About three to five percent of all
pregnant women develop gestational diabetes during pregnancy. It is
different from type 1 diabetes, in which the body produces no insulin and
insulin must be injected, and from the more common type 2 diabetes.
Patients with type 2 diabetes suffer from varying levels of insulin
resistance and may control blood glucose levels through diet and exercise,
with oral medication, or with insulin injections.
Gestational diabetes usually
develops about midway through a pregnancy, at about 20 to 24 weeks, and is
caused by the changes in hormones in your body during pregnancy. In
addition to supplying your baby with nutrients and water from your
circulation, the placenta produces a number of hormones vital to the
pregnancy. Some of these have a blocking effect on insulin. As the
placenta grows larger, the more hormones are produced, and the greater the
insulin resistance becomes. In most women, the pancreas is able to make
additional insulin to overcome this insulin resistance. When the pancreas
makes all the insulin it can, and there still isn't enough to overcome the
effect of the placenta's hormones, gestational diabetes results.
Any woman might develop gestational
diabetes during pregnancy. Factors that have been identified as increasing
the risk for gestational diabetes are obesity, a family history of
diabetes, having given birth to a very large infant previously, having had
a stillbirth or a child with a birth defect, or having too much amniotic
fluid. Women older than 25 are at greater risk than younger ones.
Gestational diabetes usually clears
up as soon as the baby is born, since when the placenta is removed, the
hormones it was producing - which were causing the insulin resistance --
are also removed. Once again your insulin is permitted to work normally
without resistance, and you should no longer have any problems with blood
Although this type of diabetes
disappears when the baby is born, some women who have gestational diabetes
go on to develop diabetes when they get older. Some studies have reported
that almost 40 percent of women who have gestational diabetes will go on
to develop type 2 diabetes. So, if you have gestational diabetes, you will
need to be screened for type 2 diabetes every year.
One of the major concerns about
diabetes in pregnancy is the harmful effect that high blood glucose levels
can have on the developing baby. In women who don't have their blood
glucose levels controlled at near normal levels during the first
trimester, there is a higher incidence of miscarriage and birth defects.
However, since gestational diabetes doesn't appear until well after that
critical period, there is little likelihood of those types of problems in
Although most women with this
condition are treated with diet, some may need insulin. Gestational
diabetes can't be treated with pills because it is not known what effects
those medications may have on the baby.
Your healthcare provider may
recommend that you see a diabetes specialist, and you will need to take
additional steps to control your blood glucose levels for the duration of
your pregnancy. The following steps can help you achieve a smooth
pregnancy and a healthy baby:
- Following an appropriate meal
- Frequent self-monitoring of
blood glucose (SMBG)
- Administering insulin injections
and knowing how to adjust the doses depending on results of SMBG
- Adding or maintaining an
appropriate level of physical activity
steps to achieve a smooth pregnancy
an appropriate meal plan
Your eating patterns are
especially important now, since you want to control blood glucose
levels and also assure that both you and your baby are getting
adequate nutrition during your pregnancy. Your doctor will provide
you with a personalized meal plan as part of your diabetes
self-management program. This plan will be geared toward helping
you maintain normal blood glucose levels. It will incorporate
these fundamental patterns that have been proven to help keep
glucose under control in people with diabetes:
- Avoid sugar and foods
high in sugar
- Emphasize complex
carbohydrates, such as vegetables, cereal, grains, beans,
peas, and other starchy foods
- Emphasize foods high in
- Keep your diet low in
- Have bedtime snacks that
include both protein and complex carbohydrate
self-monitoring of blood glucose (SMBG)
The only way to tell if you
are succeeding in controlling your blood glucose is to monitor
your levels, and to do it frequently. This is called
self-monitoring of blood glucose, or SMBG. Pregnant women are
advised to monitor at least four times a day, and sometimes as
often as 10 times a day. It requires a drop of your blood (from a
fingerstick) and a home glucose monitor. Since your need for this
will be temporary, inquire about renting the equipment from your
local pharmacy or diabetes supplier.
Your doctor and diabetes
specialist will teach you about this important aspect of your
testing | Monitoring
insulin injections and knowing how to adjust the doses depending
on the results of SMBG
If you are unable to
control your glucose levels with diet and exercise, you may need
to take insulin. Pregnant women cannot take oral anti-diabetes
medications, since the safety of those medications during
pregnancy has not been established. You should use only human
insulin, since the use of insulin analogs has not been adequately
tested in pregnant women.
Your body's need for
insulin is going to steadily increase throughout your pregnancy.
Your insulin dose may have to be adjusted upward periodically; it
may also have to be recalculated as you and your baby get bigger.
Your doctor will be watching this area carefully and will want to
see your SMBG results for guidance.
In order to maintain tight
control, you will need to know how to adjust your dosage depending
on the results of your frequent monitoring. Again, your healthcare
provider or pharmacist can help you master this process.
delivery device | Latest
When people with diabetes
undertake a program to achieve tight control of their blood
glucose levels, they increase the risk of severe hypoglycemia, or
low blood glucose. There is no evidence that hypoglycemia is a
risk to the developing baby, but it can be a problem for you.
Therefore, be sure to keep ready sources of carbohydrates with you
at all times. It would also be a good idea for you, your family,
and perhaps a close co-worker to learn how to administer glucagon
injections in case of a hypoglycemic crisis.
or maintaining an appropriate level of physical activity
A moderate exercise program
will help maintain control of blood glucose levels while also
making you feel better. It will help get you in shape for
delivery, too. If you've already been exercising, you can probably
continue it, although you should avoid sports or exercises where
you might fall. Bicycling, jogging, and cross-country skiing are
good exercises to continue during your pregnancy.
If you aren't exercising
regularly, now is a good time to start, but check with your doctor
about your planned activity and start slowly. Vigorous walking is
an excellent way to start. Even if you are having some problems
during your pregnancy, light exercise such as leisurely walking is
still a good idea.
You'll need to plan your
periods of activity along with your food intake and insulin
injections. If you're on insulin, you'll need to take a few
- Be aware of the risk of
hypoglycemia, and take a high-sugar snack along with you.
- It may be necessary to
eat small snacks between meals.
- If you exercise right
after a meal, have a snack after the exercise.
- If you exercise two
hours or more after a meal, eat the snack before the exercise.
- One serving of fruit
will maintain blood sugar for most short-term activities
(about 30 minutes).
- One serving of fruit
plus a serving of starch will be enough for activities that
last longer (an hour or more).
- Don't reduce your
insulin intake before exercising.
- Don't inject insulin
into a part of the body that will be exercised; for example,
if you'll be walking, avoid injecting into your leg.
much weight to gain?
Your doctor has already given you
guidelines for gaining weight during your pregnancy. Caloric input and
nutrition are especially important for you and your baby.
The "optimal" weight gain
depends on your weight when you became pregnant. If your weight was in a
good range for your body size, then a weight gain of 24 to 27 pounds is
recommended. If you are 20 or more pounds above your desirable level, you
should gain 24 pounds.
If you gain too much weight, the
extra fat requires the body to produce more insulin to try to keep blood
sugar levels normal. But if your body is incapable of producing more
insulin, then your blood glucose levels will rise above acceptable levels.
do some women get gestational diabetes?
Usually, the body breaks down
much of the food you eat into a type of sugar, called glucose (pronounced
gloo-kos). Because glucose moves from the stomach into the blood, some
people use the term blood sugar, instead of glucose. Your body makes a
hormone called insulin (pronounced in-suh-lin) that moves glucose out of
the blood and into the cells of the body. In women with gestational
diabetes, the glucose can't get into the cells, so the amount of glucose
in the blood gets higher and higher. This is called high blood sugar or
do I know if I'm at risk?
the questions below to learn your risk level for gestational
you a member of a high-risk ethnic group (Hispanic, African
American, Native American, South or East
Asian, Pacific Islander, or Indigenous
you overweight or very overweight?
you related to anyone who has diabetes now or had diabetes in
you older than 25?
you have gestational diabetes with a past pregnancy?
you had a stillbirth or a very large baby with a past
If you answered YES to TWO or
more of these questions, you are at HIGH
RISK for gestational diabetes.
If you answered YES to ONLY
ONE of these questions, you are at AVERAGE
RISK for gestational diabetes.
If you answered NO to ALL of
these questions, you are at LOW RISK
for gestational diabetes.
I get tested?
you are at...
||Get tested as
soon as you know you are pregnant.
||If your first
test is negative, get tested again when you are between 24 and 28
when you are between 24 and 28 weeks pregnant.
tested unless your doctor or nurse tells you that you should.
in mind that every pregnancy is different. Even if you didn't have
gestational diabetes when you were pregnant before, you might get it
during your current pregnancy. Or, if you had gestational diabetes before,
you may not get it with this pregnancy. Follow your doctor's or nurse's
advice about your risk level and getting tested.
is involved in getting tested?
Tests for gestational diabetes
have two parts. First, you drink about one full glass of a sugar drink.
Then, after a certain amount of time, a doctor, nurse, or other healthcare
worker takes a sample of your blood and tests the blood to see how much
sugar is in it (called a blood sugar test).
If the level of sugar in your
blood is normal, then you probably don't have gestational diabetes.
If your blood sugar level is
high, then you might have gestational diabetes. Your doctor or nurse may
want you to take another blood test if your blood sugar level is high.
Your doctor or nurse will tell you more about the test before you take it.
You may have to follow a
special diet for a few days or fast (not eat or drink anything but water)
for a few hours before you take the test. Ask your doctor or nurse if you
have to follow any special instructions before you get tested.
if I don't get treated for gestational diabetes?
Most women with gestational
diabetes have healthy pregnancies and healthy babies because they control
their condition. Without treatment, mothers with this condition could have
very large babies. These mothers may have a harder time with labor and
natural delivery (through the vagina). Some mothers need surgery to
deliver their bigger babies, which can increase the mother's risk of
infection. Mothers who have their babies by surgery also take a longer
time to recover.
Children whose mothers had
gestational diabetes are at higher risk for certain health problems:
As babies, they are at
higher risk for Respiratory Distress Syndrome (RDS), a disease that
makes it hard for the baby to breathe.
They are more likely to be
obese (very overweight) as children or adults, which can lead to other
They are at higher risk for
getting diabetes, or high blood sugar, as they get older.
What should I do if I have gestational diabetes?
If your doctor or nurse tells
you that you have gestational diabetes, you will need to follow a
treatment plan to keep the condition under control. Most treatment plans
include testing your blood sugar level, eating a healthy diet, and getting
regular physical activity. Some women also need to take insulin as part of
their treatment plan.
More and more women with
gestational diabetes have healthy pregnancies and healthy babies because
they follow their treatment plan and control their blood sugar level.