There is the usual list of challenges and limitations that pregnancy places on a woman – things like difficulty getting comfortable, restrictions on alcohol, caffeine and sushi and, of course, morning sickness. But for some, pregnancy can also come with another complication that can be dangerous if untreated – gestational diabetes.
Elizabeth Whelan, APRN, from OSF Maternal-Fetal Medicine, has lots of experience providing care for women who have gestational diabetes. She has tips and insights to help you understand what gestational diabetes is and how it impacts a pregnancy.
Worried about diabetes?
“The best ways to prevent diabetes in pregnancy are to achieve a healthy weight prior to becoming pregnant, live an active lifestyle, eat a diet high in protein and fiber and low in fat and sugar, and avoid gaining weight too quickly during pregnancy,” Elizabeth said.
What is gestational diabetes?
Gestational diabetes is diabetes that a woman has just during pregnancy. She doesn’t have it before, and it goes away after birth. The reason for it is insulin resistance caused by a hormone called human placental lactogen, which is made by the placenta.
Like other types of diabetes, gestational diabetes affects how cells use the sugar you eat. It causes high blood sugar that can affect the health of your pregnancy and your baby’s health. And if it’s left untreated or poorly treated, it can lead to stillbirth.
Complications that may affect baby:
- Excessive birth weight may increase risk for birth injury or need for cesarean section delivery
- Early pre-term birth
- Breathing difficulties in the baby
- Low blood sugar or hypoglycemia in the baby
- Increased chance of childhood obesity and developing Type 2 diabetes later in life
Risks to mom:
- Higher blood pressure or pre-eclampsia during pregnancy
- Having operative delivery or C-section
- Have 50-60% chance to develop Type 2 diabetes after pregnancy
There are several risk factors for gestational diabetes:
- Overweight or obese
- Lack of physical activity or sedentary lifestyle
- Have history of gestational diabetes in prior pregnancy or prediabetes
- Have polycystic ovarian syndrome (PCOS)
- Have strong family history of Type 2 diabetes
- Had previous baby weighing more than 9 pounds
- Black, Hispanic, Indian American or Asian American
“We usually screen for diabetes at 24-28 weeks with an initial one-hour test in which you drink 50 grams of a glucose drink and we test your blood sugars after one hour,” Elizabeth said. “If your results show that you are at higher risk for gestational diabetes, then we perform a two- to three-hour version of the glucose drink test to officially diagnose diabetes.
“We will test a patient in their first trimester if they had gestational diabetes with a previous pregnancy or if they have multiple risk factors.”
Living with gestational diabetes
A diagnosis of gestational diabetes requires a lifestyle change. You have to eat healthy, count carbohydrates and be active. Patients check their blood sugars four to six times per day. If the blood sugars are unable to be controlled with diet and activity, they are treated with insulin.
Your blood sugar levels can be harder to control as pregnancy progresses, because your insulin resistance continues to build.
“Having gestational diabetes means more frequent appointments for non-stress testing, and we recommend you do fetal kick counts at home to make sure your baby is moving normally,” Elizabeth said. “You will also need detailed ultrasounds to monitor fetal growth and check for birth defects.”
Women with gestational diabetes will require a non-stress test up to twice a week. You will be hooked up to a monitor for usually about 30 minutes. The test allows your care provider to monitor the health of the placenta and how the baby is doing.
“We monitor the baby closely as pregnancy develops because of the risk of stillbirth,” Elizabeth said.
Some women – 10-20% of them – will need insulin to reach their blood sugar targets. Some might need it just overnight. Some might need insulin doses all day long.
Women with gestational diabetes will also need a follow-up appointment with their OB/GYN six to 12 weeks after delivery to test for diabetes. They will need a diabetes test with their primary care physician every two to three years after that, too, because the risk for developing Type 2 diabetes is so high.
To help control your blood sugars, you will need to stay as active as you comfortably can be as you go through pregnancy. Elizabeth suggests 30 minutes of moderate activity most days of the week. Walking, swimming and bicycling are good low-impact choices for pregnancy. If you’re not used to exercising, start slowly and build your tolerance gradually.
“There is no way to cheat the system,” Elizabeth said. “Treating gestational diabetes appropriately is so important for a healthy mom and a healthy baby.”