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Gestational Diabetes: Everything You Need to Know


Pregnancy is an incredible experience, and for some women, it can also be incredibly challenging. One of those potential challenges is gestational diabetes. 

In this article, we’ll discuss the causes of gestational diabetes, what it means for you and your baby’s health, and how to manage it.

What is gestational diabetes?

“Gestational diabetes is a type of diabetes that is first seen in a pregnant woman who did not have diabetes before she was pregnant,” explains the Center for Disease Control and Prevention (CDC). 

Gestational diabetes means your body is struggling to produce or properly use the insulin your pancreas secretes to keep your blood sugars within a normal range. 

Gestational diabetes is defined by higher than normal blood sugar levels during pregnancy that are not the result of type 1 or type 2 diabetes but instead related merely to the insulin resistance that comes with pregnancy and weight gain during pregnancy.

For some women, gestational diabetes may only develop during one of their pregnancies. For others, it may be a challenge they face with every pregnancy they experience.

“From 1 in 50 to 1 in 20 pregnant women has gestational diabetes,” explains the CDC. “It is more common in Native American, Alaskan Native, Hispanic, Asian, and Black women, but it is found in White women, too.”

Causes of gestational diabetes

Like type 2 diabetes, gestational diabetes is largely about insulin resistance. 

Insulin resistance

“Insulin resistance is when cells in your muscles, fat, and liver don’t respond well to insulin and can’t easily take up glucose from your blood,” explains the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

“As a result, your pancreas makes more insulin to help glucose enter your cells. As long as your pancreas can make enough insulin to overcome your cells’ weak response to insulin, your blood glucose levels will stay in the healthy range.”

Eventually, your blood sugar levels start to rise.

Insulin resistance during pregnancy is common and expected to a certain degree because rising pregnancy hormones naturally increase insulin resistance and your body’s insulin needs.

However, when your insulin resistance is severe enough that your blood sugars are consistently higher than normal, this can negatively impact both you and your growing baby.

Three things that increase insulin resistance during pregnancy, besides rising hormone levels:

  • A diet high in heavily processed, high-carb, high-fat foods
  • Too little exercise or general activity
  • Excessive weight gain

Fortunately, these are three things you have tremendous power over. Let’s take a closer look.

A diet high in heavily processed, high-carb, high-fat foods

Cravings during pregnancy are intense — no one can argue otherwise — but giving in to every craving is a road headed for gestational diabetes. Remember, there may be two people consuming the calories from what you eat, but that second little person is very little.

Just like it’s important to eat a balanced diet during every other year of your life, it’s especially important during the year you’re pregnant, too.

Managing those cravings can be as simple as earning one indulgence per day by ensuring you’re feeding your body (and your baby) mostly whole, real foods throughout the rest of the day.

That means you can eat the strawberry ice cream you’ve been thinking about since you woke up in the morning, but you can keep that indulgence from getting out of control by insisting that you’ll start your day with a healthy breakfast, followed by a healthy lunch and a healthy dinner!

Make room in your day’s calories for one less-than-healthy craving by choosing healthy, real food at most of your other meals. It’s about balance, just like your choices around food when you’re not pregnant.

Too little exercise or general activity

Activity increases the amount of glucose in your bloodstream that your muscles take up and burn for energy. And of course, even after you’ve stopped exercising, your body still burns more calories (and glucose) while resting when exercise is a regular habit.

Exercising during pregnant gets significantly harder with each passing month. While some women manage to jog and show up for CrossFit throughout every trimester, this really isn’t common or necessary. (In fact, it can also put a great deal of strain on your abdominal muscles and groin muscles.)

Instead, think of exercising during pregnancy as going for a good walk every single day. 

Walking is easy on the joints, easy on the muscles carrying your growing baby, and a great way to burn both calories, body fat, and glucose. 

If you can enjoy other types of exercise during your pregnancy, go for it! But if it doesn’t feel good to go for a jog or sit on a spin-bike, don’t beat yourself and give-up altogether. 

Go for a walk. Every day.

Excessive weight gain

Body fat blunts your sensitivity to insulin. It’s truly that simple. While gaining weight is part of any healthy pregnancy, the recommended goal is between 25 to 35 pounds. 

Preventing weight gain during pregnancy isn’t easy, especially in that last trimester — and swelling plays a role, too, so it’s important not to worry about each individual pound too much.

And there are some women — usually those who are very thin at the start of their pregnancy — who actually need to gain more than the recommended 25 to 35 pounds. 

However, for most women, a weight gain over 35 pounds is a clear sign that you are overeating and getting too little exercise. Contrary to the common belief, it won’t come off easily after the baby is born. Even a weight gain of 35 pounds can leave you with a stubborn 5 or 10 pounds well after your baby is born.

Weight gain during pregnancy is something that should not be taken lightly — no pun intended. 

Your risk of gestational diabetes

The following criteria increase your risk of developing gestational diabetes during pregnancy, according to the March of Dimes.

  • Over 25 years old
  • Being overweight or obese before or during pregnancy
  • Lack of physical activity
  • Gestational diabetes or macrosomia with a previous pregnancy 
  • Prediabetes prior to or during pregnancy
  • High blood pressure or a history of heart disease
  • Polycystic ovarian syndrome (also called polycystic ovary syndrome or PCOS)
  • Prediabetes prior to or during pregnancy
  • Related to someone with type 2 or gestational diabetes 

What does gestational diabetes mean for you and your baby?

Just because gestational diabetes goes away after pregnancy doesn’t mean it isn’t a big deal. The threats and concerns it poses to your growing baby and to you is real and should be taken very seriously.

While women with gestational diabetes can deliver very healthy babies, there are several known risks associated with this condition and how it will impact you and your baby.

Low blood sugar (hypoglycemia) at birth

When a baby is getting higher than normal amounts of glucose while in utero, it’s producing higher than normal amounts of insulin to manage that glucose. 

Then, when your baby is born and disconnected from that source (you) of extra glucose, it may continue to produce insulin to match that higher glucose delivery that it’s been enduring for the last few months even though it’s no longer receiving that glucose from your bloodstream. 

This can result in low blood sugars during the first few hours after being born. Fortunately, most babies’ blood sugar levels will rise as soon as they start nursing, but some may need a bottle of glucose or formula to treat more severe hypoglycemia.

After the first 12 hours, your baby’s blood sugar levels should stabilize fully.

Macrosomia: a very “chubby” baby

First, gestational diabetes means that there is a lot more glucose in your blood than normal. 

This means that your baby is getting a lot more glucose, too. And glucose = calories. While your baby gets more glucose, it’s going to produce more of its own insulin to manage and store all of that glucose. And a large percentage of it will be stored as body fat.

This means that the number one consequence of gestational diabetes in the mother is excessive weight gain for the baby. Women with gestational diabetes tend to have very “chubby” babies. 

Your baby’s weight will be estimated at several points during the last trimester of your pregnancy — especially if you have gestational diabetes. While these estimates can be inaccurate and “off” by a couple of pounds, they give your healthcare team a general idea of how much weight your baby is gaining, and the overall risk it might present during delivery.

Shoulder dystocia

Macrosomia also comes with an increased risk of “shoulder dystocia,” which happens when the baby gets stuck in the vaginal canal. 

“It can cause serious injury to both mom and baby. Complications for moms caused by shoulder dystocia include postpartum hemorrhage (heavy bleeding),” explains the March of Dimes. 

“For babies, the most common injuries are fractures to the collarbone and arm, and damage to the brachial plexus nerves. These nerves go from the spinal cord in the neck down the arm. They provide feeling and movement in the shoulder, arm, and hand.”

Preeclampsia & high blood pressure

“Preeclampsia is when a pregnant woman has high blood pressure and signs that some of her organs, like her kidneys and liver, may not be working properly,” explained the March of Diabetes. 

This condition can be very dangerous, and life-threatening if ignored.

Signs of preeclampsia include:

  • Presence of protein in your urine
  • Changes in vision and severe headaches
  • High blood pressure 

Once diagnosed, preeclampsia can sometimes be managed without much effort beyond medication and bed rest. But for some, it can mean 24-hour observation in a hospital room until your baby is born, or an unexpected premature birth or premature C-section for the safety of both you and your baby.

Higher risk of needing a C-section

A very “chubby” baby also means an increased risk of your baby getting stuck in your vaginal canal during delivery and needing a cesarean section in order to deliver the baby.

Is a C-section the end of the world? No, it’s still an incredibly beautiful moment that introduces you to your baby. It feels just as special and just as incredible, but the recovery from a C-section is longer than the recovery from vaginal birth. 

Risk of obesity and diabetes later in life

This one applies to both mom and baby. Gestational diabetes significantly increases your risk as the mother of developing type 2 diabetes after your baby is born — especially if you aren’t able to lose any extra weight gain. 

But gestational diabetes also increases your baby’s risk of diabetes and obesity because, during the very first months of their existence, they were consuming excessive amounts of glucose in utero. 

Jaundice

Jaundice is a very common medical condition, especially in babies born earlier than 39 weeks. A newborn baby with jaundice will have a yellow pigment in their skin, and the white’s of their eyes may look yellow, too. 

This is a sign that its liver isn’t functioning fully or properly yet. For most, this clears up during the first week or two of life, but for some, it can require further observation and treatment.

Stillbirth 

“This is the death of a baby in the womb after 20 weeks of pregnancy,” explains March of Dimes. High blood sugars during pregnancy have shown in research to increase a baby’s risk of stillbirth. 

The best thing you can do to lessen this risk as a mother with gestational diabetes is to take action and lower your blood sugar levels: improve your diet, get moving, manage your weight-gain, and work with your healthcare team to take any prescribed diabetes medications.

Because of this stillbirth risk, women with any type of diabetes are often induced or scheduled for a C-section delivery by 39 weeks. The research has simply shown that the risk of stillbirth is significantly higher past the 39-week mark.

Symptoms of gestational diabetes

The symptoms of only moderately high blood sugars can be easy to ignore or dismiss as mere symptoms of pregnancy. (Like, who doesn’t need to pee more often when they’re pregnant?)

The following are symptoms of persistently high blood sugars. You may experience some or all of them if you have gestational diabetes.

  • Excessive thirst
  • Urinating more often (and larger amounts of urine)
  • Headaches
  • Blurry vision
  • Difficulty concentrating
  • Yeast infections

Talk to your doctor immediately if you suspect that you’re experiencing at least a few of these symptoms.

Testing for gestational diabetes

The “Oral Glucose Tolerance Test” (OGTT) is usually done when a woman is between 24 to 28 weeks pregnant. It is administered to nearly all pregnant women, except for those already diagnosed with type 1, type 1.5, or type 2 diabetes.

The OGTT requires that you are in a fasted state at the start of the test, which means you haven’t had anything to eat or drink besides water since the evening before. 

Yes, you can and should drink plenty of water on the day of your OGTT.

The OGTT test first measures your fasted blood sugar, when it’s been at least 8 hours since your first meal.

This requires an intravenous blood draw.

Then, you’ll drink a sugary liquid, and your blood will be drawn multiple times within the 3-hour window after consuming the sugary liquid. 

Your blood sugar results will then be compared to the range in a non-diabetic.

Normal blood sugar levels, according to the American Diabetes Association:

  • Fasting blood sugar (in the morning, before eating): under 100 mg/dL
  • 1 hour after a meal: 90 to 130 mg/dL
  • 2 hours after a meal: 90 to 110 mg/dL
  • 5 or more hours after eating: 70 to 90 mg/dL

Blood sugar levels in a woman with gestational diabetes:

  • Fasting blood sugar level over 100 mg/dL (at least 8 hours since your last meal)
  • Within 3 hours of a meal: 140 mg/dL or higher 

Treatment options for gestational diabetes

Fortunately, the treatment plans for gestational diabetes are fairly straight-forward.

Depending on the severity of your high blood sugars, you will manage your diabetes through changes in nutrition and exercise as described earlier, or you may also be prescribed a diabetes-related medication to bring your blood sugar levels down more quickly.

Insulin

This sounds scary, but for many, it can be the fastest and surest way to bring your blood sugar levels down to a healthier level for both you and your baby. Every living mammal needs insulin to survive, and your body isn’t getting enough insulin during your pregnancy.

To mimic the effects of a healthy pancreas producing insulin 24 hours a day, there are two categories of insulin you might be prescribed as a woman with gestational diabetes

  • Fast-acting insulin: This is taken with meals to help cover the carbohydrates (and some of the fat and protein) in the meals you eat.
  • Long-acting insulin: This is taken once or twice a day and it gives you a “background” presence of insulin to help cover your overall insulin needs.

Depending on the severity of your blood sugar levels, your doctor might prescribe both types of only one to help improve your blood sugar levels.

Oral medications

These are the two most common and most likely drugs your doctor would prescribe to support your blood sugar management goals with gestational diabetes.

Glyburide

Brand names: 

How it works:

  • Helps your body produce more insulin
  • Helps your busy use the sugar in your blood more effectively for energy

Side-effects:

  • Nausea 
  • Heartburn
  • Decreased appetite
  • Joint and muscle pain
  • Blurry vision
  • Weight gain

Metformin

Brand names: 

  • Glucophage
  • Glumetza
  • Fortamet
  • Riomet

How it works:

  • Reduces the amount of sugar your liver makes
  • Reduces your appetite

Side-effects:

  • Diarrhea
  • Sore muscles
  • Gas
  • Constipation
  • Weight loss
  • Heartburn

Digestive side-effects should improve over the first few weeks but can be very inconvenient at first. Ask your doctor for the “extended-release” version if you can’t tolerate the side-effects of the original version.

As if pregnancy isn’t challenging enough, a gestational diabetes diagnosis can be incredibly overwhelming and scary. Don’t face it alone. Work with your healthcare openly about your challenges and let your friends and family help you by including them in your nutrition and activity goals!

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