Some women develop diabetes only during pregnancy; this is called gestational diabetes. Gestational diabetes is defined as glucose intolerance that is first diagnosed in pregnancy, and it occurs when pregnancy hormones affect how the body makes or uses insulin, which is a hormone that converts sugar in food into energy the body uses.
If your body does not make enough insulin or if it does not use the insulin appropriately, the level of sugar in the blood rises to an unacceptable level. This is called hyperglycemia and means you have too much sugar in your blood. Occasionally, hormones made by the placenta can also hamper the actions of insulin, and gestational diabetes can occur. Several other factors can affect your glucose levels, including stress, the time of day (glucose values are often higher in the morning), the amount of exercise you do and the amount of carbohydrates in your diet.
Symptoms of gestational diabetes include the following:
- Blurred vision
- Tingling or numbness in the hands and/or feet
- Excessive thirst
- Frequent urination
- Sores that heal slowly
- Excess fatigue
Pregnancy causes most women to urinate more often and to feel hungrier, so having these symptoms does not always mean that a woman has diabetes. Talk with your health care provider if you have these symptoms so you can be tested for diabetes.
Gestational diabetes affects about 10 percent of all pregnancies. After pregnancy is over, most women who experienced
gestational diabetes return to normal, and the problem disappears. However, if gestational diabetes occurs with one pregnancy, there is an increased chance it will recur in subsequent pregnancies.
Gestational diabetes occurs for two reasons. One is that the mother’s body produces less insulin during pregnancy. The second is that the mother’s body cannot use insulin effectively. Both situations result in high blood sugar levels.
When you eat, your body breaks down sugar and starches from food into glucose to use for energy. Your pancreas (an organ behind your stomach) makes a hormone called insulin, which helps your body keep the right amount of glucose in your blood. When you have diabetes, your body doesn’t make enough insulin or can’t use insulin well, so you end up with too much sugar in your blood. This can cause serious health problems, like heart disease, kidney failure and blindness. It’s very important to get treatment for diabetes to help prevent problems like these.
Risk factors for developing gestational diabetes include:
- Age over 30 years old
- Family history of diabetes
- Gestational diabetes in previous pregnancy
- Previously gave birth to a baby who weighed over 9.5 pounds
- Previously had a stillborn baby
- African-American, Hispanic, Asian, Native American/Pacific Islander
- A woman’s weight when she was born may also be an indicator of her chances of developing gestational diabetes.
If left untreated, gestational diabetes can be a serious health concern for you and your baby. You will both be exposed to a high concentration of sugar, which is not healthy for either of you. You may experience polhydyraminos—excessive amounts of amniotic fluid. This may cause premature labor if the uterus becomes over-distended.
A woman with gestational diabetes may have a longer labor because the excess sugar can cause baby to become quite large. Sometimes a baby cannot fit through the birth canal, and a cesarean is required. If your blood-sugar levels are high, you may experience more infections during pregnancy. The most common infections include those in the kidneys, bladder, cervix and uterus.
Good control of gestational diabetes is important during pregnancy. Treatment of gestational diabetes includes regular exercise and increased fluid intake. Diet is essential. Your health care provider will probably recommend a six-meal, 2,000- to 2,500-calorie-per-day eating plan. You may also be referred to a dietitian. Research shows that women who receive dietary counseling, blood-sugar monitoring and insulin therapy, when needed, do better during pregnancy than women who receive only routine care. Many experts believe that glyburide, an oral hypoglycemic agent used to treat type 2 diabetes, is a good alternative to insulin, and just as effective in treating women with gestational diabetes.
Testing your blood glucose levels at home at specific times or after meals will be recommended to determine if your glucose levels are within acceptable limits. Testing at least four times per day is typical. You may also be asked to test your urine for ketones, substances that are produced when your body metabolizes fat. Ketones are elevated when the body is unable to use glucose for energy.
If diet and exercise are not sufficient to maintain tight control of your blood glucose levels, it may be necessary to start insulin therapy. Insulin is the only officially approved medication for treating gestational diabetes; however, many use oral agents to control the blood sugar in selected patients. As the pregnancy progresses, insulin requirements may change, and insulin doses may need to be adjusted.
It really is not known what can be done to prevent gestational diabetes. This condition might be the result of hormones blocking the insulin in your body. Maintaining a healthy weight before your pregnancy can help lower your risk, as obesity is a prime determinant for developing the disease. Keeping active and following a good nutritional plan both before and during pregnancy can decrease your chances of developing gestational diabetes. Maintaining a healthy weight can also decrease your chances of developing type 2 diabetes following pregnancy.
If possible, seek health care early, when you first think about trying to get pregnant, so your health care provider can evaluate your risk of gestational diabetes as part of your overall pregnancy plan. Once you are pregnant, your health care provider will address gestational diabetes as part of your prenatal care. If you develop gestational diabetes, you may need more-frequent checkups. These are most likely to occur during the last three months of pregnancy, when your health care provider will monitor your blood sugar level and your baby’s health.
Because gestational diabetes does not cause symptoms, you need to be tested for the condition. This is usually done between the 24th and 28th weeks of pregnancy. You may be surprised if your test shows a high blood sugar level. It is important for you to be tested for gestational diabetes, because high blood sugar can cause problems for both you and your baby. Health care providers test for gestational diabetes during this time because the placenta is producing large amounts of hormones that may cause insulin resistance. If the results indicate elevated levels, further testing would be done to confirm a gestational diabetes diagnosis.
All pregnant women will be tested for gestational diabetes at some point during their pregnancy. Expecting mothers who are over the age of 35, overweight, or have a family history of diabetes may be tested earlier and more frequently.
Blood testing confirms the diagnosis. A screening glucose tolerance test involves drinking a sugary beverage and having your blood drawn an hour later to test the glucose levels. If the screening test is not normal, you may need additional testing. Another type of test is an oral glucose challenge test (OGTT). For this test your baseline blood glucose level is checked and then measured 1, 2, and sometimes 3 hours after consuming a sugary drink.
Glycosylated hemoglobin, or hemoglobin A1c, is another test that may be performed. This test is used to monitor long-term blood glucose levels in people with diabetes. The hemoglobin A1c level offers a measure of the average blood glucose level over the past few months.
Women with gestational diabetes who receive proper care typically go on to deliver healthy babies. However, if you have persistently elevated blood glucose levels throughout pregnancy, the fetus will also have elevated blood glucose levels. High blood glucose can cause the fetus to be larger than normal, possibly making delivery more complicated. The baby is also at risk for having low blood glucose immediately after birth. Other serious complications of poorly controlled gestational diabetes in the newborn can include an greater risk of jaundice can increased risk for respiratory distress syndrome, and a higher chance of dying before or following birth. The baby is also at a greater risk of becoming overweight and developing type 2 diabetes later in life.
Most of the time gestational diabetes can be controlled and treated during pregnancy to protect both you and your baby. But if not treated, it can cause problems during pregnancy, including:
- Preeclampsia. This is when a pregnant woman has high blood pressure and signs that some of her organs, like her kidneys and liver, may not be working properly. Signs of preeclampsia include having protein in the urine, changes in vision and severe headaches.
- Premature birth. This is birth before 37 weeks of pregnancy. Premature babies are more likely to have health problems at birth and later in life than full-term babies.
- Having a very large baby. weighing more than 9 pounds. Weighing this much makes your baby more likely to get hurt during labor and birth.Large babies are also more likely to be obese or have diabetes later in life. You may need to have a cesarean birth (also called c-section) to keep your baby safe. A c-section is surgery in which your baby is born through a cut that your doctor makes in your belly and uterus (womb).
- Stillbirth. This is when a baby dies in the womb after 20 weeks of pregnancy.
During your prenatal visit, your health care provider will give you a sweet, but not necessarily tasty liquid to drink one hour before your blood is drawn. It may cause you to feel a bit nauseated. The results will indicate if you are producing enough insulin or not.
Your health care provider may refer you to additional health professionals who specialize in diabetes, such as an endocrinologist, a registered dietitian, or a diabetes educator. They can help you learn to manage your blood sugar level during your pregnancy.
While there is no specific diet that is recommended for all women with gestational diabetes, following a meal plan can help keep your blood sugar levels under control and avoid complications. The following are some great tips.
- A nutritionist may be helpful in designing a meal plan that takes into account individual schedules and preferences.
- Eating a variety of foods is recommended, and it is better to eat smaller portions throughout the day (e.g. 3 small to moderate meals and 2-4 snacks) rather than just a few large meals.
- Many women with gestational diabetes will be advised to eat fewer carbohydrates than in their normal diet and to eat complex carbohydrates that contain fiber. It is important to limit consumption of foods containing large amounts of simple sugars.
- High-fiber foods like fresh fruits and vegetables, as well as whole-grain products, are not only nutritious but also effective in keeping blood sugar levels stable.
- Skipping meals is not recommended because this leads to undesirable fluctuations in blood sugar levels.
To make sure your blood sugar level has returned to normal after your baby is born, your health care team will check your blood sugar right after delivery and again in six weeks. Once you have had gestational diabetes, it is a good idea to have your blood sugar level tested regularly. The frequency of blood sugar tests will in part depend on your test results soon after you deliver your baby.
Being diagnosed with any condition such as gestational diabetes can be scary and concerning. Luckily, if you catch your gestational diabetes symptoms sooner rather than later, you and your baby will remain healthy.