Understanding gestational diabetes

You've probably heard of diabetes, and think of it as a lifelong disease. There are several types of diabetes, and most types do last a lifetime. However, gestational diabetes occurs only during pregnancy, usually disappears after your baby is born, and often does not have noticeable symptoms.

What is diabetes?

Diabetes prevents your body from using food properly. During digestion, most foods are converted to a sugar called glucose. Glucose is your body’s main source of energy. Your body's pancreas produces a hormone called insulin to convert the glucose to energy. When you have diabetes, your body has trouble producing enough insulin or using insulin, or both.

There are three main types of diabetes:

In type 1 diabetes, the pancreas makes no insulin, and daily injections of insulin are needed to process glucose.
In type 2 diabetes, the pancreas may not make enough insulin or the body may not use it properly (called insulin resistance).
In gestational diabetes, the body has trouble producing the extra insulin needed during pregnancy.

Gestational diabetes

During pregnancy, important hormones that are needed for the baby's growth interfere with insulin. This happens to all women during pregnancy, but most women can make enough extra insulin to keep their blood glucose levels under control.

With gestational diabetes:

Your body has trouble producing the extra insulin needed.
Your blood glucose levels become higher than normal.
The extra glucose is passed on to your baby.

Who gets gestational diabetes?

About 3 to 5 percent of pregnant women in America develop gestational diabetes. The risk is higher than average if you:

had it during previous pregnancies
have given birth to a baby weighing more than 9 pounds
had abnormal blood glucose levels in the past
are obese
have a family history of diabetes
are older than age of 25
have had a stillbirth or more than one miscarriage
are carrying twins or triplets
are a member of certain ethnic groups.

However, women sometimes develop gestational diabetes without being in any one of the risk groups. You did not cause this to happen to you and your baby — gestational diabetes often happens for reasons that can't be explained.

How can gestational diabetes affect your baby?

Untreated gestational diabetes can:

cause your baby to store extra glucose as extra fat and have a higher than average birth weight. This can result in delivery problems for both you and the baby.
cause your baby to be born with low blood glucose (called hypoglycemia)

During pregnancy, the baby's body produces more insulin to balance the extra blood glucose passed from you.
After birth, the baby may continue to produce too much insulin.
When undetected, the glucose-insulin imbalance can lead to seizures and even coma.

cause breathing problems, jaundice or premature delivery
cause stillbirth in rare cases
put your baby at a higher risk of developing obesity and type 2 diabetes later in life.

How can gestational diabetes affect you?

Even when gestational diabetes is treated, you are at an increased risk of developing high blood pressure and urinary tract infections during pregnancy, as well as type 2 diabetes later in life.

Following all the management guidelines for gestational diabetes will help you lower these risks:

How is gestational diabetes diagnosed?

Since any woman might develop gestational diabetes during pregnancy, all pregnant women, whether they fall into a high risk group or not, are typically screened for gestational diabetes. This usually occurs between 24 and 28 weeks of pregnancy, when the hormones that cause gestational diabetes are at high levels. No preparations are required for this screening test.

Screening for gestational diabetes

The typical steps for the screening test at your health care provider's office are:

You drink a 50-gram glucose beverage.
You sit quietly for an hour.
Your blood glucose level is measured. A result over 140 is considered a positive glucose screen.

After a positive result, you may be given a three-hour glucose tolerance test on another day to confirm or withdraw the diagnosis.

Diagnosing gestational diabetes

The typical steps to diagnose gestational diabetes using the glucose tolerance test are:

You fast the night before the test. On the days before the test, you should eat normally.
Your fasting blood glucose is measured before the test begins.
You drink a 100-gram glucose beverage at your health care provider’s office or lab.
You sit quietly for three hours.
Your blood glucose is measured at the one-, two-, and three-hour time spans during the three-hour period.
Two or more elevated test results means you have gestational diabetes.

Your health care provider will review your test results and tell you what happens next. Information covered may include:

a special meal plan
blood glucose monitoring
urine testing for ketones
exercise guidelines
insulin therapy.

Your health care provider's clinic may have a diabetes dietitian or educator help you, or you may be referred to a diabetes center at your hospital.

How is gestational diabetes managed?

The goal of managing gestational diabetes is to keep your blood glucose levels within a "normal" range for pregnancy. Your health care provider or diabetes educator will tell you what this range is.

Certain things directly affect your blood glucose level, including:

food (what you eat, how much you eat and how often you eat)
how much you exercise
how much stress you feel

Gestational diabetes is managed by controlling all of these things with the help of your health care provider and diabetes educator.

Until your baby is born, you'll have to think carefully every day about your food choices, the timing of your meals, your activity level and your exercise routine. You'll have to plan your day's schedule to make room for eating, exercising and monitoring your blood glucose regularly.

General guidelines will help you choose foods and a routine. However, you may need to customize your diet and exercise plan from time to time to achieve the results you want.

Sometimes, even when all guidelines are carefully followed, blood glucose doesn't stay at an acceptable level. In these cases, it's necessary to add insulin injections to your management plan.

This is a significant change in your life. Expect it to take concentration and effort at first. Try not to get impatient with yourself.

Remember that many resources are available to you. Your health care provider, the diabetes educators at your clinic or at your hospital's diabetes center, diabetes information telephone numbers and this online information are all here to help you.