Has your doctor diagnosed you with gestational diabetes (GDM)? While the diagnosis might feel overwhelming at first, it turns out this pregnancy complication is much more common than you might think — and the number of cases is growing. Know that with careful monitoring and treatment, it can be managed and you can have a safe and healthy pregnancy.
- What causes gestational diabetes?
- Who's most at risk?
- What are the symptoms?
- How is it diagnosed?
- What are the complications?
- How can you prevent gestational diabetes?
- How is it treated?
- What happens to mom and baby after birth?
GDM usually starts between week 24 and week 28 of pregnancy when the body does not produce enough insulin (the hormone that helps convert sugar into energy) to deal with the increased glucose, or sugar, that’s circulating in your blood to help your baby grow. One of the most common pregnancy complications, gestational diabetes affects one in 10 expectant women — and because it occurs more often among obese women, rates of GDM in the United States have been rising along with obesity rates. The good news: While the potential complications from untreated GDM are serious, the condition is easily managed — and as long as it’s diagnosed early and well controlled, it’s not harmful to you or your baby.
What causes gestational diabetes?
To understand what causes gestational diabetes, it helps to first understand what’s happening to your body during pregnancy. In some women, hormones from the placenta block insulin — a hormone produced in the pancreas that regulates the body's metabolism of fats and carbs and helps the body turn sugar into energy — from doing its job, resulting in high glucose levels. This causes hyperglycemia (or high levels of sugar in the blood), which can damage the nerves, blood vessels and organs in your body. While researchers are continuing to research GDM, the jury is still out on why some women get gestational diabetes while others don’t.
Who’s most at risk for gestational diabetes?
Research shows you’re also at an increased risk if you:
- Being 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.
- 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 abdominal fat in the first trimester of pregnancy may be more likely to be diagnosed with gestational diabetes later in pregnancy.
- Are older. Doctors have noted that women over the age of 35 have a significantly higher risk of developing GDM.
- Have a family history. If diabetes runs in the family, you may be more at risk of GDM. Women who are African-American, Hispanic, Asian or Native American are also statistically more likely to receive a GDM diagnosis.
- Have a personal history of GDM. If you had gestational diabetes in a previous pregnancy, research suggests you're more likely to have it again in a subsequent pregnancy.
- Received a pre-diabetes diagnosis. If your blood sugar levels are elevated slightly before pregnancy, you may be at higher risk of GDM.
- Have been put on bed rest. Some research has shown that since you’re inactive on bed rest, you’re more likely to put on more pregnancy weight and therefore more likely to develop GDM.
What are the symptoms of gestational diabetes?
Most women with have gestational diabetes have no symptoms, though a few may experience:
- Extreme thirst
- Frequent and very copious urination (distinguished from the also frequent but usually light urination of early pregnancy)
- Fatigue (which may be difficult to differentiate from normal pregnancy fatigue)
- Snoring — although pregnancy hormones cause nasal congestion, making you more likely to snore than usual whether or not you have GDM. Still, if you've been snoring more than usual you should still let your practitioner know.
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 GDM).
In addition, the U.S. government now recommends all pregnant women should be screened specifically for gestational diabetes. Around week 28 of pregnancy your practitioner should give you a glucose screening test, where you'll drink a sugary liquid and have your blood drawn an hour later. If your blood work picks up high sugar levels, your doctor will have you take a three-hour glucose tolerance test to determine whether you have gestational diabetes.
What are the complications of gestational diabetes?
With proper treatment and regular monitoring by your practitioner, gestational diabetes can be managed and you can have a healthy pregnancy. However if gestational diabetes is left untreated, excessive sugar will circulate in your blood and enter your baby’s bloodstream through the placenta, putting you and your baby at risk for potentially serious complications. Babies of women with uncontrolled GDM are more likely to grow too large (a condition called macrosomia), making delivery more difficult and C-section more likely. Being born large can also lead to high blood sugar levels in baby at birth and obesity later in childhood.
Moms with GDM are also at risk for developing preeclampsia (pregnancy-induced hypertension), which can lead to other problems for your baby after birth including jaundice, breathing difficulties and low blood sugar levels. Later in life, preeclampsia can also put your baby at greater risk for obesity and type 2 diabetes.
What you can do to prevent gestational diabetes?
If your only risk factors for gestational diabete 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, starting 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 variety of fruits and vegetables, aim to limit your fat intake to 30 percent of your total daily calories, and try to avoid sugary, processed foods. Think high-fiber, low-fat options (whole grains, low-fat dairy, meat, legumes and fish), and watch your portions. Check out ChooseMyPlate.gov for more information on how much you should aim to eat from each food group and what constitutes a portion. While it takes a bit of work at first, it quickly becomes your habitual — and you’ll soon be an expert on what to eat (and what to avoid).
- 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 sure levels. If you’re diagnosed with GDM, 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 dietician. She can help you review healthy food options and make a meal plan. Many women stick to their “gestational diabetes” diet of low-carb, low-sugar foods 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 increasingly often for GDM.
SEE ALSO: Diabetes Step-by-Step Program
Your doctor may suggest additional fetal monitoring in your third trimester, including non-stress 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 your doctor. Make sure your primary care physician and/or OB-GYN reevaluates you after your postpartum visit — at six weeks and then again every year — to check for continued problems with glucose and HgbA1C (glycated hemoglobin) 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 GDM.
- Fit in fitness. Although it’s hard to stay active with a baby who requires all of your attention (and more!) try 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 maintained 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. The same diet you follow during pregnancy and beyond is good for your child, too. When he gets old enough, have him help you in the kitchen — children who help prepare dishes are more likely to eat them.
- Gets plenty of exercise as he grows. Start by taking walks. As he gets older, toddler soccer and other activities are a great way to get him interested in healthy movement.
- Maintains a healthy weight. Talk to his pediatrician to make sure his BMI is on target, and talk openly to him about healthy weight and the increase in obesity he might notice in American schools.
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