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What is gestational diabetes?
The types of diabetes encountered in pregnancy are either pre-gestational (diagnosed before pregnancy) or gestational (diagnosed during pregnancy). Gestational diabetes is by far the most common type, accounting for 90% of all diabetes in pregnancy. Women with gestational diabetes have high blood glucose that appears to result, in part, from the hormones of pregnancy. These hormones make it so that your body develops resistance to insulin, which raises the blood glucose. Risk factors for gestational diabetes include if you have any of the following:
- Prior history of gestational diabetes or a family history of diabetes
- Known impaired glucose metabolism often referred to as pre-diabetes
- Obesity – considered if you have a body mass index over 30
- Are Hispanic, African American, Native American, Asian, Pacific Islander
- Are older than 25
How common is gestational diabetes?
Gestational diabetes affects an estimated 6 to 7% of all pregnancies.
How is gestational diabetes diagnosed?
It is recommended that all pregnant women receive a gestational diabetes screen, usually between 24 and 28 gestational weeks. This is done by having you drink glucola, a sugary drink, and then taking your blood one hour later to measure the glucose level. If your test is high, you will need to do a three hour version of this test. Before you drink the glucola, your blood glucose level will be checked and then, after you drink it, your blood glucose is checked at one hour, two hours and, again, at three hours. If you have two or more high values, you are diagnosed with gestational diabetes.
If you have any of the risk factors discussed above, you may be screened for gestational diabetes earlier in the pregnancy. If this screen is normal, it is repeated between 24 and 28 weeks gestation. If it is abnormal, then you will be diagnosed with gestational diabetes and treatment will begin.
Does gestational diabetes cause problems?
If you have gestational diabetes, you are at higher risk of developing pregnancy complications, especially if your blood sugars are high or poorly controlled. There is a higher chance of also developing high blood pressure of pregnancy or preeclampsia (read more about it here). You are also more likely to need a cesarean delivery compared to women who don’t have gestational diabetes.
Does gestational diabetes cause problems to the baby?
It can, especially if your blood sugars are not well controlled. Your unborn baby can grow larger than expected, particularly in the abdomen and shoulders. This can lead to problems delivering the baby’s shoulders during a vaginal delivery which may cause nerve damage or a broken bone. There is also a small risk of stillbirth. To help prevent these complications, most moms with diabetes are seen more frequently by their health care providers.
What should I know about using medications to treat gestational diabetes?
Blood sugars in gestational diabetes can frequently be controlled with diet and may not require medication. Blood glucose monitoring, done by pricking a finger and testing with a monitor, is usually done four times per day to determine if glucose control has been achieved. In pregnancy, blood glucose is monitored fasting and one or two hours after you eat rather than before you eat (as done by non-pregnant diabetics). It is recommend to keep one hour glucose values below 140 mg/dL, two hour glucose values below 120 mg/dL, and fasting glucose below 95 mg/dL. If the majority of values are high, a medication may be started.
What should I know about choosing a medication for my gestational diabetes?
The recommended treatment for gestational diabetes is insulin. However, glyburide is used more frequently. Glyburide is not approved by the United States Food and Drug Administration to treat gestational diabetes; however, it appears to be a safe and effective option. The main problem with using glyburide during pregnancy is that 20 to 40% of women will not be adequately treated with it and will require insulin therapy to achieve optimal blood sugar control.
What alternative therapies, besides medications, can I use to treat my gestational diabetes?
There are no alternative medications to treat diabetes in pregnancy. However, regular exercise and strict adherence to diet while pregnant can help you reduce the amount of insulin needed to control your blood sugars. Up to 85% of women with gestational diabetes will not need medication to control their blood sugars if they get regular exercise and follow the diet.
A nutritionist can help you determine how many calories you should eat per day and what types of food you should be eating to get these calories. In general, your daily caloric intake is determined by your pre-pregnancy BMI, how much weight you have already gained in pregnancy, and your activity level. Once you know how many calories you should eat, it is recommended that these calories come from 40 to 50% complex, high fiber carbohydrates, 20% protein, and 30 to 40% fats. These calories are typically divided throughout the day as follows: 10 – 20% at breakfast; 20 – 30% at lunch; 30 – 40% at dinner; and 30% for snacks.
What can I do for myself and my baby when I have gestational diabetes?
The majority of women with gestational diabetes can be managed with diet alone. It is important to monitor your blood glucose regularly, usually four times per day, so that your health care provider can determine if the diet is lowering your blood glucose enough or whether you may need to use medication. In general, you will be asked to see your health care provider more frequently during pregnancy to help with glucose control and to monitor the pregnancy more closely. It is important to attend all of these appointments and to bring along the record of all of your blood sugars tests.
Once you have the baby, you will need to repeat the diabetes screen 6 to 12 weeks later to determine if your diabetes has resolved. If this test is normal, it is recommended that you be re-screened for diabetes every 3 years because you have a 7-fold increased risk of developing type II diabetes later in life compared to women without gestational diabetes.
