to you — and stick to it to lessen related risks for you and your baby.
Culpepper adds that the importance of physical activity during pregnancy is frequently overlooked. “It’s OK to be active when you’re pregnant,” she says.
Checking blood sugar
Your diabetes educator will work with you to check your blood sugar throughout the day, usually with a finger stick in the morning and after meals. A flash glucose monitor (diabetes patches) are available to continuously monitor blood sugar levels, as an alternative to frequently pricking a finger to draw blood. It’s a small patch sensor that you put on your arm.
“It does have a tiny needle that goes just under the skin — then you don’t have to prick your finger for blood sugars, you just swipe a sensor in front of it,” Philis-Tsimikas explains. It stays on for 10 days, before you replace it with another patch sensor.
Whatever approach you take, clinicians remind us that there are plenty of reasons to properly control GDM. When it’s not well-managed, along with an increased likelihood of developing pre-eclampsia, women have a greater chance of delivering a bigger baby, which can increase the risk for childbirth-related injury to mother and child.
Medication
In some cases, patients may require insulin injections, if lifestyle changes alone aren’t enough to bring down blood sugar levels. (Medications like metformin are sometimes prescribed, as an alternative to insulin, though research supports insulin as the first choice.)
Health Care Providers That Treat Gestational Diabetes
Potential Complications of Gestational Diabetes
Gestational diabetes can raise the risk for a number of complications, particularly if it’s not treated or managed properly.
Those complications include:
— Having a big baby.
— Shoulder dystocia, when the baby gets stuck during vaginal delivery.
— High blood pressure during pregnancy.
— Increased chance of C-section.
— Preterm labor, or premature birth.
— Respiratory distress syndrome.
— Stillbirth.
— Hypoglycemia, or low blood sugar.
Having a big baby
Also called fetal macrosomia — which describes a baby who weighs more than 8 pounds, 13 ounces at birth — this can result in difficulties for the mother and child, including childbirth injuries.
“Too much glucose in mom leads to too much glucose in the baby and we have what we call fetal overgrowth, or macrosomia — lots of fancy words for just a very large baby that does not lead to a vaginal delivery,” Duryea says.
Where some vaginal tearing commonly occurs with vaginal birth, for instance, delivering a larger baby is often more difficult. In the most serious cases, fourth-degree vaginal tears, the most severe type, can occur.
Shoulder dystocia
Higher levels of sugar in the blood cross the placenta, which provides nutrients, to the baby. But as a result of untreated or uncontrolled gestational diabetes, babies don’t just get bigger. They gain mass in certain areas like through the trunk and shoulders, Leiva says, which can complicate vaginal birth. That increases the risk for shoulder dystocia, where the shoulders are too big to fit in the birth canal.
This can be especially dangerous and requires a baby be delivered quickly — within a few short minutes of becoming stuck — to avoid permanent brain injury due to lack of oxygen.
High blood pressure during pregnancy
Gestational diabetes is associated with a higher risk for maternal high blood pressure during pregnancy, or preeclampsia. Studies show that women who have insulin resistance or gestational diabetes are also at risk of having preeclampsia.
Increased chance of C-section
Both having a larger baby and gaining extra weight during pregnancy can increase the chances that a woman may have a cesarean delivery, or a C-section. And while surgery to deliver the child may be recommended over vaginal delivery in some cases, this carries risks ranging from infection to increased bleeding, or hemorrhage.
A healthy diet can lay a foundation for healthy maternal weight gain and fetal growth. It’s key to speak with a dietitian or another health professional who is knowledgeable about developing a diet plan that fits the individual patient after a diagnosis of gestational diabetes.
Together with being physically active, even just walking after meals, can help rein in blood glucose and aid in staying within recommended parameters for weight gain during pregnancy: That’s 25 to 35 pounds for someone at a normal, healthy weight, 15 to 25 for a woman who is overweight (25 to 29.9 body mass index) and 11 to 20 pounds if obese (30 or higher BMI), according to guidelines from the National Academy of Medicine.
Preterm labor
High blood sugar can cause a woman to go into labor early, which can raise the risk for the child to be born sooner than may have happened otherwise. In other cases, preterm labor occurs when a woman is induced by her doctor because the baby is bigger.
Being born prematurely or too early — before 37 weeks — can leave a child more vulnerable to health problems not only after their birth, but also throughout their lives. Some develop respiratory distress syndrome, which makes breathing difficult for the baby after delivery, and infections can be a problem for the child as well.
Respiratory distress syndrome
This is a condition which makes it difficult for the baby to breathe. It can happen in babies who are born early. However, even a baby born to a mother with gestational diabetes who doesn’t arrive early can experience respiratory distress syndrome.
Stillbirth
Diabetes of all types, including gestational diabetes, is linked with a higher incidence of pregnancy loss. That includes stillbirth, or fetal death in the third trimester, also called intrauterine fetal demise.
Other complications related to gestational diabetes — particularly that’s uncontrolled — range from hypoglycemia when the baby’s blood sugar is low — sometimes dangerously so — after birth, to hyperbilirubinemia. The latter occurs when there’s too much of a substance known as bilirubin, which is created when part of red blood cells break down. This can lead to jaundice, which makes the baby’s skin and whites of their eyes yellowish, and requires treatment.
Fortunately, by working closely with health professionals to properly manage gestational diabetes, a healthy pregnancy and safe delivery is not only possible but likely. That begins with patient education and means taking a regimented, collaborative approach to managing the condition.
Hypoglycemia, or low blood sugar
Some babies of mothers with gestational diabetes experience this shortly after birth. In severe cases, it can lead to seizures.
[READ Meal Plans for People With Diabetes]
Prevention of Type 2 Diabetes After Pregnancy
In addition to immediate complications, women with gestational diabetes and their babies may face long-term risks.
Will gestational diabetes go away?
Namely, about 50% of women who have gestational diabetes are at significantly higher risk for going on to develop Type 2 diabetes later. For that reason, it’s important to get blood sugar rechecked after giving birth. What’s more, clinicians stress the importance of lasting changes to reduce the future risk of developing Type 2 diabetes.
While that doesn’t mean you’ll need to regularly check blood sugar throughout the day as you did during pregnancy, experts stress that after the baby arrives it is key that women should continue to be vigilant about staying active and eating well. It’s also seen as an opportunity — though at an especially busy time in the life of a parent — to try to connect women with programs that may reduce Type 2 diabetes risk, like the Diabetes Prevention Program sponsored by NIDDK.
“If a woman has had diabetes during pregnancy, the recommendation from most organizations, including the American Diabetes Association, is that she adopt a healthy lifestyle to lose weight and be physically active,” Seely says. The goal is, by eating healthy and exercising, to get back to pre-pregnancy weight. “Then if they’re obese or overweight, just continue losing weight.”
Gestational diabetes in the mother also leads to a higher risk a child will go on to develop prediabetes — a precursor to Type 2 diabetes — according to research published in the journal Diabetes Care. The research focused on the incidence of what’s also referred to as impaired glucose tolerance, and found this in 10.6% of children ages 10 to 14 of mothers who had untreated gestational diabetes. “What we found is that impaired glucose tolerance is significantly more frequent in those whose mothers had gestational diabetes,” says Dr. Boyd E. Metzger, the study’s corresponding author and a professor emeritus of endocrinology at the Feinberg School of Medicine at Northwestern University in Chicago.
When to See a Doctor
If possible, before becoming pregnant, speak with your doctor and check if you are at risk for developing GDM.
Bottom Line
By working closely with health professionals to properly manage gestational diabetes, a healthy pregnancy and safe delivery is not only possible but likely. That begins with patient education and means taking a regimented, collaborative approach to managing the condition.
Besides being monitored during the pregnancy, anyone who’s had gestational diabetes should get blood sugar checked again after delivery at the postpartum visit to make sure it’s back to normal. In some cases, those thought to have had gestational diabetes actually had preexisting diabetes before pregnancy that had previously gone undetected.
Extending lifestyle changes into the future — beyond pregnancy — is critical, rather than just limiting that to when you have gestational diabetes.
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