Gestational Diabetes

Information about Gestational Diabetes

What Is Gestational Diabetes?

Gestational diabetes is diabetes that is found for the first time when a woman is pregnant. It is one of the most common health problems for pregnant women. The condition affects about 5 percent of all pregnancies, which means there are about 200,000 cases each year. If not treated, gestational diabetes can cause health problems for the mother and the fetus.

The good news is that gestational diabetes can be treated, especially if it's found early in the pregnancy. There are some things that women with the condition can do to keep themselves well and their pregnancies healthy. Controlling gestational diabetes is the key to a healthy pregnancy.

Diabetes means that your blood glucose (also called blood sugar) is too high. Your body uses glucose for energy, but too much in your blood can be harmful. When you are pregnant, too much glucose is not good for your baby either.

Understanding Digestion

Your stomach and intestines break down (or digest) much of the food you eat.

After digestion, the glucose passes into your bloodstream, which is why glucose is also called blood sugar. This article uses the terms "glucose" and "blood sugar" interchangeably. Once in the blood, the glucose is ready for your cells to use. But your cells need insulin, a hormone made by your body, to get the glucose. Insulin "opens" your cells so that glucose can get in. When your metabolism is normal, your body makes enough insulin to move all the glucose smoothly from your bloodstream into your cells.

If you have diabetes, your insulin and glucose levels are out of balance. Either your body doesn't make enough insulin, or your cells can't use insulin the way they should. Without insulin, the glucose that can't get into your cells builds up in your bloodstream. This is called high blood sugar, or diabetes. After a while, there is so much glucose in the blood that it spills over into your urine and passes out of your body. The medical name for diabetes, diabetes mellitus, means "sweet urine."

What Causes Gestational Diabetes?

Changing hormones and weight gain are part of a healthy pregnancy, but both changes make it hard for your body to keep up with its need for a hormone called insulin. When that happens, your body doesn't get the energy it needs from the food you eat. This can result in gestational diabetes.

Risk Factors for Gestational Diabetes

Risk factors for gestational diabetes include:

Having a parent, brother, or sister with diabetes.

Being of African American, American Indian, Asian American, Hispanic American, or Pacific Islander descent.

Being 25 years old or older.

Being overweight.

Having had gestational diabetes before, or given birth to at least one baby weighing more than 9 pounds.

Having a history of pre-diabetes, a condition in which blood glucose levels are higher than normal, but not yet high enough for a diagnosis of diabetes. Other names for it are "impaired glucose tolerance" and "impaired fasting glucose."

You are at high risk for the condition if you:

Are very overweight
Have had gestational diabetes before
Have a strong family history of diabetes
Have glucose in your urine.

You are at average risk for gestational diabetes if you have one or more of the risk factors.

You are at low risk for gestational diabetes if you don't have any of the risk factors.

Screening for Gestational Diabetes

Your doctor will decide when you need to be checked for gestational diabetes, depending on your risk factors.

If you are at high risk for gestational diabetes, your blood glucose level may be checked at your first prenatal visit. If your test results are normal, you will be checked again some time between weeks 24 and 28 of your pregnancy.

If you have an average risk, you will be tested some time between weeks 24 and 28 of your pregnancy.

If you are at low risk for gestational diabetes, your doctor may decide that you do not need to be checked.

How Is Gestational Diabetes Diagnosed?

Your healthcare team will check your blood glucose level. Depending on your risk factors and your test results, you may have one or more of the following tests:

Fasting blood glucose or random blood glucose test
Screening glucose challenge test
Oral glucose tolerance test.

(Click Gestational Diabetes Testing for more information about these tests.)

Impact of Gestational Diabetes on the Baby

Untreated or uncontrolled gestational diabetes can mean problems for your baby, such as:

Being born very large and with extra fat; this can make delivery difficult and more dangerous for your baby
Low blood glucose right after birth
Breathing problems.

If you have gestational diabetes, your healthcare team may recommend some extra tests to check on your baby, such as:

An ultrasound exam, to see how your baby is growing
"Kick counts" to check your baby's activity (the time between the baby's movements) or special "stress" tests.

Working closely with your healthcare team will help you give birth to a healthy baby.

Impact of Gestational Diabetes on the Mother

Often, women with gestational diabetes have no symptoms. However, the condition may increase your risk of:

High blood pressure during pregnancy
A large baby and the need for cesarean section at delivery.

The good news is that gestational diabetes will probably go away after your baby is born. However, you will be more likely to get type 2 diabetes later in life. You may also get gestational diabetes again if you get pregnant again.

Some women wonder whether breastfeeding is okay after they have had gestational diabetes. Breastfeeding is recommended for most babies, including those whose mothers had gestational diabetes.

This condition is serious, even if you have no symptoms. Taking care of yourself helps keep you and your baby healthy.

Treating Gestational Diabetes

Treating gestational diabetes means taking steps to keep your blood glucose levels in a target range. You will learn how to control your blood glucose using:

A meal plan
Physical activity
Insulin (if needed).

Meal Plan

Women with gestational diabetes should talk with a dietitian or a diabetes educator, who will design a gestational diabetes diet plan to help you choose foods that are healthy for you and your baby.

Using a meal plan will help keep your blood glucose in your target range. The plan will provide guidelines on which foods to eat, how much to eat, and when to eat. Choices, amounts, and timing are all important in keeping your blood glucose levels in your target range.

You may be advised to:

Limit sweets

Eat three small meals and one to three snacks every day

Be careful about when and how much carbohydrate-rich food you eat; your meal plan will tell you when to eat carbohydrates and how much to eat at each meal and snack

Include fiber in the form of fruits; vegetables; and whole-grain crackers, cereals, and bread in your meals.

Physical Activity

Physical activity, such as walking and swimming, can help you reach your blood glucose targets. Talk with your healthcare team about the type of activity that is best for someone with gestational diabetes. If you are already active, tell your healthcare team what you do.

Insulin

Some women with gestational diabetes need insulin -- in addition to a meal plan and physical activity -- to reach their blood glucose targets. If necessary, your healthcare team will show you how to give yourself the shots. Insulin is not harmful for your baby. It cannot move from your bloodstream to the baby's.

Maintaining Your Target

Your healthcare team may ask you to use a small device called a blood glucose meter to check your levels on your own. You will learn:

How to use the meter
How to prick your finger to obtain a drop of blood
What your target range is
When to check your blood glucose.

You may be asked to check your blood glucose:

When you wake up
Just before meals
One or two hours after breakfast
One or two hours after lunch
One or two hours after dinner.

The following chart shows blood glucose targets for most women with gestational diabetes. Talk with your healthcare team about whether these targets are right for you.

Blood Glucose Targets for Most Women With Gestational Diabetes
On awakening	Less than 105
One hour after a meal	Less than 155
Two hours after a meal	Less than 130

Each time you check your blood glucose, write down the results in a record book. Take the book with you when you visit your healthcare team. If your results are often out of your target range, your healthcare team will suggest ways you can reach your targets.

Other Tests With Gestational Diabetes

Women with gestational diabetes may also learn how to test for ketones in morning urine or in blood. High levels of ketones (which are harmful for your baby) are a sign that your body is using your body fat for energy instead of the food you eat. Using fat for energy is not recommended during pregnancy.

If your ketone levels are high, your healthcare providers may suggest that you change the type or amount of food you eat. Or, you may need to change your meal times or snack times.

Gestational Diabetes After the Pregnancy

Some women wonder: "After I have my baby, how can I find out whether my diabetes is gone?" You will probably have a blood glucose test 6 to 12 weeks after your baby is born to see whether you still have diabetes.

For most women, the condition goes away after pregnancy. However, you are at risk of having gestational diabetes during future pregnancies or getting type 2 diabetes later on in life.

Preventing Type 2 Diabetes After Gestational Diabetes

Even if you have had gestational diabetes, you can do a lot to prevent or delay type 2 diabetes:

Reach and maintain a reasonable weight. Even if you stay above your ideal weight, losing 5 to 7 percent of your body weight is enough to make a big difference. For example, if you weigh 200 pounds, losing 10 to 14 pounds can greatly reduce your chance of getting diabetes.
Be physically active for 30 minutes most days. Walk, swim, exercise, or go dancing.
Follow a healthy eating plan. Eat more grains, fruits, and vegetables. Cut down on fat and calories. A dietitian can help you design a meal plan.

Remind your healthcare team to check your blood glucose levels regularly. Women who have had gestational diabetes should continue to be tested for diabetes or pre-diabetes every three years. Diagnosing diabetes or pre-diabetes early can help prevent complications later, such as heart disease.