What you need to know about Pregnancy-Related Diabetes

Gestational diabetes is a condition in which women develop high levels of blood sugar (also called blood glucose) during pregnancy that by definition fall into the range for the diagnosis of pregnancy-associated diabetes. This condition results from insufficient amounts of insulin being produced by your body to compensate for the added stress of pregnancy and is contributed to by an insensitivity to the insulin that is present (a condition also called insulin resistance). Insulin is important because it helps keep the amount of sugar in your blood at normal levels.

Conditions that put you at a high risk of developing gestational diabetes include obesity, having a history of gestational diabetes during a previous pregnancy, older age and a family history of diabetes. As many as 9.2 percent of pregnant women have gestational diabetes.

Typically, your OB/GYN or healthcare professional will test you for gestational diabetes when you are between 24 and 28 weeks pregnant. However, if you are at a high risk of developing gestational diabetes, you may get tested earlier in your pregnancy.

There are differences in opinion among medical experts regarding the screening guidelines for gestational diabetes. The “glucose challenge” is a commonly used test in which you drink a sugar solution and have your blood sugar measured an hour later. If your blood sugar is higher than normal, it means you have a higher risk of gestational diabetes. In these women, a follow-up glucose tolerance test is done, in which fasting is required after midnight. Your blood sugar will be measured in the morning and then you will be given a sugar solution to drink. Furthermore, your blood sugar levels will be checked every hour for three hours. A higher than normal reading on at least two of your blood sugar readings gives a diagnosis of gestational diabetes.

Also, it’s important to note that there is a small group of women who are at such a low risk of developing gestational diabetes that they may not be tested at all. Your physician should discuss your risk factors and whether testing is appropriate for you, as well as whether the challenge test or the intolerance test should be done initially.

Why is checking for gestational diabetes important?
Early diagnosis and treatment of gestational diabetes is important in order to reduce the risk of complications such as preeclampsia, a dangerous condition in pregnant women that causes high blood pressure, swelling and protein in the urine. Insulin does not cross the placenta, however glucose does. So when your body has higher than normal levels of glucose, the baby is exposed as well. Extra glucose that the baby receives is typically converted into fat. As a result, the baby is born larger (often more than nine pounds at birth), putting the baby and mother at risk for injury during delivery. Some of those injuries to the baby include shoulder dystocia, in which the shoulder gets stuck in the birth canal; fractured bones; nerve damage; and, in rare cases, brain damage from decreased oxygen supply to the baby during the delivery process. If your baby is too large, your physician may suggest a surgical delivery (Cesarean section) to decrease the chance of these complications. In addition, your baby may have low blood sugar levels after delivery as his or her body is still producing a lot of insulin from the high glucose exposure while in the womb. After birth, these babies may have breathing problems as their lungs mature a bit later, and as children, they are at a higher risk of developing obesity and type 2 diabetes.

The main method of treatment is to keep blood sugars under control during your pregnancy. Below are some helpful steps to follow:

  • Make changes to your diet
    If available, get nutritional counseling from a registered dietitian who will help you develop meal plans with the necessary amounts of protein, fat and carbohydrates. Some general recommendations include:
    • Avoid high-calorie snacks and desserts
    • Increase vegetables and fruits (at least five servings a day)
    • Substitute whole grains for refined starches in your diet
    • Limit the amount of red meat and choose lean cuts of meat
    • Choose low-fat or fat-free dairy products
    • Use healthy oils such as canola and olive oil
  • Exercise
    Studies show that exercising during pregnancy helps control blood sugars. Your healthcare team can help you determine what type and how much exercise can be safe for you.
  • Medications
    About 15 percent of women with gestational diabetes will need insulin. This medication is given as an injection just underneath your skin. You may be advised to give yourself a single shot or multiple injections per day depending on your sugar levels. Oral medications may also be used alone or in combination with insulin.

Most women who develop gestational diabetes during pregnancy will not have the condition after the baby is born. However, you are at a higher risk of developing gestational diabetes with subsequent pregnancies, and as many as one-third of these women have higher than normal levels of glucose, also known as impaired glucose tolerance or diabetes after pregnancy. Thus, women who have been diagnosed with gestational diabetes need to have follow-up testing about six to 12 weeks after the baby is born. Even if these tests are normal, testing blood sugar levels is often recommended yearly, as the risk of developing the more common form of diabetes remains high.

While there are no absolute guarantees that you can prevent gestational diabetes, you can decrease your risk of developing it by making healthier choices prior to your pregnancy.

To help get you started, here are some tips :

  • Make healthy food choices – Focus on foods that are high in fiber, low in fat and calories. Also increase the amount of fruits, vegetables and whole grains. It’s important to realize that these choices are lifestyle changes which are beneficial even if you are not considering pregnancy.
  • Maintaining a healthy weight – If you are 20 percent or more above your ideal body weight, losing just a few pounds can decrease the risk of developing diabetes.
  • Exercising regularly – Try to aim for 30 minutes a day for at least five days a week. It’s okay to break the 30 minutes into several smaller time intervals throughout the day. You can use various forms of exercise such as running, brisk walking, swimming or cycling. Forming “exercise buddies” or a realistic workout routine will help you maintain your exercise program for a longer time. Use your smartphone or tablet to help you monitor your habits – there are many apps that can be used to help your journey to better health.

Even if you had gestational diabetes, the above recommendations will help lower your chances of developing it with future pregnancies as well as developing type 2 diabetes later in life.

Dr. Victoria Bouhairie is a first-year Fellow in Endocrinology, Diabetes and Metabolism at Washington University School of Medicine in St Louis, Missouri. She finished undergraduate school at the University of Alabama in Huntsville then attended medical school at Northwestern University. She completed her internal medicine residency at Loyola Medical School in 2011 and worked as a primary care physician for two years, where she focused her interest on diabetes and obesity through a variety of community activities. Currently she is involved in various investigator and industry-initiated clinical trials in diabetes and metabolic syndrome.