| Signs and symptoms |
It's unusual for women to experience any signs or symptoms with gestational diabetes. When they do occur, symptoms may include:
- More fatigue than would be expected during pregnancy
- Excessive thirst
- Increased urination
| Causes |
During digestion, your body breaks down carbohydrates from food you eat into various sugar molecules. One of these sugar molecules is glucose, the main energy source for your body. Glucose is absorbed directly into your bloodstream after you eat, but it can't enter your cells without the help of insulin.
Your pancreas — a gland located just behind your stomach — produces insulin continuously. But when the amount of blood sugar increases after eating, insulin production also increases. The extra insulin "escorts" more sugar into your cells, providing your body with energy and maintaining a normal level of sugar in your blood.
Your liver also plays a key role in maintaining a normal blood sugar level. If you have more glucose than your cells need for energy, your body can remove that excess from your bloodstream and store it in your liver as glycogen. Then, when you run low on glucose — if you haven't eaten for a while, say — your body can tap into that stored glucose and release it into your bloodstream.
The amount of glucose in your blood fluctuates in response to a number of factors, including food you eat, exercise, stress and infections. Yet the complex relationship among insulin, glucose and your liver ensures that your blood sugar stays within set limits.
But during pregnancy, your placenta — the organ that supplies your baby with nutrients through the umbilical cord — produces hormones that make it harder for glucose to enter your cells. These hormones, which include estrogen, cortisol and human placental lactogen, are vital to preserving your pregnancy. Yet they also make your cells more resistant to insulin.
As your placenta grows larger in the second and third trimesters, it secretes even more of these hormones, further increasing insulin resistance. Normally, your pancreas responds by producing enough extra insulin to overcome this resistance. But sometimes your pancreas simply can't make enough insulin, which means too little glucose gets into your cells. The result is an increase in the level of sugar in your blood. When that happens, you're said to have gestational diabetes. After your baby is born and placental hormones disappear from your bloodstream, your blood sugar levels should quickly return to normal.
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| Risk factors |
Some women are at greater risk of gestational diabetes than others. Factors that make it more likely you'll develop the disorder include:
- Family history. Your chance of developing gestational diabetes increases if a close family
member, such as a parent or sibling, has type 2 diabetes (formerly called adult-onset diabetes or
noninsulin dependent diabetes).
- Weight. Being overweight before pregnancy makes it more likely you'll develop gestational
diabetes, but gaining a lot of weight during your pregnancy doesn't cause gestational diabetes. Your
obstetrician will recommend a good target for weight gain.
- Race. For reasons that aren't clear, women of some races are more likely to develop
gestational diabetes than are others. You're at increased risk if you're black, Hispanic or American
Indian. Researchers believe that the gene for type 2 diabetes may once have protected certain
populations from starvation.
- Complicated pregnancy. If you've had a stillbirth, a large baby or gestational diabetes in a previous pregnancy, you'll be screened more closely for gestational diabetes the next time you become pregnant.
| When to seek medical advice |
If you're pregnant or planning to become pregnant and are at risk of gestational diabetes, be sure to tell your doctor.
If you develop gestational diabetes, see your obstetrician for regular checkups. How often you see your doctor likely depends on how well your blood sugar levels are controlled. Office visits are especially important during the final three months of your pregnancy, when your doctor will carefully monitor your blood sugar levels. He or she will also watch for complications that can occur during the late stage of any pregnancy, such as high blood pressure, kidney problems or excessive amniotic fluid.
In addition, your obstetrician may refer you to other health professionals who specialize in the management of diabetes, such as an endocrinologist, a registered dietitian or a diabetes educator. They can help you learn to manage your blood sugar during your pregnancy.
To make sure that your glucose level has returned to normal after your baby is born, your doctor may check your blood sugar once or twice the day after delivery and again in six weeks. Once you've had gestational diabetes, continue to have your blood sugar tested at least once a year.
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| Screening and diagnosis |
Your doctor may not screen you for gestational diabetes if you're younger than 25 and have no other risk factors for the disorder. Otherwise, you may be screened using a glucose challenge test. The test is usually done between 24 and 28 weeks of pregnancy, although it may be performed earlier if your doctor thinks you're especially at risk.
There's no special preparation for this test, but you do need to fast for six hours beforehand. On the day of the test, you'll be asked to drink a glucose solution. An hour later, blood is drawn from a vein in your arm, and your blood sugar level is checked.
Although the amount of sugar in your blood fluctuates, the range is relatively narrow. After fasting all night, most people have levels between 70 and 110 milligrams of glucose per deciliter of blood (mg/dL). That's the equivalent of about 1 teaspoon of sugar in a gallon of water. But your blood sugar levels rise considerably after a meal, especially one high in sugar. A blood sugar level below 140 mg/dL is considered normal on a fasting glucose challenge test.
Having a blood sugar level above 140 mg/dL doesn't necessarily mean you have gestational diabetes. To confirm the diagnosis, a second test is necessary.
For the follow-up test, you'll be asked to fast overnight. You're then given another solution to drink — this one containing a higher concentration of glucose — and your blood sugar levels are checked every hour for a period of three hours. Having at least two instances of abnormally high blood sugar levels confirms the diagnosis of gestational diabetes.
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| Complications |
Some women worry that having gestational diabetes will cause birth defects, but fortunately, this usually isn't the case. In general, birth defects originate during the first three months of pregnancy, whereas gestational diabetes generally doesn't develop until the second or third trimester. This means your blood sugar levels are normal during the first critical months.
The greatest risk of gestational diabetes is a baby that grows too large (macrosomia). For a full-term pregnancy, this means a birth weight of 4,500 grams (9 pounds, 14 ounces) or more. Very large babies may have difficulty during delivery and are more likely to sustain birth injuries or be born by Caesarean section. Consistently keeping your blood sugar levels within a normal range can reduce these risks.
Sometimes babies of mothers with gestational diabetes develop low blood sugar (hypoglycemia) shortly after birth. That's because they're accustomed to receiving large amounts of blood sugar from their mothers, and their own insulin production is normal. These infants should have their blood sugar levels checked regularly after delivery. They may need early feeding or even a glucose solution through an intravenous line to prevent low blood sugar.
Babies born prematurely to mothers with gestational diabetes are more likely to develop respiratory distress syndrome, a condition that makes breathing difficult. It's caused by a lack of certain substances in the lungs that help prevent the lungs from collapsing every time the baby takes a breath. Babies with respiratory distress syndrome may need help breathing until their lungs become stronger.
Jaundice — a yellowish discoloration of the skin and eyes — is another potential complication. Newborn jaundice may begin during the second or third day of life, but sometimes isn't evident until around a week after birth.
Jaundice itself isn't a disease. In most cases it occurs because a baby's liver isn't mature enough to break down a substance called bilirubin, which normally forms when the body recycles old or damaged red blood cells. Although jaundice usually isn't a cause for concern, it should be carefully monitored by your doctor.
If gestational diabetes goes undetected, a baby has an increased risk of stillbirth or death as a newborn. But monitoring your blood sugar levels and following your doctor's recommendations regarding diet and exercise will prevent most problems for your baby.
Women who have gestational diabetes in one pregnancy have a greater risk of developing it again in another pregnancy. They're also more likely to develop type 2 diabetes — a type of diabetes that's present all the time, not just during pregnancy — as they get older. In fact, more than half the women with gestational diabetes eventually develop type 2 diabetes, a serious condition that can affect nearly every organ in your body.
Many cases of diabetes can be prevented with a healthy diet and regular exercise. That's why it's important to follow your doctor's advice about diet and exercise after delivery and to have your blood sugar level checked at least once a year.
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| Treatment |
Controlling your blood sugar is essential to keeping your baby healthy and avoiding complications during delivery. Almost all women are able to control their blood sugar simply with diet and exercise, although a few may need to use medication in addition to lifestyle changes. In either case, monitoring your blood sugar is a key part of your treatment program because it tells you whether your blood sugar is staying within a normal range.
Monitoring blood sugar
If you've just learned you have diabetes, monitoring your blood sugar may sound inconvenient and difficult. But once you learn how it's done, you'll likely grow more comfortable with the procedure.
To test your blood sugar, you draw a drop of blood from your finger using a small needle (lancet), then place the blood on a test strip inserted into a blood glucose monitor — a small, computerized device that measures and displays your blood sugar level.
Your blood sugar fluctuates throughout the day and is highest one to two hours after you eat. What and how much you eat and even the time of day also can have an effect. For that reason, your doctor may ask you to check your blood sugar in the morning before you eat breakfast and then two hours after you eat. You may also need to check your blood sugar in midafternoon. Your goal is to make sure you're keeping your blood sugar levels within a healthy range.
Your doctor will also monitor your blood sugar during labor. If your blood sugar levels rise, your baby's blood sugar will rise, too. This can cause your baby to have high levels of insulin, which may lead to low blood sugar right after birth.
Eating a healthy diet
A healthy diet is important for every pregnant woman, but it's even more important if you have gestational diabetes. Eating the right kind and amount of food is one of the best ways to control your blood sugar levels.
But contrary to what you may have heard, this doesn't mean you have to eat tiny portions of bland, boring foods. In general, you'll eat more fruits, vegetables and whole grains — foods that are high in nutrition and low in fat and calories — and fewer animal products and sweets. This is essentially the diet all Americans should follow.
Not only are fruits, vegetables and whole grains packed with nutrients, but they're also high in fiber — a substance that may help lower blood sugar. In fact, a recent study by the University of Texas Southwestern Medical Center found that a diet containing 50 grams of fiber a day — that's about seven or eight servings of fruits and vegetables and three servings of whole grains — reduced blood sugar levels by nearly 10 percent.
Even so, no one diet is right for every woman. Fortunately, you don't have to figure it out alone. A registered dietitian can help you put together a meal plan based on your blood sugar level, weight, exercise habits and food preferences.
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Exercise
In general, the more active you are, the lower your blood sugar. Physical activity causes sugar to be transported to your cells where it's used for energy, lowering the levels in your blood. Exercise also reduces blood sugar by increasing your sensitivity to insulin: Your body requires less insulin to transport glucose into your cells.
In addition, regular exercise can help prevent some of the discomforts of pregnancy, such as back pain, muscle cramps, swelling, constipation and difficulty sleeping. It can also help prepare you for labor and delivery. The increased muscle strength and endurance you develop reduce stress on your ligaments and joints during delivery, help you during labor, and shorten your recovery time.
See your doctor before beginning any exercise program. Once you have the go-ahead, take some time to think about which activities you enjoy and are likely to continue after your baby is born. Walking, cycling and swimming are good ways to get a safe aerobic workout. And although aerobic exercises are especially good, ordinary activities such as housework and gardening also can lower your blood sugar.
Aim for at least 30 minutes of aerobic exercise most days. But if you haven't been active for a while, start slowly and build up gradually. For best results, combine your aerobic activity with stretching and strength-training exercises. Exercising at the same time every day, varying your fitness routine and working out with other pregnant women can help you stay motivated.
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Medications
Sometimes diet and exercise may not be enough. In that case, you may need to take daily medication to help lower your blood sugar to safe levels.
Until recently, insulin was the only option for women with gestational diabetes because it doesn't cross the placental barrier. But the oral anti-diabetes drug, glyburide, has been shown to be safe and effective in controlling blood sugar in gestational diabetes. Talk to your doctor about the best choice for you.
Keeping your baby healthy before birth
Your obstetrician will likely recommend close monitoring of your baby's growth — usually using ultrasound. This is a test that combines high-frequency sound waves and computer processing to generate pictures of the inside of your uterus. Although ultrasound can give a good idea of your baby's size, it tends to be less accurate as your baby gets bigger.
Your obstetrician may also recommend a nonstress test (NST) or biophysical profile to make sure your baby is getting enough oxygen and nourishment, especially as you approach your due date.
A nonstress test is just that — a noninvasive test that causes no stress to your baby. In fact, it shouldn't be stressful for you either. NST usually takes less than 30 minutes and requires no hospitalization. It's a simple procedure that checks how often your baby moves and how much his or her heart rate increases with movement. A biophysical profile combines an ultrasound with NST to provide more information about your baby's breathing, tone, movement and the volume of amniotic fluid in your uterus.
In most cases, your doctor will try to prevent your pregnancy from going longer than 40 weeks because being overdue may increase the risk of gestational diabetes. Although your baby will almost always be born healthy, labor with gestational diabetes isn't routine, and a Caesarean delivery is much more likely.
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| Coping skills |
It's not easy living with a condition that can affect the health of your unborn child. Fortunately, most of the complications of gestational diabetes can be prevented with diet and exercise. Still, it sometimes can be stressful to regularly monitor your blood sugar and follow a specific diet and exercise plan.
Being under stress can make it harder to take care of yourself and manage your gestational diabetes. You may find yourself eating all of the wrong foods or forgetting to exercise. Furthermore, prolonged stress can actually cause your blood sugar levels to rise.
You'll probably feel better if you learn as much as you can about your condition. In addition to talking to your doctor and a diabetes educator or dietitian, look for information in books or on the Internet. Your doctor also may be able to put you in touch with other women who have the same disorder.
What's more, the very steps you're taking to control your blood sugar — such as eating a healthy diet and getting regular exercise — can help relieve stress. These same activities may also help prevent you from developing type 2 diabetes in the future. That makes exercise and a nutritious diet your most powerful tools for a healthy life as well as for a healthy pregnancy.
— May 22, 2003 —