With so many news stories about diabetes recently, the word loses its impact until a pregnant woman hears that she has it. Suddenly, diabetes is in your medical chart and your baby may be at risk. It’s common for women to be shocked and even depressed at the news, as some of you noted on our Facebook page this week. Many women wonder whether they have caused irreversible harm to their baby and how they’re to blame for putting their child and pregnancy at risk.
It’s important to understand gestational diabetes, or diabetes that occurs during pregnancy. There are risk factors that increase your chances of developing gestational diabetes, but some women develop it even if they do not have any risk factors. When you’re pregnant, your body undergoes normal physiologic changes that predispose you to have higher levels of sugar in your bloodstream. Hormones produced by the placenta cause this to happen so that your baby can get nutrients and grow. At the same time, because your body has higher blood sugar levels and your cells have become slightly insulin resistant, your pancreas has to work a little harder to produce insulin to keep up and provide balance. Gestational diabetes occurs when your pancreas can’t quite keep up, and your blood sugar levels then start to trend higher. You probably won’t feel any differently or notice any symptoms.
As part of routine prenatal care, our obstetric providers screen patients for gestational diabetes with a glucose tolerance test at 26 to 28 weeks. Your provider may recommend earlier screening if you have had gestational diabetes in the past, or if you have risk factors for developing gestational diabetes, including:
- You are older than 25.
- You are overweight or obese.
- You have had a previous baby that was very large, or a previous stillbirth.
- You have a strong family history of diabetes.
- You are pregnant with twins.
- You are African American, Native American, Asian American or Pacific Islander, or Hispanic or Latina.
The risks to your baby of gestational diabetes include being very large, having problems with being able to maintain their own blood sugar levels after they are born, jaundice and possible problems with breathing. With very large babies, there is an increased chance of having nerve damage during delivery and of needing to have a cesarean section. Children born to women with gestational diabetes are also at higher risk of having diabetes themselves. In addition to a higher chance of having a cesarean section, moms with gestational diabetes are also more likely to be induced for medical reasons and they are at higher risk of developing preeclampsia or high blood pressure during pregnancy.
While having gestational diabetes means that you do need to monitor your blood sugar closely, the good news is that it can often be controlled with dietary modifications, as some of you shared in our Facebook discussion. These dietary changes are not extreme, but actually involve eating healthy, balanced meals at regular intervals throughout the day. Sometimes women are able to learn new health habits that they can continue beyond pregnancy. Exercise may also be recommended, but you should discuss this with your doctor before starting a vigorous program. Occasionally, gestational diabetes cannot be controlled through diet and additional medications may be needed. These may include pills that can be taken by mouth or insulin, which is given via daily injection.
Thankfully, gestational diabetes generally goes away after the baby is born. A small percentage of women will continue to have high blood sugars, so it is important to get tested again at your postpartum visit. If you still have elevated sugars at that time, you may have diabetes and will need to follow-up with your primary care physician. Even if you do not have diabetes, you should be screened at regular intervals, as women who have gestational diabetes are at higher risk for developing diabetes later in life.
Diagnosis and treatment of gestational diabetes is one of the most important things your obstetric care provider can help with during your pregnancy. The diagnosis can be worrisome for patients, but is important to remember that the risks can be greatly reduced. Taking excellent care of yourself if you have gestational diabetes will help you stay healthy and have a healthy baby.
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