Gestational Diabetes

What is gestational diabetes?

Gestational diabetes is a type of diabetes that is found for the first time when a woman is pregnant. Recent research suggests that the number of women getting gestational diabetes has increased to 18 percent of all pregnancies (ADA 2011). Diabetes means that your blood glucose (also called blood sugar) is too high. Your body uses glucose for energy, but too much glucose in your blood can be harmful. When you are pregnant, too much glucose is not good for your baby.

What causes gestational diabetes?

Changing hormones and weight gain are part of a healthy pregnancy. But both changes make it hard for your body to keep up with its need for a hormone called insulin. When that happens, your body doesn’t get the energy it needs from the food you eat.

When is gestational diabetes diagnosed?

Your doctor reviews your risk factors and decides when you need to be checked for diabetes. If you are at high risk, your blood glucose level may be checked at an early prenatal visit. If your test results are normal, you will be checked again sometime between weeks 24 and 28 of your pregnancy.

What increases the risk of gestational diabetes?

You are at risk if you can answer yes to any of the following:

• You have a parent, brother, or sister with diabetes
• You are of African American, American Indian, Asian American, Hispanic American or Pacific Islander decent
• You are 25 years old or older
• You are overweight
• You have had gestational diabetes before, or have given birth to at least one baby weighing more than nine pounds
• You have been told that you have “pre-diabetes,” a condition in which blood glucose levels are higher than normal, but not yet high enough for a diagnosis of diabetes. Other names for it are “impaired glucose tolerance” and “impaired fasting glucose”
• You have a diagnosis of Polycystic Ovarian Syndrome 

You are at high risk if you are very overweight, have had gestational diabetes before, have a strong family history of diabetes or have glucose in your urine.

You are at average risk if you checked one or more of the risk factors.

You are at low risk if you did not check any of the risk factors.

How is gestational diabetes diagnosed?

Depending on your risk and your test results, you may have one or more of the following tests:

Fasting Blood Glucose or Random Blood Glucose Tests

• Fasting Blood Glucose Test - your doctor asks you to fast, which means having nothing to eat or drink except water for at least eight hours.
• Random Blood Glucose Test - your doctor checks your blood glucose at a random time during the day.

These tests can find gestational diabetes in some people, but other tests are needed to be sure diabetes is not missed.

Screening Glucose Challenge Test

For this test, a sugary beverage (usually 50 gms of glucose) is consumed and then the blood glucose level is checked an hour later. This test can be done at any time of the day. If the results are above normal, further tests may be needed.

A normal result is < 130mg/dl.

Oral Glucose Tolerance Test

This will be scheduled on different day than a challenge test.

For this test, your health care provider gives you special instructions to follow. For at least three days before the test, you should eat normally. Then you fast for at least eight hours before the test. Your blood glucose is checked while you are fasting, and at one hour, two hours and three hours later.

How will gestational diabetes affect my baby?

Untreated or uncontrolled gestational diabetes can mean problems for your baby, such as being born very large and with extra fat; this can make delivery difficult and more dangerous for your baby. Low blood glucose right after birth and breathing problems are also potential complications. If you have gestational diabetes, your health care team may recommend some extra tests to check on your baby, such as:

• An ultrasound exam to see how your baby is growing, or special “stress” tests.
• “Kick counts” to check your baby’s activity (the time between the baby’s movements). These are done after 24 weeks. During a stress test, you lie on your left side or sit in a comfortable position, note the time you feel the baby move, count every movement until your baby has moved 10 times, then note the time again. If the baby takes longer each day to move 10 times, if in one hour your baby has not moved 10 times or if you have not felt your baby move all day, then notify your doctor

How will gestational diabetes affect me?

Often women with gestational diabetes have no symptoms. Gestational diabetes may increase your risk of high blood pressure during pregnancy and/or increase your risk of a large baby and the need for cesarean section at delivery. If you have elevated blood glucose levels, it can increase your risk of vaginal, bladder and kidney infections. There is also an increased risk of polyhydramnios (an excess of fluid in the amniotic sac).

The good news is your gestational diabetes will probably go away after your baby is born. However, you will be more likely to get Type 2 diabetes later in your life. (See the information on how to lower your chances of getting Type 2 diabetes.) You may also get gestational diabetes again if you get pregnant again.

Some women wonder whether breastfeeding is OK after they have had gestational diabetes. Breastfeeding is recommended for most babies, including those whose mothers had gestational diabetes. Gestational diabetes is serious, even if you have no symptoms. Taking care of yourself helps keep your baby healthy.

How to know if you blood glucose levels are on target

Your health care team will teach you to use a small device called a blood glucose meter to check your levels on your own. You will learn:

• To write down the results each time you check your blood glucose.
• How to use the meter.
• How to prick your finger to obtain a drop of blood.
• Your target range for blood glucose.
• When to check your blood glucose.

You may be asked to check your blood glucose when you wake up, just before meals (possibly but only if on insulin) and usually two hours after breakfast, lunch and dinner.

After my baby is born, how can I find out whether my diabetes is gone?

You will probably have a blood glucose test six to 12 weeks after your baby is born to see whether you still have diabetes. For most women, gestational diabetes goes away after pregnancy. You are, however, at risk of having gestational diabetes during future pregnancies or getting Type 2 diabetes later.

The registered nurses and registered dietitians in the St. Charles Diabetes Program are here to help you manage your gestational diabetes in Bend, Redmond, Prineville and Madras.