Gestational Diabetes

Diabetes that is diagnosed for the first time during pregnancy is called gestational diabetes.  According to the American Pregnancy Association, between 2 and 5 percent of women develop diabetes during pregnancy.  It can cause some serious complications for both mom and baby if it is not recognized and treated.  

What causes gestational diabetes?

During pregnancy, the placenta produces hormones to sustain pregnancy.  Unfortunately, these hormones also make your cells more resistant to insulin.  Your pancreas will respond by making more insulin.  Normally, the pancreas can make enough extra insulin to overcome the resistance in the cells, but sometimes the pancreas just can't keep up with the demand.  When this happens, not enough glucose gets into the cells, and blood glucose levels get too high.  

What are the symptoms of gestational diabetes?

Most women don't notice the symptoms of gestational diabetes.  They usually blame the more frequent urination on the pregnancy itself.  It may also cause some increased thirst, but this is also usually not that noticeable.  

What are the risk factors for gestational diabetes?

• Being overweight or obese
• Having a sedentary lifestyle with low level of physical activity
• Having prediabetes, or having had gestational diabetes with a prior pregnancy
• Polycystic ovary syndrome
• Family history of diabetes in a close relative
• Women who are Black, Hispanic, American Indian, or Asian American have a higher risk 
• Previously delivering a baby that weighed more than 9 pounds

How is gestational diabetes diagnosed?

Because of the seriousness of the condition and the fact that it causes few symptoms, all pregnant women are screened for gestational diabetes as a part of routine prenatal care.

• If you are at average risk, the screening is typically done between 24-28 weeks of pregnancy.
• If you have any of the risk factors mentioned above, your doctor may want to screen for diabetes early in pregnancy, even at your first prenatal visit, and may screen you more than once during pregnancy.

Screening tests can vary slightly but in general the screening test is a glucose challenge test.  For this test, you will drink a syrupy drink that is a concentrated glucose solution.  One hour later, your blood will be drawn to test your blood sugar.  If your blood sugar result is in the normal range, that's great.

If your blood sugar falls into the high range, then you will have another test called a glucose tolerance test.  This test uses a higher concentration of glucose solution.  After drinking the solution, your blood sugar will be checked every hour for 3 hours.  If two or three of the blood sugar readings are higher than expected, you will be diagnosed with gestational diabetes.

How is gestational diabetes treated?

• Lifestyle changes - Eating a healthy diet and being more physically active.
• Monitoring your blood sugar regularly - Your doctor will tell you how often.
• Medication, if necessary - When diet and exercise do not keep your blood sugar down, medication is required.  Insulin is the usual medication used during pregnancy.
• Close monitoring of your baby - You may have additional ultrasounds to monitor the baby's growth and development.  Your doctor may also want to induce labor if you do not go into labor by your due date.
  

What are the complications that can happen if gestational diabetes is not carefully managed?

Complications that may affect the baby:

• Excessive birth weight - From high glucose levels going to the baby.  Babies weighing 9 pounds or more are more likely to get wedged in the birth canal, have birth injuries, or require a C-section birth.
• Premature birth 
• Serious breathing difficulties shortly after birth
• Low blood sugar shortly after birth - This can be serious and even cause seizures in the baby.
• Higher risk for obesity and type 2 diabetes later in life.
• Stillbirth - Untreated gestational diabetes can result in a baby's death either before birth or shortly after birth.

Complications that may affect the mother:

• High blood pressure
• Preeclampsia - A serious complication of pregnancy that causes high blood pressure and other serious symptoms including seizures, which can threaten the lives of both mother and baby.
• Having a C-section delivery is more likely.
• Future diabetes - Women who have gestational diabetes have a higher risk of gestational diabetes in future pregnancies, as well as a higher risk of developing type 2 diabetes over time.

Gestational diabetes is a serious condition.  To lower your risk, try to form healthy habits before getting pregnant and try to start pregnancy at a healthy weight.

If you have any questions about gestational diabetes, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor