- Gestational Diabetes Q and A | Nutrition Now | Dietitian-Nutritionist for Fertility, Preconception, and Prenatal Health
- Glucose tolerance test
- World Diabetes Day 2017: Understanding Gestational Diabetes
- Managing Gestational Diabetes: Let’s Nip It in The Bud
- Gestational diabetes: Q and A
- Q. Am I at risk of gestational diabetes?
- Q. How would I know if I had gestational diabetes?
- Q. What is the test for gestational diabetes?
- Q. What does gestational diabetes mean?
- Q. Does this mean that I will always have diabetes?
- Q. Will my baby be affected?
- Q. What happens if gestational diabetes isn’t treated?
- Q. What is the treatment for gestational diabetes?
- Q. Will I have to monitor my blood glucose levels?
- Q. What if I need insulin?
- Q. What are my chances of getting gestational diabetes again in a later pregnancy?
- Q. What does having gestational diabetes mean for my future?
- Q. Can gestational diabetes be prevented?
- When Pregnancy Becomes Risky: Gestational Diabetes
Gestational Diabetes Q and A | Nutrition Now | Dietitian-Nutritionist for Fertility, Preconception, and Prenatal Health
Hearing the words Gestational Diabetes has an amazing way of making any pregnant woman’s skin crawl.
Often, all they think about is the dreaded Glucola drink and not being able to eat a slice of cake at their baby shower.
My colleague Rachelle Mallick rounded up some questions and misunderstandings that we have heard along the way (with the help of our friend Lauren Fox) and are happy to tackle them for yall’s reading pleasure.
What exactly is Gestational Diabetes?
To understand how gestational diabetes comes about, you first have to have a basic understand the placenta. Your placenta does more than support your baby; it also produces hormones to help the baby develop. The hormones are released into your body and some hormones may cause what is called insulin resistance.
Think about a time that you have eaten a carbohydrate-rich meal, spaghetti. During digestion, the carbohydrates from the meal were broken down into a simple sugar called glucose.
Your body depends on the hormone insulin to help absorb and use glucose. Insulin is released when your body senses glucose in the bloodstream after carbohydrates are eaten.
The glucose needs to enter the cells of organs ( the brain) in order for it to be used as energy. The glucose depends on insulin to help it get into the cells. Otherwise, glucose would remain in the bloodstream.
In insulin resistance, your cells do not respond to insulin. As a result, the glucose may not enter the cells, and may stay in the bloodstream. This is called having a HIGH blood sugar level. The body will attempt to overcome this challenge by secreting MORE insulin. The cells literally become resistant to insulin.
THE PROBLEM WITH INSULIN RESISTANCE WHILE PREGNANT
So, your body is experiencing insulin resistance. As a result, the extra glucose that is not entering your cells it did before pregnancy can pass the placenta and essentially go to your baby. Your baby is therefore being exposed to way too much sugar if mom is not managing her gestational diabetes.
Baby can become very large, become at risk for developing diabetes herself, and have a higher chance of becoming obese. Carrying a larger baby puts mom at risk for being unable to deliver vaginally and delivering via c-section is associated with its own risks.
Additionally, unmanaged gestational diabetes is a risk factor for premature birth.
If you have gestational diabetes, you want to make sure that you are eating enough carbohydrates to sustain yourself and your pregnancy, but not eat TOO many that results in a high blood sugar. It is a balance that many women achieve successfully.
Are the gestational diabetes tests a test of how healthy I have been eating since I became pregnant?
In a word: no. Gestational diabetes is a result of those pesky hormones that naturally are secreted from your placenta. It is not a test to determine how many milkshakes you enjoyed during your first trimester.
With that being said, carrying excess weight puts you at a higher risk of having gestational diabetes, so swapping out a milkshake for a Greek Yogurt parfait once in a while is a good practice.
Are there any factors that put you at risk for developing gestational diabetes?
Yes, some factors put you more at risk for developing gestational diabetes. Most are unfortunately your control. So, even if you have been eating a well-balanced diet and taking care of yourself, you may still be at risk.
Some risk factors include:
advanced age (≥35 years old according to some experts, >25 according to others)
overweight or obesity
excessive gestational weight gain
excessive central body fat deposition
family history of diabetes
history of recurrent miscarriage
gestational diabetes during prior pregnancies
polycystic ovary syndrome
sedentary lifestyle (1)
In the literature, the lowest cutoff is ≥25 years old as a risk factor, as recommended by the American Diabetes Association. (2)
How does the gestational diabetes glucose tolerance test work?
Many providers will start with a glucose challenge test. This test determines how your body tolerates and utilizes a large amount of carbohydrate/sugar/glucose that is taken in at once.
Before the test, a woman will drink a very sweet drink called glucola (or an alternative). One hour later, she will get her blood drawn to determine how much of the sugar from the glucola was used by her body, and how much remains in the bloodstream. If the blood has too much sugar remaining in the blood after an hour of drinking the glucola, further testing may be recommended.
The one-hour glucose challenge test is not a foolproof test and is not 100% accurate. It is used more as a screening to determine whether a woman needs to do the three-hour test. As long as your provider approves and your insurance will cover it, you may be able to just take the three-hour test and skip the initial test.
Glucose tolerance test
Un before the one-hour test, the three-hour glucose tolerance test should be taken after fasting. You may be permitted to take some medication, but otherwise should not eat or drink anything before the test.
The test is then performed as follows:
1. You will first have your blood measured to get a value of fasting blood sugar.
2. Afterward, you will drink Glucola (or equivalent).
3. Your provider measures your glucose levels once per hour for the next three hours (bring a good book to read!).
From there, your provider will evaluate your blood sugar results obtained from your blood draws and determine whether you have gestational diabetes.
What is glucola? Can I drink something other than glucola?
Glucola is a a liquid that provides a specific amount of carbohydrates. Is it the healthiest drink in the world? No way. Does it taste great? Not really. Will it harm your baby if you drink one or two bottles of it? In our opinion, no.
While the ingredients are not what we normally recommend pregnant women drink, we do not feel that one or two servings of the syrupy drink will cause any negative consequences to your baby.
Living with gestational diabetes and not being aware of it and therefore not managing it is much more risky to yourself and to your baby.
Some alternatives that have been suggested to be an acceptable alternative to the glucola are 28 jellybeans that provide 50 gm glucose (2) or ten strawberry-flavored Twizzlers (3).
Please speak with your health care provider if you are exploring any alternatives to the glucola. For the record, both of us drank the glucola. We opted for the dye-free version. It was not organic, not non-GMO, not that great for you. But we both felt one or two bottles of the sweet stuff won’t kill us. It’s all about balance, and we generally ate very balanced diets.
Does the flavor of the glucola change the results?
We are not aware of one flavor having a different effect on the results vs. another. All Glucola formulations contain 50 gm glucose.
If I have been eating super-healthy, can I skip the glucose tolerance test?
We feel knowledge is power. Even if you are low-risk for getting the diagnosis and have been eating well, you are not risk-free (nobody is). As we mentioned previously, gestational diabetes is often a result of the hormones secreted by your placenta on your body, not a result of you frequenting the fast-food lane and enjoying that afternoon daily Frosty.
With that being said, it is your right to decline these tests. Please discuss pros and cons with your provider. And if you do decline the test, please make sure that you are eating in a way that promotes stabilized blood sugars just in case (it is a healthy way of eating regardless of a diagnosis anyways).
What should I eat before the test?
If you are going in for the three-hour test, you should be fasting unless your provider tells you otherwise.
For the one-hour test, the goal should not be to “pass” the test. The goal is to allow your provider to get accurate results. Failing has such a negative connotation to it. If your results indicate that you have a diagnosis of gestational diabetes, don’t consider it a failure, consider it a blessing that you know what you have to do to keep your baby healthy while you are pregnant.
With that being said, it is possible for you to eat in a way that may give you a false-positive. Some tips:
1. Avoid high-sugar foods shortly before the test and cut back on simple, or refined, carbs. This includes fruit juice, candy, soda, and sweet tea for all of our Southern friends. If you choose to eat a piece of fruit, pair it with a healthy fat and protein a Tablespoon of nut butter or piece of string cheese.
2. Focus on a balance of complex carbs ( whole grains), protein, and healthy fat. A piece of whole grain toast topped with mashed avocado and an egg is a perfect option!
3. Don’t starve yourself. Your body may over-compensate for the lack of energy that you did not take in and cause your blood sugars to go sky-high.
If you are taking the three-hour test, you must be fasting before the test. Some say that eating a carbohydrate-free snack may be ok, but this is something you need to confirm with your provider before you decide to nosh on a handful of walnuts or some scrambled eggs.
Is there any risk to baby if I “cheat” and try to pass?
We understand why people may want to do everything they can to pass the test. Just when you were in school, cheating catches up with you in the long-run (do we sound your parents right now?).
If your body is truly experiencing gestational diabetes, why wouldn’t you want to know about it and make some changes to help manage it.
If you have gestational diabetes and are not aware of it and therefore not managing it, ultimately you are putting your baby at risk.
Don’t cheat the system. Follow the guidelines your doctor provided you and learn what your true results are.
We addressed the risks to baby previously if you do not manage your gestational diabetes if you truly have the condition.
Is it normal to feel crap after the test? What can I do to help me feel better?
Yes, you may feel terrible after you take the three-hour test. Make sure to have a snack waiting for you so you can eat it when you are dismissed from your test. Bring along a snack that contains some protein and healthy fat. A trail mix made with nuts and dried fruit is a great quick snack after your test.
If you get a diagnosis, now what?
I know that many look at pregnancy as a time for them to “eat for two”. Honestly, the recommended dietary pattern to manage gestational diabetes is a way of eating that would ly benefit almost all pregnant women. It is a balanced way of eating that is rich in fiber, healthy fats, and protein while being low in concentrated sweets.
You should schedule a time to meet with a registered dietitian or a certified diabetes educator to help guide you with your food choices. You will ly be checking your blood sugars to learn your body and determine which foods you should be focusing on. We are both trained in personalized gestational diabetes nutrition coaching and see clients virtually nationwide.
Some additional supplements to consider if you get a diagnosis of gestational diabetes:
l-carnitine supplementation may be something to consider to help manage your gestational diabetes or reduce the risk of developing gestational diabetes (4).
Some data also suggests that certain probiotic supplementation may help manage gestational diabetes as well (5).
We hope this helps address some of your concerns and misconceptions about the gestational diabetes testing process.
Ultimately, we believe that knowledge is power and understanding how your body digests carbohydrates will help guide you when making food choices. Please lean on licensed professionals if you receive a diagnosis and need some dietary guidance.
We are always happy to help either by nutrition coaching or by referring you to one of our fabulous colleagues in our network.
World Diabetes Day 2017: Understanding Gestational Diabetes
By Susan B. Sloane, BS, RPh, CDE
November 14, 2017, is World Diabetes Day and this year’s theme is Women and Diabetes. Believe it or not, over 200 million women are living with diabetes worldwide and that number is expected to jump to 313 million by 2040.
Diabetes is a serious condition and is currently one of the leading cause of death among women. Type 1 and type 2 diabetes are the most well-known forms of the condition, but many people don’t realize there is a third manifestation of diabetes that affects only women: gestational diabetes.
Gestational diabetes – also known by the acronym GDM – is defined by abnormally high blood glucose during pregnancy and annually, over 200,000 women are affected by the condition.
Women know that pregnancy causes a lot of biological changes in their bodies, but most don’t realize that pregnancy affects the body’s processing of glucose.
During pregnancy, a mother’s body is focused on maintaining good nutrition for the developing fetus.
In order to maintain these levels of nutrition, a woman generally becomes more resistant to insulin as the body tries to preserve glucose.
Most women react to this metabolic shift by producing and utilizing more insulin; but in some women predisposed to GDM, the body fails to keep up with the demands of pregnancy. This results in hyperglycemia, or high blood glucose.
The good news is that pregnant women are routinely screened for gestational diabetes between weeks 24 to 28 of their pregnancy. This is generally done by seeing how well an expectant mom handles a large glucose load.
For example, many practitioners will tell a pregnant mother to eat a heavy breakfast after an overnight fast (8 hours without food). They’ll encourage her to eat a substantial meal pancakes with orange juice, and then blood sugars at intervals after the meal.
Another way to test for GDM is to take a glucose tolerance test which involves drinking a product containing 75 grams of glucose. The blood glucose is then checked at 0, 1, and 2-hour intervals after consumption. A diagnosis is made when at least one of the blood glucose values meets or exceeds the following conditions:
- A fasting measure of 92mg/dl (5.1 mmol/L)
- 1 hour after consumption: 180mg/dl (10.0 mmol/L)
- 2 hours after consumption: 153mg/dl (8.45 mmol/L)
Women who may be at risk for developing GDM are those over the age of 25, women who have a high BMI, and those that gain excessive weight during pregnancy. Also at risk for GDM are women who have previously had GDM, those who are pregnant with multiples, and women who have had a stillborn baby.
The treatment for GDM involves lifestyle changes such as dietary modifications, an increase in exercise, and oral drug therapy with metformin. Dietary modifications focus on limiting simple carbohydrates and patients are often referred to a registered dietician for nutritional counseling.
Sometimes, these steps aren’t enough to control blood sugars. In that case, insulin may be added as a treatment protocol. Yet, some practitioners use insulin as a first line drug because they feel it is the safest option for the developing fetus.
Regardless of which way gestational diabetes is treated, self-monitoring of blood glucose (SMBG) is the mainstay of care for pregnant women. SMBG is an important element to ensure the health of the mother and the developing fetus.
Similarly, women living with gestational diabetes should make an effort to see their OB/GYN more regularly and may be referred to a physician specializing in “high risk” pregnancies.
Uncontrolled blood sugars during pregnancy can increase the risk of pregnancy complications in the mom such as high blood pressure and strain on the kidneys. The newborn can be at risk for hypoglycemia if an expectant mother’s blood sugars run too high.
This is due to a feedback mechanism that occurs when the developing baby’s system senses high blood sugars and tries to kick out extra insulin to offset the high blood sugars. Once a child is born and is no longer subject to the mother’s system, insulin production may remain higher than is necessary, resulting in potentially low blood sugar in the newborn.
As we already mentioned, one of the key elements of the treatment of GDM is SMBG. If you are living with gestational diabetes, you can’t be sure that your blood glucose levels are in check if you don’t perform regular SMBG and therefore you can’t be sure you’ll have a healthy pregnancy.
Knowing when to test blood sugars and what those values mean are critical aspects of treatment. An important parameter to look at is post-prandial testing: the blood glucose measurements taken after a meal. Post-prandial measures will help patients and providers see how a given meal affects blood sugars and if medication needs to be added or adjusted to bring blood glucose down.
While hyperglycemia is a serious threat to pregnant mothers, hypoglycemia – low blood sugars – also need to be avoided. This is especially important for pregnant mothers that are using insulin. Treatments for low blood sugar need to be thoroughly explained to the expectant mother as well as how to identify symptoms of low blood sugar.
Symptoms of low blood sugar include sweating, dizziness, irritability, and shakiness. If a pregnant mother experiences any of these symptoms, blood glucose testing is important to understand how to care for the hypoglycemic event.
For women that are diagnosed with GDM for the first time, all of this information can be really overwhelming. Luckily, with the proper education and regular glucose monitoring, both mother and child can be just fine.
While the majority of expectant mothers who are diagnosed with gestational diabetes revert to having normal blood sugars after giving birth, a small percentage of women continue to live with diabetes after their child is born.
Overall, gestational diabetes is a serious condition that shouldn’t be forgotten when talking about the diabetes epidemic this World Diabetes Day. For women, gestational diabetes is a serious concern and the best way for a mother to protect her health and that of her baby is by managing blood glucose levels.
About Susan Sloane
Susan B. Sloane, BS, RPh, CDE, has been a registered pharmacist for more than 29 years and a Certified Diabetes Educator for most of her career. Her two sons were diagnosed with diabetes, and since then, she has been dedicated to promoting wellness and optimal outcomes as a patient advocate, information expert, educator, and corporate partner.
Susan has published numerous articles on the topic of diabetes for patients and health care professionals. She has committed her career goals to helping patients with diabetes stay well through education.
The articles provided on this website are for informational purposes only.
In addition, it is written for a generic audience and not a specific case; therefore, this information should not be used for diagnostic or medical treatment.
This site does not attempt to replace the patient-physician relationship and fully recommends the reader to seek out the best care from his/her physician and/or diabetes educator.
 van Leeuwen M, Opmeer BC, Zweers EJ, van Ballegooie E, ter Brugge HG, de Valk HW, et al. (2010) Estimating the risk of gestational diabetes mellitus: a clinical prediction model patient characteristics and medical history. BJOG 117: 69–75. pmid:20002371
 Rowan JA, Hague WM, Gao W, Battin MR, Moore MP; MiG Trial Investigators.Metformin versus insulin for the treatment of gestational diabetes. N Engl J Med.2008 May 8;358(19):2003-15. doi: 10.1056/NEJMoa0707193. Erratum in: N Engl J Med.2008 Jul 3;359(1):106. PubMed PMID: 18463376.
 WEI, Q. et al. Effect of a CGMS and SMBG on Maternal and Neonatal Outcomes in Gestational Diabetes Mellitus: a Randomized Controlled Trial. Sci. Rep. 6, 19920; doi: 10.1038/srep19920 (2016).
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Managing Gestational Diabetes: Let’s Nip It in The Bud
One of the most common complications of pregnancy is gestational diabetes mellitus (GDM). It is defined as glucose intolerance with first onset during pregnancy.1 In 2011, the incidence of GDM in the United States was between 2% and 10% of all pregnancies.
Potential complications associated with GDM include macrosomia, pre-eclampsia, preterm birth, increased risk for cesarean section, neonatal hypoglycemia, shoulder dystocia, and polyhydramnios.
Women with a history of gestational diabetes have a 35% to 60% lihood of developing type 2 diabetes over the following 10 to 20 years.2
Q:When should screening for GDM occur?
According to the American Diabetes Association’s (ADA) 2012 Clinical Practice Recommendations, a pregnant woman should be screened for undiagnosed type 2 diabetes at her first prenatal visit if she has certain risk factors.
3 These include, but are not limited to, family history of diabetes, overweight/obesity, sedentary lifestyle, elevated blood pressure and/or cholesterol, impaired fasting glucose or impaired glucose tolerance, or certain ethnic backgrounds (eg, Hispanic, Native American, and non-Hispanic black).4 In 2011, the ADA revised its recommendations for GDM screening and diagnosis to be in accordance with those from the International Association of Diabetes and Pregnancy Study Groups (IADPSG), an international consensus group with representatives from multiple obstetric and diabetes organizations, including ADA.
Q:How is GDM diagnosed?
Current recommendations stipulate that women with no previous history of diabetes or prediabetes undergo one-step testing: a 75-g glucose tolerance test (GTT) at 24 to 28 weeks’ gestation.5,6 For women with a prior history of GDM, screening is recommended earlier in the pregnancy.
The GTT should be performed after an overnight fast of at least eight hours.3 An elevation of any one of the values above normal reference range is consistent with the diagnosis of GDM. (Previously, the diagnostic criteria required two abnormal values.
) Multiple international studies using the new criteria have estimated an increased incidence of gestational diabetes in up to 18% of pregnancies.5,6
Some organizations have not endorsed the IADPSG/ADA diagnostic criteria at this time; as a result, many practitioners continue to use two-step testing for diagnosing GDM.
To do the two-step testing, a 50-g glucose load is given, followed by a blood glucose reading one hour later. If the one-hour reading is within normal range, no further testing is warranted and the patient does not have gestational diabetes.
If the test is abnormal, she must undergo a fasting three-hour GTT using a 100-g glucose load.
Q:What advice should a woman get once she’s diagnosed with GDM?
As soon as a woman is diagnosed with GDM, she should be referred for a gestational diabetes education class and nutrition counseling.
Specifically, she should learn what it means for her to have GDM, implications for her and her baby, and the importance of eating a healthy diet (not the proverbial concept of “eating for two”), physical activity, self-monitoring blood glucose, and adherence to any prescribed medications.
Probably the most important aspect of education is nutrition counseling. It is known that smaller meals consumed more frequently throughout the day reduce spikes in blood glucose levels.
One suggestion is to eat three small meals and three low-carbohydrate (15 g) snacks each day. Meals and snacks are generally established fixed carbohydrate amounts.
A certified diabetes educator or registered dietitian (RD) can recommend healthy meal and snack ideas that are tasty, promote satiety, and minimize spikes in glucose levels.
Q:What are the current treatment options for GDM?
During the process of receiving GDM education, the patient should be prescribed a glucometer, along with specific glucose targets. Blood glucose should be checked multiple times a day, preferably fasting and postprandial measurements. Medical practices vary in their preferred glucose targets; some individuals require tighter control than others. The ADA suggests the following targets:
• Before a meal (preprandial):
95 mg/dL or less.
• One hour after a meal (postprandial): 140 mg/dL or less.
• Two hours after a meal (postprandial): 120 mg/dL or less. 7
If blood glucose levels remain within normal range, it is possible to control gestational diabetes with dietary modification and physical activity. If readings are consistently elevated, then the patient must be started on medication.
There are currently no FDA-approved oral medications to treat gestational diabetes. Glyburide is commonly used, although it is not FDA approved for this indication. More studies to establish its safety are ly needed for FDA approval.
If pharmaceutical treatment is warranted, insulin is the safest and most effective agent. It is the only medication that is FDA approved for treatment of GDM. Levemir (insulin detemir [rDNA origin] injection) gained FDA approval for use in pregnancy in 2012, so it has become more widespread than NPH for basal insulin usage.9
Gestational diabetes: Q and A
A. Gestational diabetes is a form of diabetes that develops during pregnancy. It is different from having known diabetes before pregnancy and then getting pregnant.
Gestational diabetes is generally diagnosed in the second and third trimesters of pregnancy, and usually goes away after the baby is born.
Gestational diabetes can cause problems for the mother and baby, but treatment and regular check-ups mean most women have healthy pregnancies and healthy babies.
Q. Am I at risk of gestational diabetes?
A. Gestational diabetes affects between 10 and 15 per cent of pregnancies in Australia. Women of certain ethnic backgrounds — Australian Aboriginal or Torres Strait Islander, Indian, Asian, Middle Eastern, African, Maori and Pacific Islander — are more at risk of developing gestational diabetes than women of Anglo-Celtic backgrounds.
Other factors can also increase your risk, including:
- being overweight;
- having a family history of diabetes;
- having had gestational diabetes in a previous pregnancy;
- being 40 years or older;
- having polycystic ovary syndrome (PCOS);
- taking medicines that can affect blood sugar levels (such as corticosteroids and antipsychotic medicines); and
- previously having a very large baby (more than 4.5 kg).
Q. How would I know if I had gestational diabetes?
A. Gestational diabetes does not usually give rise to symptoms. For this reason it is important to be tested during pregnancy, usually between 24 and 28 weeks.
Women with risk factors for diabetes may be offered testing earlier than this – sometimes at the first antenatal visit, which is often at around 10 weeks.
Women who do develop symptoms may experience:
- extreme tiredness;
- being thirsty all the time;
- symptoms of recurrent infections (such as thrush); and
- needing to pass urine more than usual.
Women who experience symptoms at any stage of pregnancy should be tested for diabetes.
Q. What is the test for gestational diabetes?
A. The usual screening test for gestational diabetes is called a glucose tolerance test. This test is routinely recommended for pregnant women at 24-28 weeks.
Women with symptoms or risk factors for diabetes will usually be tested earlier in the pregnancy and again at 24-28 weeks (if the first test was normal).
Q. What does gestational diabetes mean?
A. In women with gestational diabetes, natural hormones secreted by the placenta during pregnancy increase the body’s resistance to insulin. In other words, your body’s cells are not responding normally to insulin.
This means that your body needs much more insulin than usual to carry out its job of helping the body’s cells to take up glucose from the bloodstream after a meal. The result is that the glucose stays around in the bloodstream, hence the high glucose reading of your blood test.
Women who are found to have very high blood glucose levels may be given the diagnosis of diabetes in pregnancy.
These women are ly to have had pre-existing, undiagnosed diabetes before they were pregnant, and are often diagnosed in the first 12 weeks of pregnancy (first trimester).
Women with diabetes in pregnancy may need to have more tests, more intensive treatment during pregnancy, and closer follow-up after pregnancy.
Q. Does this mean that I will always have diabetes?
A. In women with gestational diabetes, blood glucose levels usually go back to normal after the baby is delivered.
It is recommended that women with gestational diabetes have another glucose tolerance test 6 to 12 weeks after having the baby to make sure that their blood glucose levels have returned to normal.
Some women’s blood sugar levels will remain high after giving birth. These women most ly have underlying type 2 diabetes.
Because having gestational diabetes increases your risk of developing type 2 diabetes, it is advised that all women who have had gestational diabetes have a blood glucose test every year, or a glucose tolerance test about every 2 years.
Q. Will my baby be affected?
A. Gestational diabetes in a mother should not cause birth defects in her unborn child. However, if gestational diabetes goes undiagnosed and is not treated, there is a higher risk of certain problems in the baby, including the following.
- High birth weight. This can make vaginal delivery difficult, and can result in having an assisted delivery or a Caesarean section. Sometimes the baby may be injured during vaginal birth.
- Breathing difficulties after birth.
- Low blood glucose levels (hypoglycaemia) after birth. Babies born to mothers with diabetes will have their blood glucose levels tested regularly for the first few days after birth.
Q. What happens if gestational diabetes isn’t treated?
A. It is not good for your baby if extra glucose from your blood is crossing the placenta and going into the baby’s bloodstream. The high blood glucose levels of the baby will make it produce extra insulin to try to get rid of the extra glucose. The extra glucose can also feed the baby up, which is why women with untreated gestational diabetes give birth to big babies.
If the baby has been pumping out extra insulin to deal with the excess glucose coming its way across the placenta from the mother, when the baby is born, it can suffer from low blood glucose.
This happens because suddenly, the extra glucose the baby has been receiving has gone, but the baby’s pancreas is still secreting lots of insulin to take the glucose the bloodstream.
Babies at risk usually have their blood glucose monitored after birth.
In addition, pregnant women with gestational diabetes have an increased risk of developing high blood pressure and pre-eclampsia (a pregnancy condition characterised by high blood pressure, protein in the urine and swelling of the hands, feet and face). This can be dangerous for both the mother and the unborn baby.
The good news is that if you can achieve good blood glucose control during pregnancy, a healthy baby and a safe delivery are ly.
Q. What is the treatment for gestational diabetes?
A. Treatment for gestational diabetes will focus on bringing your blood glucose levels within the normal range and keeping tight control of them. Most women can achieve good control with diet and exercise, but others may have to take insulin.
Your doctor may refer you to a diabetes specialist (an endocrinologist) and will probably advise that you see a dietitian or a diabetes educator to help you with your diet.
They will be able to advise you about low glycaemic index foods, and ensure that your dietary intake is rich in vitamins and nutrients for your growing baby.
While it is important not to over-eat, it is also important not to under-eat, as this too can affect the baby’s growth.
Getting 30 minutes of moderate intensity physical activity on most, if not all, days of the week is safe and recommended for most pregnant women, including those with gestational diabetes.
Your doctor or diabetes educator can advise you about what exercise you can do. Walking is one of the best and easiest ways to increase the amount of exercise you get.
Try walking for 20 to 30 minutes 3 or 4 days a week to start with.
If diet and exercise measures don’t give you good control of your blood glucose, your doctor may advise that you start on insulin.
Q. Will I have to monitor my blood glucose levels?
A. Self-monitoring of your blood glucose levels (blood sugars) is the best way of knowing whether you have achieved good control of your blood glucose levels.
Usually you will be advised to take fasting measurements (before meals when you have an empty stomach) as well as measurements one to 2 hours after you have eaten.
You should record all your results in a home glucose diary.
Measuring your blood glucose levels should be done 4 times per day to start with. If your blood glucose levels are well controlled, you may be able to start measuring your levels less frequently.
Monitoring of your blood glucose is done using a blood glucose meter. To get a drop of blood for monitoring, your finger is pricked with a special device. There are several different types of these devices available and they aim to make it as easy and as painless as possible.
Q. What if I need insulin?
A. For some women, diet and exercise will not be enough to bring their blood glucose into the required range. If this is the case, you will probably need to have insulin injections.
what times of day your blood glucose readings are high, members of your health team will advise you when you should inject insulin. If your glucose levels are staying high after a meal, you will probably be advised to inject short-acting insulin before meals.
In some women, oral diabetes medicine (tablets) may be given, sometimes in combination with insulin, to treat gestational diabetes.
Q. What are my chances of getting gestational diabetes again in a later pregnancy?
A. Once you’ve had gestational diabetes, the chance of you having it again in any future pregnancy is increased. In future pregnancies, it’s recommended that you have early testing for gestational diabetes (at 12 to 16 weeks) and testing again at the usual recommended time (around 26 weeks) if the first test was normal.
Following a healthy diet, getting regular physical activity and maintaining a healthy weight will help to reduce your chance of developing gestational diabetes again.
Q. What does having gestational diabetes mean for my future?
A. As mentioned, your chance of developing gestational diabetes again in further pregnancies is increased. Plus the chance of you developing type 2 diabetes is also increased.
Following a healthy diet, keeping your weight at a safe level, and having regular physical activity will help to reduce your chances of these things happening. Your doctor will recommend that you also have your blood sugar levels checked yearly, or have a glucose tolerance test about every 2 years.
Q. Can gestational diabetes be prevented?
A. There are things you can do to reduce your risk of getting gestational diabetes. Making sure you eat a healthy diet, get enough physical activity and maintain a healthy weight lowers your chances.
Ensuring you have a healthy lifestyle before you get pregnant and then continuing on this track once you become pregnant will give you the best chance of avoiding gestational diabetes.
Royal Australian and New Zealand College of Obstetricians and Gynaecologists. www.ranzcog.edu.au/college-statements-guidelines.html Diagnosis of gestational diabetes mellitus (GDM) and diabetes mellitus in pregnancy (reviewed July 2014). http://www.ranzcog.edu.au/college-statements-guidelines.html (accessed May 2016).
Sweeting AN, Rudland VL, Ross GP. medicinetoday.com.au/2013/may/feature-article/gestational-diabetes-towards-new-diagnostic-criteria Gestational diabetes: Towards new diagnostic criteria. Medicine Today 2013;14(5);46-53. http://medicinetoday.com.au/2013/may/feature-article/gestational-diabetes-towards-new-diagnostic-criteria (accessed May 2016).
BMJ Best Practice.
When Pregnancy Becomes Risky: Gestational Diabetes
Q: WHAT IS GESTATIONAL DIABETES?
A: Gestational diabetes is diabetes that is found for the first time when a woman is pregnant. Diabetes means that your blood glucose (also called blood sugar) is too high. You and your baby use glucose for energy. But too much glucose in your blood can be harmful and when you are pregnant, too much glucose is not good for you or your baby.
Changing hormones and weight gain are part of a healthy pregnancy. Both changes make it harder for your body’s insulin to do its job. When that happens, glucose levels may increase in your blood, leading to gestational diabetes.
Pregnant women are usually tested for gestational diabetes between 24 and 28 weeks of pregnancy, using a blood test. Gestational diabetes occurs more frequently among women with a family history of diabetes; oversight and obese women; and, African American, Hispanic/Latino and American Indian women.
Treatment for gestational diabetes includes healthy eating and physical activity. Sometimes insulin or oral medication is needed. Most of the time, gestational diabetes goes away after the baby is born.
However, it is estimated that about half of all women who had gestational diabetes will go on to develop type 2 diabetes later in life.
That’s why it’s important for women with a history of gestational diabetes to continue to get tested for diabetes.
Q:WHY ARE WOMEN OVER 35 AT A GREATER RISK FOR DEVELOPING HIGH BLOOD PRESSURE AND GESTATIONAL DIABETES DURING A PREGNANCY COMPARED TO YOUNGER WOMEN?
A: Many women in their 30s and beyond deliver healthy babies. While there is nothing magical about age 35, research has shown that mothers giving birth over the age of 35 may have an increased risk of developing pregnancy-related health problems such as high blood pressure and gestational diabetes.
While age is one risk factor for gestational diabetes, if the mom has additional risk factors such as being overweight or obese, or having a family history of diabetes, the risk for gestational diabetes is greater. It’s important for women to stay healthy – at any age – when preparing for a pregnancy.
Q: HOW CAN GESTATIONAL DIABETES AFFECT MOM AND BABY?
A: Gestational diabetes may increase a woman’s risk of high blood pressure during pregnancy and could increase the need for cesarean section at delivery.
Untreated or uncontrolled gestational diabetes can mean problems for the baby, such as being born very large and with extra fat, which can make delivery difficult and more dangerous for the baby.
These babies may also experience low blood glucose right after birth as well as breathing problems.
Q: WHAT CAN A WOMAN DO IF SHE IS DIAGNOSED WITH GESTATIONAL DIABETES?
A: Managing gestational diabetes means taking steps to keep blood glucose levels in a target range. Many women who have gestational diabetes see a dietitian or diabetes educator to guide them in developing healthy habits during pregnancy.
Women with gestational diabetes can manage their blood glucose with healthy eating, being active, and by monitoring their blood glucose. Some women may need insulin or other medications.
All women with gestational diabetes should work closely with their health care team to help ensure a healthy outcome for both mother and baby.
Q: WHY IS GESTATIONAL DIABETES A CONCERN AFTER THE PREGNANCY?
A: Having gestational diabetes increases a woman’s future chances of developing diabetes. It is estimated that half of all women who had gestational diabetes will go on to develop type 2 diabetes later in life. Additionally, the children of pregnancies where the mother had gestational diabetes may also be at increased risk for obesity and type 2 diabetes throughout their lives.
Q: WHAT FOLLOW-UP MONITORING OR CARE DOES A WOMAN WITH GESTATIONAL DIABETES NEED AFTER SHE DELIVERS THE BABY?
A: Women with a history of gestational diabetes should be tested for diabetes no later than 12 weeks after their baby is born. In many cases, their blood glucose levels return to normal after delivery. Although they no longer have gestational diabetes, they are at high risk for developing type 2 diabetes in the future.
If the test results show that your blood glucose (sugar) is higher than normal, but not high enough to be diabetes — also called prediabetes — get tested for diabetes every year. If the test is normal, get tested every 3 years.
If your test results show that you could get diabetes and you are overweight, ask your doctor about what changes you can make to lose weight and for help in making them. Your doctor may recommend that you take medicine such as metformin to help prevent type 2 diabetes findings from the NIH-funded Diabetes Prevention Program.
Even after the baby is born, it is important for women with a history of gestational diabetes to reach and maintain a healthy weight by making healthy food choices, such as following an eating plan lower in fat and calories and high in fiber, and being active for at least 30 minutes a day, 5 days a week. Even if you do not reach your “goal” weight, research shows that maintaining a healthy lifestyle can help lower a person’s chances for developing type 2 diabetes in the future.
Women with a history of gestational diabetes should also talk to her doctor if she plans to become pregnant again.
Q: WHAT IS THE LONG-TERM IMPACT OF GESTATIONAL DIABETES ON THE HEALTH OF THE MOM AND THE BABY?
A: Most of the time, gestational diabetes goes away after pregnancy, but sometimes diabetes stays. It is important to get tested for diabetes after the baby is born. Women with a history of gestational diabetes need to know that they have a greater chance of developing type 2 diabetes later in life and should continue to get tested for diabetes every 1 to 3 years.
A child born from a pregnancy affected by gestational diabetes may also be at risk for obesity and type 2 diabetes later in life. Tell your child’s doctor if you had gestational diabetes while you were pregnant with that child. This fact is an important part of your child’s health history and can alert your child’s doctor to monitor growth charts more closely.
Q: WHAT CAN A WOMAN WITH A HISTORY OF GESTATIONAL DIABETES DO TO PROTECT HER OWN HEALTH, AND THE HEALTH OF HER CHILD?
A: Women with a history of gestational diabetes can take modest but important steps — for themselves and their children — to prevent or delay type 2 diabetes. Here are a few tips:
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