You have questions and you need simple and logical, evidence-based answers! This is everything you need to know about gestational diabetes.
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Table of Contents
- Gestational Diabetes Defined
- How does gestational diabetes develop?
- After Pregnancy
When I was diagnosed with gestational diabetes I searched for "gestationaldiabetes.com" and "gestationaldiabetesdiet.com" but neither site existed. So, I Googled "gestational diabetes" and various sites popped up with matches. A few were well-known medical sites, but I was disappointed at the quality of information - they all lacked depth of explanation and directed me back to my healthcare team (who I felt had already failed in educating me). I wanted someone to plainly tell me what was happening, and why, so I could figure out the best approach to managing it.
I did find one article that got close, and there is better information available today, but this article will be the plain, in-depth explanation I looked for during my diagnosis.
Just quickly, a favorite resource of mine is Real Food for Gestational Diabetes by Lily Nichols. She is a highly experienced Registered Dietitian-Nutritionist and Certified Diabetes Educator well versed in gestational diabetes treatment. This book is an easy read with extremely helpful information to understand gestational diabetes as a whole, and proper treatment. But if you're not into reading you can sign up for her FREE 3-video series here, or visit the free audio resources page.
Lily also authored a fabulous second book, Real Food for Pregnancy. It's another easy read that takes you through understanding the best way to eat for you and Baby, and why. It's great for any person who is pregnant or wanting to get pregnant, whether they have gestational diabetes or not. You can read the first chapter for FREE here.
Gestational Diabetes Defined
What is gestational diabetes?
In a nutshell, gestational diabetes is high blood sugar in a pregnant woman, and it poses harm to the baby.
It's possible that you were prediabetic or diabetic before conceiving and just didn't know it, but a gestational diabetes diagnosis could simply be the result of pregnancy hormones. Regardless of the situation, the diabetic state has been recognized and diagnosed during pregnancy.
What does it mean if you have gestational diabetes?
When you eat carbohydrates your blood sugar raises, as does everyone's, but in this pregnancy your blood sugar raises to an unsafe level and stays at that level longer than normal. This means that although your pancreas still produces insulin, it's not as effective as it needs to be. So, your body experiences an extended surge of glucose (glucose is what your body converts carbohydrates into - also known as sugar in your blood).
What happens to the baby if I have gestational diabetes?
The baby also experiences this surge because the placenta allows it to pass from your body to the baby. It's too much for the baby to handle and the effects can be both immediate and long term. More on this in Effects below.
How Does Gestational Diabetes Develop?
There's no exact answer to this because so much affects blood sugar - genes, stress, food, sleep, hormones and more! So, to pin point a direct cause would be nearly impossible. However, there are certain Risk Factors that increase your chances of developing gestational diabetes.
Typically, symptoms won't be noticed because they're mild and common in pregnancy, like thirst, lowered immunity, exhaustion and frequent urination. However, stronger symptoms common to diabetes are:
- blurred vision.
- numb or tingling hands or feet.
- excessively dry skin.
- slow healing sores.
If you're experiencing symptoms, or even if you're just curious, ask your doctor to test for gestational diabetes. Read below in Testing for more information.
Every pregnant woman can potentially develop gestational diabetes, but you're at higher risk for developing gestational diabetes if you:
- had gestational diabetes in a previous pregnancy.
- had a baby 8lbs 13oz or larger at birth - a condition known as macrosomia.
- have a family history of type 2 diabetes.
- have Polycystic Ovary Syndrome (PCOS).
- are overweight.
- are at least 25 years old.
- are any non-White ethnicity.
It's important to know that a diagnosis is possible even with no risk factors at all, as proven in this study that found that 44% of women with gestational diabetes surveyed possessed no risk factors. This means that you can be healthy, young, on your first pregnancy or fourth, and it's still possible develop gestational diabetes.
How do you prevent gestational diabetes?
Obviously, there are some risk factors that can't be controlled or changed, such as age and ethnicity. And even though you can still develop gestational diabetes with no risk factors at all, there are things you can do to lessen your chances:
- eat a balanced diet.
- exercise regularly.
- maintain a healthy weight.
These steps are natural and effective in maintaining a steady blood sugar! Hence, they are the recommended treatment options as well. However, there is no 100% prevention method for gestational diabetes - women with zero risk factors and a healthy lifestyle can still develop it.
Eat a balanced diet
Eating a balanced diet means including alland having a well-proportioned ratio of macronutrients (protein, fat and carbohydrates).
Since the average American meal is carb-heavy with pasta, rice, bread, other grains and sugary condiments, the best way to balance your plate is to emphasize vegetables and whole fruits (not juices).
Another way to smartly balance your plate is to include healthy fats and proteins because they fight to keep your blood sugar down.
Visit the Gestational Diabetes Diet page for more information.
When it comes to exercise, movement of any kind helps. Do what you can, whether is five minutes or 15, walking or strength training, once a day or three times a week. Make it as regular as you can. Just remember that something is better than nothing, and inconsistency is better than never.
What tests are done to diagnose gestational diabetes?
Testing is commonly done between 24-28 weeks, because insulin resistance is a natural part of pregnancy, and it worsens the further you are in pregnancy.
This test an oral glucose tolerance test (OGTT). It consists of you drinking a sugary drink and the doctor testing your blood one hour later. This test is considered the most accurate method to know whether or not you've developed gestational diabetes.
There are other testing methods. To read about them and the OGTT, click Gestational Diabetes Tests & Alternatives.
Can I get tested for gestational diabetes early?
Testing in the first trimester is smart and effective, especially if you had gestational diabetes before, are prediabetic, or have any combination of risk factors. An A1c test in the first trimester is over 95% accurate in predicting a diagnosis later in pregnancy. The benefit of testing in the first trimester is early intervention - it gives you the chance to do what's best for Baby earlier on.
Have your doctor to test your A1c when you have your initial blood work done at your first appointment. It requires nothing extra from you. The doctor just needs to check that box. If you've already had your initial blood work, don't worry. Bring it up at the next appointment.
Testing in this phase for prediabetes and diabetes is proactive! It's an opportunity to get ahead of a (possible) gestational diabetes diagnosis. Knowing the state of your body enables you to make minor adjustments before having to make big changes because of a diagnosis.
How do you get diagnosed with gestational diabetes?
If your blood sugar is above the safe range after taking the OGTT (most common testing method) you will be diagnosed with gestational diabetes. Your doctor will make referrals for you to see treatment specialists - a dietitian/nutritionist will guide you in diet changes, carb limits and advise exercise, and an endocrinologist will monitor you and Baby regularly.
If your blood sugar is in the safe range, you aren't diagnosed. If your blood sugar is in a mildly unsafe range, your doctor will likely order a three-hour test for you. The three-hour test requires you to have your blood drawn, then drink a sugary drink and have your blood tested every hour for the next three hours.
Diagnosed but haven't started treatment yet?
How do you treat gestational diabetes?
There are three methods of treatment:
Diet and exercise are the best treatments for a few reasons:
- they're natural and don't interfere with the changes happening inside of your body.
- they allow you stay in control of what happens to your body.
- they help you adjust to a new lifestyle of being proactive and preventative (lowering your risk of developing type 2 diabetes after pregnancy).
- medication is synthetic and has side effects.
- insulin has to be self-injected daily.
In some cases, a mother may require medication immediately, and that's okay. The goal is to keep the baby safe, so do what's necessary. Proper treatment lessens the possibility of potential effects.
You and your treatment team will decide what's best for you and the baby based on your specific case. Remember that YOU have a voice too!
How does gestational diabetes affect me?
- Hypertension - high blood pressure
- Preeclampsia - hypertension and damage to organs
- C-section - increased risk due to various complicating factors
These are all potential effects, meaning there's no guarantee any of them will or won't happen. They're all risky situations because you're put under excessive stress, and as a result, so is your baby.
How does gestational diabetes affect my baby?
- Macrosomia - 8lbs 13oz or larger
- Shoulder dystocia - shoulders getting stuck during birth
- Jaundice - yellowing of the skin
- Hypoglycemia - extremely low blood sugar
- Stillbirth - death before or at birth
The first four effects are not only conditions on their own, but they are added stress to the baby who is already under stress as he/she experiences birth.
Shoulders getting stuck is a huge and scary problem for everyone; unfortunately, there's no way to predict or prevent it. It can possibly cause physical and/or brain damage to the baby. Obviously, it's a significant medical emergency. For this reason, your doctor will likely suggest a c-section if your baby is measuring large. This is the only way to avoid the issue altogether.
Be sure to listen to the evidence and statistics behind for babies measuring large.
Each of the effects is possible in non gestational diabetes pregnancies, but in this case they are higher risk.
What are the long term effects of gestational diabetes for me?
It's possible to develop type 2 diabetes (long term insulin resistance). More on this in After Pregnancy.
What are the long term effects of gestational diabetes for my baby?
Metabolic programming is a concept worth knowing. Essentially, you're programming the baby's metabolism as he/she develops in utero. So, exposing him/her to high amounts of glucose is predisposing him/her to diabetes after birth; whether in infancy, childhood or adulthood.
It's the same concept as if you were to feed your child candy and dessert all day.
Un-managed blood sugars can program the baby's metabolism to work inefficiently.
Gestational diabetes continues through to the end of pregnancy. However, the effects of having gestational diabetes may continue after pregnancy in both mom and baby.
Does gestational diabetes go away after you have the baby?
Lily Nichols reported in Real Food for Gestational Diabetes that some mothers' blood sugars return to normal directly after birth, and others don't. Some even return to normal during breastfeeding, then "become problematic in the first few years after delivery."
It's recommended to get tested at your postpartum check up, then annually.
What happens to the baby?
Baby's blood sugar will automatically get tested after birth to see how he/she is doing without your constant supply of nutrients. It will continue to get tested until there are two to three acceptable readings. If the readings are low, the staff will monitor closely to determine the best course of action.
For the long term, continuing a proper diet is best because a study showed that 30% of children exposed to gestational diabetes went on to have glucose issues in adolescence.