Gestational diabetes is the label given to diabetes that is diagnosed during pregnancy. For some mothers, gestational diabetes may be diabetes or prediabetes that was undiagnosed before pregnancy. Sometimes, diabetes may resolve after pregnancy only to appear in subsequent pregnancies. A diagnosis of diabetes during pregnancy increases the risk of having diabetes after pregnancy. ACOG recommends every woman get tested for diabetes at around 24- 28 weeks gestation.
How is it diagnosed?
Symptoms of gestational diabetes may be increased thirst, increased urinary output, fatigue, or recurring yeast infections (most women have no symptoms). Also, if there are any predisposing factors such as PCOS, multiple unexplained miscarriages, or a family history of diabetes, we might want to consider testing. I like to check HbA1c which measures average blood sugar for the past 90 days during the first trimester (after the first trimester, the results aren’t as reliable). If the HbAic results are elevated, or in the high end of the normal range, we may discuss testing for diabetes. Typically gestational diabetes is diagnosed by having the mother drink a hyper-sweetened beverage and then have a blood sugar check in one hour to see how well your body processed the sugar. If sugar levels are too high with that test, then a second test using an even sweeter beverage and checking blood sugar over 2-3 hours is done. There are other testing options I prefer to use if we decide there is a reason or if a client wants to check for gestational diabetes. I like to start with checking fasting blood sugar, so you would stop eating at least 8 hours before your test. If your blood sugar is outside of normal range, we may want to run a two-hour postprandial blood test. For this test, you would fast for eight hours or overnight, have your fasting blood sugar checked and then go eat a high carbohydrate meal and have your blood drawn two hours after you started eating your meal. These two blood glucose numbers will tell us if your body is handling sugar in an appropriate manner.
What are the risks of gestational diabetes?
Your baby will have an elevated blood sugar, so baby’s pancreas reacts by overproducing insulin, leading to an increase in growth so you may birth a very large baby. Baby’s increased insulin production can interrupt production of surfactant in the lungs which can lead to respiratory distress. The newborn may have severe problems with hypoglycemia (low blood sugar) or hypocalcemia (low calcium levels) after birth. The risks to the mother includeincreased risk of high blood pressure, higher risk of developing preeclampsia, higher risk of polyhydramnios, and a high risk of postpartum hemorrhage.
What is the treatment if I have it?
Treatment for diabetes in pregnancy depends on how severe it is. A diet that is high in protein and complex carbohydrates and low in simple sugars is the first thing to adopt to manage blood sugar. Regular exercise is also key to managing blood sugar levels. The goal of all treatments is to hold blood sugar steady at a safe level. For some women, insulin therapy may be needed to manage blood sugar in addition to diet and exercise.