Gestational Diabetes and Your Pregnancy- What You Should Know.

My Doctor or Midwife Diagnosed Me With Gestational Diabetes… What Now? What Do I Need To Know?

First off- What IS Gestational Diabetes?

Diabetes mellitus (also called “diabetes”) is a condition in which too much glucose (sugar) stays in the blood instead of being used for energy. Health problems can occur when blood sugar is too high. Some women develop diabetes for the first time during pregnancy. This condition is called gestational diabetes (GD). Women with GD need special care both during and after pregnancy.

OK- I get that… But what CAUSES it?

The body produces a hormone called insulin that keeps blood sugar levels in the normal range. During pregnancy, higher levels of pregnancy hormones can interfere with insulin. Usually the body can make more insulin during pregnancy to keep blood sugar normal. But in some women, the body cannot make enough insulin during pregnancy, and blood sugar levels go up. This leads to GD.

How do I know if I have it? I didn’t have diabetes before I got pregnant! I was totally healthy!

Approximately 2-5% of pregnant women develop gestational diabetes; this number may increase to 7-9% of mothers who are more likely to have risk factors. The screening for this disease usually takes place between your 24th and 28th week of pregnancy.

Doctors 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.

During your prenatal appointment, your provider will give you a sweet liquid (note- not very tasty) to drink one hour before your blood is drawn. It may cause you to feel a bit nauseous. The results will indicate if you are producing enough insulin or not. If you have had this test before (called a Glucose Tolerance Test) and you know you don’t do well with the liquid, ask your provider if you can use an alternative such as a specific meal or jelly beans instead of the glucose drink! **I highly recommend bringing a protein bar or something to eat after the test- it usually will make you feel better!

***Important to note here- a GD diagnosis is NOT your fault! As you read above- because of the placenta producing large amounts of hormones during pregnancy- many women can become “glucose intolerant” or insulin resistant. This doesn’t mean you weren’t staying healthy or that you were sitting around binging on chocolate. Don’t blame yourself!

So- My Doctor or Midwife diagnosed me with GD- What Now?

The primary means of treating gestational diabetes is controlling your blood sugar levels.

There are steps you and your doctor can take in order to ensure you maintain healthy blood sugar levels:

  • Diet and Exercise!! Many women can control their GD simply with moderate amounts of walking/light exercise and being careful with their diet. Usually this is the first modification to try!

  • Extra Monitoring of the Baby and Pregnant Woman

  • Oral Medication

  • Self-monitoring of blood glucose levels at home

  • Insulin therapy, if necessary and glucose levels cannot be controlled with diet and exercise alone.

If gestational diabetes is diagnosed and treated effectively, there is little risk of complications. In such cases, women with gestational diabetes can have healthy babies, and the diabetes should disappear after delivery.

A Cochrane Study was done in 2009 that included almost 1500 women with Gestational Diabetes. Here is what they found:

The Cochrane reviewers found that when women were randomly assigned to receive any treatment for gestational diabetes (insulin, medication, dietary changes, glucose monitoring, or a combination of these), they had the following outcomes compared to women who were randomly assigned to receive no treatment:

  • 35% decrease in the risk of pre-ecclampsia

  • 33% increase in the risk of induction

  • 54% decrease in the risk of the baby weighing more than 8 lbs 13 oz (>4,000 grams)

  • 72% decrease in the risk of having 1 of the following outcomes: shoulder dystocia, infant death, bone fracture, or nerve damage (this is what we call a composite outcome—the numbers are too small to look at individual outcomes, so we look at a combination. In this case, the risk of experiencing 1 of those 4 things is decreased, but there is no statistical decrease in the risk of infant death by itself or shoulder dystocia by itself, etc.) 

  • There were no differences between groups in the risk of C-section, pre-natal hospitalization, vacuum or forceps delivery, postpartum hemorrhage, length of hospital stay, gestational age at delivery, bone fractures, nerve palsy, infant death, infant hypoglycemia, or need for resuscitation.

When the authors compared women who were randomly assigned to receive oral medication versus women randomly assigned to receive insulin, they found that

  • Women who received oral medication had a 54% decrease in the risk of C-section compared to women who received insulin

  •  Women who received insulin had babies that were 7.7 times more likely to experience low blood sugars after birth

  • No other differences between the 2 groups

  • Note: This medication vs. insulin part of the Cochrane review was limited by small sample sizes (a total of 114 mother-baby pairs)

OK- But what are the risks?

IF Gestational Diabetes is NOT Treated/Managed/Controlled during pregnancy… These risks to mother and baby can come into play:

  • Larger than average birth weight

  • Premature delivery

  • Increased risk of non-elective cesarean delivery

  • Slightly increased risk of fetal and neonatal death

It is also important that you watch for signs of diabetes after giving birth.

These symptoms include:

  • Frequent urination, Persistent thirst, Increased sugar in blood or urine

Testing may be done a few months after the delivery to make sure your blood sugar levels have returned back to normal. Also, keep in mind that women who have gestational diabetes have an increased risk of developing Type 2 Diabetes later in life. Talk with your provider to better understand these risks and what you can do to prevent future issues!

To sum it all up- Gestational Diabetes occurs in less than 10% of Pregnant Women. Typically, it can be treated by diet, exercise and medications. IF it is treated, the risk factors associated with GD drop significantly- so it is important to work with your provider to find a treatment plan that works well for you and your baby. Many women go on to have very normal pregnancies and deliveries with some small lifestyle changes! For more information, check out the links below!

https://evidencebasedbirth.com/does-gestational-diabetes-always-mean-a-big-baby-and-induction/

https://www.acog.org/Patients/FAQs/Gestational-Diabetes?IsMobileSet=false

https://evidencebasedbirth.com/gestational-diabetes-and-the-glucola-test/

https://www.acog.org/Womens-Health/Gestational-Diabetes?IsMobileSet=false