Gestational diabetes affects 10% of all pregnancies, but it has no symptoms. It can lead to serious heart and kidney conditions for both you and your baby.
You may have heard about that syrupy drink the nurse gives you at your 24 week check-up? Drinking this very sweet drink is the first step in the glucose tolerance test, which will help your OBGYN know if you might be developing gestational diabetes.
The glucose tolerance test is designed to check how your body handles sugar while you’re pregnant. It helps answer the question of whether your body is producing enough insulin to turn sugar into energy, or if you need some extra help now that your placenta is making hormones that affect how your body utilizes insulin to meet your growing baby’s needs.
If your pancreas is struggling to keep up with the demand for insulin, you may have gestational diabetes, which is diabetes that only occurs when a woman is pregnant.
Here’s what you should know about gestational diabetes, who is at risk of getting gestational diabetes, how it can affect you and your baby, and how you can treat or even prevent it.
Why It’s Important to Test for Gestational Diabetes
Gestational diabetes can lead to serious complications; however, it rarely has any symptoms. This is why we test everyone around 24-28 weeks’ gestation.
Every year, up to 10% of women who are pregnant develop gestational diabetes, which puts their health and their baby’s health at risk if it goes untreated. Nearly half of the women with gestational diabetes go on to develop Type 2 diabetes at some time in their life. Their babies are also more likely to develop Type 2 diabetes later in life and to have obesity as children, according to the Centers for Disease Control.
But there is good news! Gestational diabetes can be managed and even reversed if it is detected and treated early on.
What is Gestational Diabetes?
Gestational diabetes means that a woman develops diabetes only when she is pregnant. People with diabetes have trouble either making insulin or using insulin. Insulin is a hormone in your blood that helps you use blood sugar for energy.
Between weeks 24 and 28 of gestation, your placenta begins producing a hormone called human placental lactogen, or hPL. HPL helps to regulate both your metabolism and your baby’s metabolism. One effect of hPL is that it makes your own body mildly insulin resistant. In some women, the resulting insulin resistance develops into diabetes.
If you develop gestational diabetes, you will need to manage your blood sugar through diet changes, exercise, and potentially insulin injections.
How is Gestational Diabetes Diagnosed?
When you’re around 24 weeks gestation, you’ll take a “glucose tolerance test” as part of your prenatal checkup. You’ll drink a cup of Glucola, which is 8 ounces of a glucose solution made with about 50 grams of sugar. (While Glucola flavors may vary, at Madison Women’s Health, you’ll get to choose from lemon, fruit punch, or orange.)
Your nurse will ask you to drink the solution quickly and then wait for an hour. After an hour has passed, your blood will be drawn and your blood glucose checked to determine how well your body handled the sugar from the Glucola.
If your results come back showing 130 mg/dl blood glucose or greater, we’ll ask you to return another day for a second glucose tolerance test, which takes 3 hours. For this second glucose tolerance test, you will be asked to not eat for 8 hours before your appointment, your drink will have 75g of glucose, and your blood sugar will be tested prior to drinking the beverage, 1, 2, and 3 hours later.
If any of those blood sugar tests are abnormal, you may be diagnosed with gestational diabetes.
Preparing for Your Glucose Tolerance Tests
- 1 Hour Glucose Tolerance Test — Schedule your appointment for a convenient time. It will last an hour. Don’t change your eating habits before the test. (But, if someone brings donuts to work and you don’t usually eat a donut every day, then don’t eat the donut before your test.)
- 3 Hour Glucose Tolerance Test — Schedule your appointment for the morning. It will last 3 hours. Do not eat anything after your dinner or drink anything other than water the night before. This test must take place after an overnight fast. You will be able to eat after your test.
Why is Gestational Diabetes Bad for My Baby?
Gestational diabetes affects both you and your developing baby. If you do not control your blood sugar with diet, exercise, and/or insulin injections, your high blood sugar can lead to the following conditions in your baby:
- Disproportionate growth: It’s common for the baby to be very big. This puts the baby at greater risk of birth trauma. The baby could be so big that your pelvis may be too small to accommodate your baby’s wider shoulders.
- Shoulder dystocia happens when the baby’s shoulders get stuck at the pubic bone during delivery.
- C-section may be required if the baby is too big for a safe vaginal birth.
- Baby born with low blood sugar: Because the baby’s body has been accustomed to a high blood sugar from the mother, their pancreas has been producing a lot of insulin in response. After the baby is born, their blood sugar drops and they will need supplemental breast milk or formula.
- Higher risk of staying in the NICU to monitor and treat the baby:
- Baby could have electrolyte imbalances after birth, which could cause arrhythmias and kidney problems.
- Baby could have high bilirubin levels after delivery.
- Baby is more likely to develop obesity as a child or teen.
- Baby is more likely to develop Type 2 diabetes later in life.
How Can Gestational Diabetes Affect My Body?
Diabetes of any kind can lead to serious complications. It increases your risk factors of other chronic health conditions. If your blood sugar levels remain too high for too long, your blood vessels could be damaged, leading to heart disease, neuropathy, vision loss and kidney disease.
If you do not control your blood sugar while you are pregnant and your baby becomes too large to deliver vaginally, you may need to have a C-section.
Having gestational diabetes also makes you more at risk of developing Type 2 diabetes later on.
Who Is at Risk?
Some women are more at risk of developing gestational diabetes than others:
- If you have a BMI (body mass index) of 26+ before becoming pregnant.
- If you have a family history of diabetes or gestational diabetes.
- If you are not physically active before or during your pregnancy.
- If you have polycystic ovarian syndrome (PCOS).
- If you previously had a baby over 9 pounds.
- If you have high blood pressure or heart disease.
- If you’re over the age of 25.
- If your body already tends toward insulin resistance, even if you are not overweight (your BMI is between 19-25).
How to Prevent and Treat Gestational Diabetes
The best way to prevent gestational diabetes is by eating a healthy, balanced diet and getting regular exercise before you become pregnant. You are less likely to develop diabetes and other complications during pregnancy if your body is at a healthy weight.
If you’re considering becoming pregnant and want to learn what you can do to reduce your risk of developing gestational diabetes, set up a pre-conception appointment. We’ll help you discover if there are any lifestyle changes you can make now that will set you up for a successful, healthy pregnancy!
If you are diagnosed with gestational diabetes, we will refer you to a diabetic educator and nutritionist at Meriter Hospital in Madison. There, you’ll learn more about what diabetes is, what causes it, and how to treat it. You’ll learn how to get your blood sugar under control and will have help from a dietitian to create a menu plan.
Best Diet for Preventing and Treating Gestational Diabetes
The best diet for preventing and treating gestational diabetes is one that balances carbohydrates, protein, and fats so that your blood sugar will not spike when you eat.
When you eat, your body turns carbohydrates into sugar to fuel your body. Some carbohydrates have a higher glycemic index than others. This means they cause a higher glucose level in your blood and require your body to produce more insulin to process it. Pairing carbs that have a higher glycemic index with protein or fiber can help “slow down” the sugar that’s entering your blood.
Taking the macronutrient (protein, carbohydrates, and fats) makeup of your foods into consideration is a new concept for many people! It may not come easily at first. That’s why we refer our patients to a diabetic educator and nutritionist at Meriter who can help you develop blood-sugar-friendly recipes and meal plans.
Prevention Diet Plan
Generally, three small meals per day with a snack between each meal and at bedtime is recommended. Eating according to this schedule helps to stabilize your blood sugar. The dietitian also recommends a minimum of 160g carbohydrates per day. (In other words, you don’t need to go “very low carb” or “keto” to keep gestational diabetes under control.)
For some people, simply changing their diet according to these guidelines is enough to keep their blood sugar in check.
To prevent gestational diabetes, exercise regularly, eat a healthy and balanced diet, and aim for a BMI between 19-25 before becoming pregnant.
What to Do If You’re Diagnosed with Gestational Diabetes
First of all, don’t panic or assume that you will need to give yourself insulin injections. Gestational diabetes can be controlled by your diet. Plus, you will receive excellent support and education through the diabetic educators at Meriter.
If you are diagnosed with gestational diabetes, do these four things right away:
- Avoid sugary drinks and sweets
- Eat protein with every meal or snack
- Take a 10-minute walk after each meal (this can also bring your blood sugar down)
- Meet with the diabetic educator and dietitian at Meriter
During the first week of changing your diet to be more blood-sugar-friendly, you will check your blood sugar first thing in the morning and an hour after each meal. After a week of following this diet and checking your blood sugar, you will learn how your body responds to specific foods. You may be able to keep your blood sugar in a healthy range. If that’s the case, you can check your blood sugar less often.
For example, you may learn that eating 1/2 cup of rice with your dinner doesn’t cause your blood sugar to spike, but eating 3/4 cup of rice makes it too high. If you eat a new food, check your blood sugar after that meal so you know how to manage it in the future.
If after two weeks of changing your diet and adding exercise you are still getting more than two high blood sugar readings in a week, then we may recommend an evening dose of insulin. Occasionally, an oral medication can be prescribed, but insulin injections are more effective at helping people control their blood sugar.
How Long Does Gestational Diabetes Last?
By definition, gestational diabetes only lasts while you’re pregnant. However, your body may still need help managing your blood sugar even after giving birth. You will take a postpartum glucose test between 6-12 weeks after giving birth (yep, another glucose drink!). If your glucose levels are still high, you may be diagnosed with pre-diabetes or Type 2 diabetes.
While no one wants a diagnosis of gestational diabetes, many women find that the support received from the dietitian help them to practice a healthier lifestyle after pregnancy. By following this kind of meal and exercise plan, they’re able to return to a healthier weight post-pregnancy more quickly, too.
Dr. Dickmeyer has been providing healthcare for women in the Madison area since 1998 and is a founding member of Madison Women’s Health. Her specialties include minimally invasive surgical techniques, high and low risk obstetrics, pelvic floor disorders and postmenopausal medicine.