Gestational diabetes

What is gestational diabetes?

Gestational diabetes is diabetes that is first diagnosed during pregnancy. Just like in type 1 and type 2 diabetes, it causes your blood sugar levels to become too high.

Unlike other types of diabetes, gestational diabetes isn't permanent. Once your baby is born, your blood sugar will most likely return to normal quickly. However, having gestational diabetes does put you at higher risk for developing diabetes in the future.

Gestational diabetes causes

When you eat, your digestive system breaks down most of the food into a sugar called glucose. Your cells use glucose as fuel. They need insulin to be able to absorb the glucose. (Insulin is hormone made by your pancreas.)

If your body doesn't produce enough insulin, or if the cells don’t respond well to it, they can't absorb enough glucose and too much of the sugar stays in your blood.

When you're pregnant, your body naturally becomes more resistant to insulin so that more glucose is available for your baby. For most moms-to-be, this isn't a problem: Your pancreas just makes more insulin so cells can absorb the extra glucose.

But if the pancreas can't keep up with the higher demand for insulin, blood sugar levels rise too high. This results in gestational diabetes, which can cause health problems for mother and baby.

Gestational diabetes symptoms

You're not likely to notice any symptoms of gestational diabetes. (You'll be tested for the condition during pregnancy.)
Gestational diabetes symptoms are similar to certain common pregnancy symptoms:

• Thirst
• Unusual hunger
• Frequent urination

Gestational diabetes risk factors

You're more likely to develop gestational diabetes if you:

• are age 25 or older
• have a close relative who has diabetes
• are overweight, especially if your body mass index (BMI) is 30 or higher
• have polycystic ovarian syndrome (PCOS)
• have a medical condition that makes diabetes more likely, such as glucose intolerance
• take certain medications like glucocorticoids (for asthma or an autoimmune disease), beta-blockers (for high blood pressure or a rapid heart rate), or antipsychotic drugs (for mental health problems)
• have had gestational diabetes before (30 to 60 percent will have it again)
• have had a big baby before (macrosomia)
• are African American, Native American, Asian American, Hispanic, or Pacific Islander

Gestational diabetes tests and diagnosis

Most women diagnosed with gestational diabetes don't have any symptoms. That's why your healthcare provider will offer you a screening test for gestational diabetes when you're 24 to 28 weeks pregnant. If you have any risk factors, your provider may suggest doing the test earlier.

The most common test for gestational diabetes is the oral glucose screening test. This test measures how well your body produces insulin. On the day of the test, your provider will give you a sweet liquid to drink. An hour later, you'll have a blood test to check your glucose levels.

If your screening test shows that your blood sugar is too high, you'll have to take a longer test called the oral glucose tolerance test. For this test, you'll need to fast for 8 hours before drinking a sweet liquid. Your blood will be tested several times: before the test, then one, two, and three hours after your drink the sugar. If two samples show your blood sugar is too high, you'll be diagnosed with gestational diabetes.

Both of these tests are safe for you and your baby and don't have any major side effects. But the liquid may taste unpleasant or make you feel nauseated.

Gestational diabetes treatment

You’ll need to monitor your blood sugar at home with a special device. This involves pricking your finger with a small needle first thing in the morning and then again an hour or two after you've eaten a meal.

About 85 percent of women can manage their gestational diabetes by getting regular exercise (even walking for 10 to 15 minutes after each meal can help) and eating a balanced, healthy diet. You may want to work with a nutritionist to understand how to follow a diabetic diet.

If your blood sugar stays high, you may also need to take medication or inject yourself with insulin. Your provider will teach you to how and when.

Do I need to change my diet if I have gestational diabetes?

If you’re eating well already, you may not need to change much. Focus on veggies, whole grains, lean protein, and healthy fats.

Carbs

Aim for about 40 percent of calories from carbohydrates. As with other types of diabetes, you’ll eat mostly complex carbs and limit “simple” carbs like sugars and refined starches. Complex carbs break down more slowly and have lots of fiber, vitamins, and minerals. These include:

• Whole grains like brown rice, whole oats, and whole wheat
• Legumes like beans, chickpeas, and lentils
• Starchy veggies like potatoes, corn, and peas
• Whole fruit is sugary, so limit to one to three portions a day. Try to avoid juice.
• Dairy has lactose, a sugar, so treat it like a carb and limit your portions.

Try to avoid refined starches like white flour and white rice, and any foods with added sugars.

Proteins

Proteins should make up about 20 percent of what you eat each day. Try to stick to lean (less fatty) options that are lower in unhealthy fats:

• Fish such as cod, catfish, tilapia, and shrimp
• Chicken and turkey without the skin
• Select or Choice grades of beef with the fat trimmed off
• Eggs or egg whites
• Beans and lentils
• Tofu and other soy products

Fats

The rest of your calories, about 40 percent, should come from fats. Most of these should be healthy (unsaturated) fats, such as:

• Olive, safflower, and canola oil
• Peanut and other nut butters (check labels, some have unhealthy trans fats)
• Nuts such as almonds, cashews, and walnuts
• Avocados

Limit unhealthy fats — saturated and trans and trans fats — to less than 10 percent of your calories per day. These include butter, high-fat dairy, fatty meats, and foods with trans fats.

How can I keep my blood sugar from spiking when I have gestational diabetes?

Your blood sugar levels naturally go up and down a bit over the course of the day and night. These tips can help keep your blood sugar in range over the day:

• Avoid foods and drinks that with a lot of simple sugars, such as sodas, fruit juices, and desserts — these will make your blood sugar levels spike.
• Have three small meals plus two to three healthy snacks every day to keep your blood sugar level stable. Try to eat something every two to three hours, and don’t skip meals.
• Include some lean protein at each meal to help balance blood sugar. Protein helps to make you feel fuller, sustain energy, and give you better blood sugar control.
• Have a snack before you go to bed and eat a good breakfast. Limit carbs and fruit
• Track your food with a journal or app to spot trends in your mood and energy.
• Remember to drink plenty of water. Try a squirt of lemon or lime if you miss soda.

How do I plan my meals if I have gestational diabetes?

Ask your doctor about medical nutrition therapy (MNT), a personalized eating plan you work out with a dietitian. A dietitian will talk to you about:

• Portion sizes
• Planning healthy meals and snacks
• Balancing carbs, protein, and fat
• Types of carbs, how much to have, when to eat them
• Timing insulin with eating
• The impact of exercise on diet and insulin
• Getting the fiber, vitamins, and minerals you need for a healthy pregnancy

As your pregnancy progresses, your dietitian may change your plan based on your blood sugar levels and how much weight you've gained. If you need to start taking insulin, your dietitian will likely make some more changes.

How will gestational diabetes affect my pregnancy?

It depends on your situation. Most women with gestational diabetes who can keep their glucose levels in check go on to have a successful pregnancy and a healthy baby. But having gestational diabetes makes you and your baby more likely to develop certain complications.

• You may have a higher risk of high blood pressure or preeclampsia. These conditions make preterm labor more likely and can cause health problems for you and your baby.
• Because of the extra sugar in their blood, babies are more likely to grow bigger than average (this is called macrosomia). Large babies can get stuck in the birth canal while being born (shoulder dystocia), which can injure nerves in the neck and shoulder. Your healthcare provider may recommend a planned c-section if your baby seems especially big.
• You're more likely to need to be medically induced before your baby is full term. Babies who are born early are more likely to have health problems and may also need extra care after birth.
• Your provider will likely monitor your labor closely. Especially if you’ve been taking medication to control your blood sugar, you may have glucose checks and insulin by IV during labor.

How will gestational diabetes affect my baby?

It's understandable to feel anxious about how gestational diabetes might affect your baby's health. The good news is that if your blood sugar is well managed, either through diet or medication (or both), your baby is much less likely to have any problems.

Gestational diabetes that isn’t well controlled can cause serious problems. It's possible that your baby will need to spend some time in the neonatal intensive care unit (NICU) after birth. It depends on how the birth went and your baby's condition.

Low blood sugar (hypoglycemia). Your baby has been used to making a lot of insulin to handle the extra glucose in her blood. After birth, there’s a risk of low blood sugar until she adjusts. Your provider will likely test and monitor your baby closely. Feeding your baby as soon as possible after birth, preferably by breastfeeding, can prevent or correct hypoglycemia. In severe cases, a baby will need glucose by IV.

Breathing problems. A baby may also be at higher risk for breathing problems at birth, especially if delivered early. If you have gestational diabetes, your baby's lungs tend to mature a bit later.

Heart problems. If your blood sugar control was especially high, the baby's heart function could be affected. Gestational diabetes sometimes thickens a baby's heart muscle (hypertrophic cardiomyopathy), which makes it hard to get enough oxygen into her blood.

Long-term concerns. There are also long-term risks associated with having a big baby. Large babies are more likely to become overweight or obese during childhood. They also have a higher risk of developing type 2 diabetes when they're older.

Can I still have a healthy pregnancy with gestational diabetes?

A diagnosis of gestational diabetes may make you feel upset and anxious. But with the right treatment and careful management, it's possible to have an uncomplicated pregnancy and healthy baby.

The most important thing you can do is follow your treatment plan. This includes sticking to your meal plans, if any, monitoring your blood sugar, exercising regularly, and going to all your prenatal appointments.

It's natural to find gestational diabetes difficult to cope with at first. You may feel deprived when you can't treat yourself to foods you love. You may also find it hard to motivate yourself to exercise, especially if you're feeling tired and sluggish.

Here are some tips that may make it easier to stick to your treatment plan:

• Ask your partner and family to keep sweets out of the house.
• If you’re missing sweets, find other ways to treat yourself. A pregnancy massage or day out with friends can boost your mood.
• Find an exercise buddy or a class to motivate you.
• Ask for help. Your provider can offer advice and extra support if you're having a hard time.

Warning signs to call the doctor if you have gestational diabetes

If you have gestational diabetes, you'll probably see your healthcare provider frequently. But if you don't feel well between visits or notice any unusual symptoms, contact your provider right away.

These symptoms could mean that your blood sugar is too high:

• feeling very thirsty
• peeing more often than usual
• feeling very tired
• feeling nauseous
• blurred vision

Your provider may have you come in for an exam and additional tests to make sure that you and your baby are doing well. If you're having trouble keeping your blood sugar at a healthy level, your provider can refer you to a specialist.