Topic Overview

What is gestational diabetes?

If your blood sugar
level first becomes too high when you are pregnant, you have gestational
diabetes. It usually goes back to normal after the baby is
born.

High blood sugar can cause problems for you and your baby.
Your baby may grow too large, which can cause problems during delivery. Your
baby may also be born with low blood sugar. But with treatment, most women who have
gestational diabetes are able to control their blood sugar and give birth to
healthy babies.

Women who have had gestational diabetes are more
likely than other women to develop
type 2 diabetes later on. You may be able to prevent
or reduce the severity of type 2 diabetes by staying at a healthy weight,
eating healthy foods, and increasing your physical activity.

What causes gestational diabetes?

The
pancreas makes a hormone called
insulin. Insulin helps your body properly use and
store the sugar from the food you eat. This keeps your blood sugar level in a target range. When you are pregnant, the
placenta makes hormones that can make it harder for
insulin to work. This is called insulin resistance.

A pregnant
woman can get diabetes when her pancreas cannot make enough insulin to keep her
blood sugar levels within a target range.

What are the symptoms?

Because
gestational diabetes may not cause symptoms, it is important for you to be tested for gestational
diabetes.

Sometimes a pregnant woman who has symptoms has been
living with another type of diabetes without knowing it. If you have symptoms
from another type of diabetes, they may include:

  • Increased thirst.
  • Increased
    urination.
  • Increased hunger.
  • Blurred vision.

Pregnancy causes most women to urinate more often and to
feel more hungry. So having these symptoms doesn’t always mean that a woman
has diabetes. Talk with your doctor if you have these symptoms, so that you can
be tested for diabetes at any time during pregnancy.

How is gestational diabetes diagnosed?

Most women are screened for gestational diabetes between the 24th and 28th weeks of pregnancy. The oral glucose tolerance test is used to diagnose the condition.

How is it treated?

Some women with gestational
diabetes can control their blood sugar level by changing the way they eat and
by exercising regularly. These healthy choices can also help prevent
gestational diabetes in future pregnancies and type 2 diabetes later in
life.

Treatment for gestational diabetes also includes checking
your blood sugar level at home and seeing your doctor regularly.

You may need to give yourself diabetes medicine or insulin shots to help control your blood
sugar. This insulin adds to the insulin that your body makes.

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Cause

During pregnancy, an organ called the
placenta develops in the
uterus. The placenta connects the mother and baby and
makes sure the baby has enough food and water. It also makes several hormones.
Some of these hormones make it hard for
insulin to do its job-controlling blood sugar-so the
mother’s body has to make more insulin to keep sugar levels in a safe range.
Gestational diabetes develops when the organ that
makes insulin, the
pancreas, cannot make enough insulin to keep blood
sugar levels within a target range.

Symptoms

Because
gestational diabetes may not cause symptoms, you need
to be tested for the condition. This is usually done between the 24th and 28th
weeks of pregnancy. You may be surprised if your test shows a high blood sugar level.
It is important for you to be tested for gestational diabetes, because high
blood sugar can cause problems for both you and your baby.

Sometimes, a pregnant woman has been living with diabetes without knowing
it. If you have symptoms from diabetes, they may include:

  • Increased thirst.
  • Increased
    urination.
  • Increased hunger.
  • Blurred vision.

Pregnancy causes most women to urinate more often and to
feel more hungry, so having these symptoms doesn’t always mean that a woman
has diabetes. Talk with your doctor if you have these symptoms so that you can
be tested for diabetes.

What Happens

Most women find out they have
gestational diabetes after being tested between the
24th and 28th weeks of their pregnancy. After you know you have gestational
diabetes, you will need to make certain changes in the way you eat and how
often you exercise to help keep your blood sugar level within a
target range. As you get farther
along in your pregnancy, your body will continue to make more and more
hormones. This can make it harder and harder to control your blood sugar. If it
is not possible to control your blood sugar with food and exercise, you may
also need to
take diabetes medicine or give yourself shots of insulin.

Most women who have gestational
diabetes give birth to healthy babies. If you are able to keep your blood sugar
level within a target range, your chances of having problems during pregnancy or
birth are the same as if you didn’t have gestational diabetes.

Sometimes a mother or her baby has problems because of high blood sugar.
These problems include:

  • High blood pressure in the mother caused by
    preeclampsia.
  • A baby that grows too large. If a developing baby (fetus) receives too much
    sugar, the sugar can turn into fat, causing the baby to grow larger than
    normal. A large baby can be injured during vaginal birth and may need to be
    delivered surgically (C-section).
  • After the baby is born, the baby’s blood
    sugar level may drop too low, and he or she may need to be given extra sugar.
  • Babies
    can also develop other treatable problems after birth, including low blood
    calcium levels, high
    bilirubin levels, and too many red blood cells.

Most of the time, gestational diabetes goes away after a
baby is born. But if you have had gestational diabetes, you have a greater
chance of having it in a future pregnancy and of developing
type 2 diabetes.

What Increases Your Risk

During your pregnancy, your doctor will recommend a test for gestational diabetes. Women who are older, overweight, or have a family history of diabetes are at a higher risk. You may also have a higher risk if you have prediabetes or if you had gestational diabetes during a previous pregnancy.

When to Call a Doctor

Call 911 or other emergency services right away if:

  • You passed out (lost consciousness), or if you suddenly become very sleepy or confused. (You may have very low blood sugar, called hypoglycemia.)

Call a doctor if:

  • You are sick and cannot control your blood sugar.
  • You have been vomiting or have had diarrhea for more than 6 hours.
  • You have a blood sugar level that stays higher than the level the doctor has set for you, for example, 300 mg/dL for two or more readings.
  • You have blood sugar that stays lower than the level the doctor has set for you, for example, 70 mg/dL for two or more readings.
  • You have symptoms of low blood sugar, such as:
    • Sweating.
    • Feeling nervous, shaky, and weak.
    • Extreme hunger and slight nausea.
    • Dizziness and headache.
    • Blurred vision.
    • Confusion.

Check with your doctor if:

  • You often have problems with high or low blood sugar levels.
  • You have questions or want to know more about gestational diabetes.

Who to see

Health professionals who can diagnose
and treat gestational diabetes include:

After you
are diagnosed with gestational diabetes, you may be referred to other health
professionals who can help you understand what gestational diabetes means.
These may include:

  • A
    certified diabetes educator (CDE). A CDE is a
    registered nurse, registered dietitian, doctor, pharmacist, or other health professional
    who has training and experience in caring for people who have diabetes. A CDE can
    help you understand how to take care of yourself and help you adjust to living
    with gestational diabetes.
  • A
    registered dietitian. All women who have gestational
    diabetes need to see a registered dietitian for help choosing the best foods. Follow-up
    visits with a dietitian are helpful if you need to change your eating
    habits.

Exams and Tests

The
U.S. Preventive Services Task Force recommends that all women who are not already diagnosed with diabetes be tested for gestational diabetes after the 24th week of pregnancy.footnote 1

The American Diabetes Association (ADA) recommends that all pregnant women who are not already diagnosed with diabetes be tested for gestational diabetes between the 24th and 28th weeks of pregnancy. The method for testing may vary. Experts think that each method works as well as the other one.footnote 2

The first method can be done in two steps. You do not need to stop eating or drinking before the first step. In this step, you drink a liquid that contains 50 grams of sugar (glucose). Your blood sample is taken 1 hour later. If you don’t have a lot of sugar in your blood, you do not have gestational diabetes. If you do have a lot of sugar in your blood, you will be asked to do the second step, the oral glucose tolerance test (OGTT).

With the OGTT, you cannot eat or drink for at least 8 hours before the test. Then a blood sample is taken when you arrive for the test. This is your fasting blood glucose value. It provides a baseline for comparing other glucose values. You will drink a liquid that contains 100 grams of sugar (glucose). Your blood sample is taken 3 hours later to see how much sugar is in your blood. If you don’t have a lot of sugar in your blood, you don’t have gestational diabetes. If you do have a lot of sugar in your blood, you may have gestational diabetes.

Some experts do not use the two-step method. They just use another version of the OGTT step. You cannot eat or drink for at least 8 hours before the test. Then a blood sample is taken when you arrive for the test. This is your fasting blood glucose value. It provides a baseline for comparing other glucose values. You will drink a liquid that contains 75 grams of sugar (glucose). Your blood sample is taken 1 and then 2 hours later to see how much sugar is in your blood. If you don’t have a lot of sugar in your blood, you do not have gestational diabetes. If you do have a lot of sugar in your blood, you may have gestational diabetes.

Tests during pregnancy

If you have gestational
diabetes, your doctor will check your
blood pressure at every visit. You will also have
certain tests throughout your pregnancy to check your and your baby’s health.
These tests include:

  • Home blood sugar monitoring. Testing your blood sugar helps you know if your blood sugar level is within a target range.
  • Fetal ultrasound. This test may be used to estimate the age, weight, and health of your baby. The
    ultrasound test also can measure the size of your baby’s head and abdomen. This measurement along with other information can be used to help your doctor decide
    on your care.
  • Nonstress test. A nonstress test can help you know how
    well your baby is doing by checking your baby’s heartbeat in response to
    movement.

Some doctors may recommend you have a hemoglobin A1c
(glycosylated hemoglobin) or a similar test every month during your pregnancy.
The A1c test estimates your average blood sugar level over the previous 2 to 3 months.

Tests during labor and delivery

During labor and
delivery, you and your baby will be monitored very closely.

  • Fetal heart monitoring is used to see
    how well your baby is doing while you are in labor.
  • Blood sugar tests are
    done regularly to make sure your blood sugar level is within a target
    range.

Tests after delivery

After your baby is born, your
blood sugar level will be checked several times. Your baby’s blood sugar level
will also be checked several times within the first few hours after birth.

Follow-up

Even though your gestational
diabetes will probably go away after your baby is born, you are at risk for
gestational diabetes again and for type 2 diabetes later
in life.

You may have a follow-up glucose tolerance
test 4 to 12 weeks after your baby is born or after you stop breastfeeding
your baby. If the results of this test are normal, experts recommend you get tested for type 2 diabetes at least every 3 years. Even if your sugar level is
normal, you are at increased risk of developing diabetes in the future. Eating
healthy foods and getting regular exercise can help prevent type 2 diabetes.

If
you want to get pregnant again, it is a good idea to be tested for diabetes both before
you become pregnant and early in your pregnancy.

Treatment Overview

Most women who have gestational diabetes give birth to
healthy babies. You are the most important person in promoting a
healthy pregnancy.

Treatment for gestational diabetes involves making healthy choices. Most
women who make changes in the way that they eat and how often they exercise are
able to keep their blood sugar level within a
target range. Controlling your
blood sugar is the key to preventing problems during pregnancy or birth.

You, your doctor, and other health professionals will work together to
develop a treatment plan just for you. You do not need to eat strange or
special foods. But you may need to change what, when, and how much you eat. And walking several times a week can really help your blood sugar.

The lifestyle changes you make now will help you have a healthy pregnancy
and prevent diabetes in the future. As you start making these changes, you will
learn more about your body and how it reacts to food and exercise. You may also
notice that you feel better and have more energy.

During pregnancy

Treatment for gestational
diabetes during pregnancy includes:

  • Eating balanced meals. After you find out that you have gestational diabetes, you will
    meet with a
    registered dietitian to create a
    healthy eating plan. You will learn how to limit the
    amount of
    carbohydrates you eat as a way to control your blood
    sugar. You may also be asked to write down everything you eat and to keep track
    of your weight. You will learn more about the range of weight gain that is good for you and your baby. Going on a diet during pregnancy is NOT recommended.
  • Getting regular exercise.
    Try to do at least 2½ hours a week of moderate exercise.footnote 3 One way to do this is to be active
    30 minutes a day, at least 5 days a week. It’s fine to be active in blocks of
    10 minutes or more throughout your day and week. Regular, moderate
    exercise during pregnancy helps your body use
    insulin better and helps control your blood sugar
    level. If you have never exercised regularly or were not exercising before you
    became pregnant, talk with your doctor before you start exercising. Low-impact
    activities, such as walking or swimming, are especially good for pregnant
    women. You may also want to try special exercise classes for pregnant
    women.
  • Checking blood sugar levels. An
    important part of treating gestational diabetes is checking your blood sugar
    level at home. Every day, you will do a
    home blood sugar test one or more times. It may be overwhelming to
    test your blood sugar so often. But knowing that your level is within a target range can help put your mind at ease. Talk to your doctor about how often to test your blood sugar.
  • Monitoring fetal growth and well-being. Your doctor may want you to monitor fetal movements called
    kick counts and let him or her know if you think your
    baby is moving less than usual. You may also have
    fetal ultrasounds to see how well your baby is
    growing. You may have a
    nonstress test to check how well your baby’s heart
    responds to movement.
  • Getting regular medical checkups. Having gestational diabetes means regular
    visits to your doctor. At these visits, your doctor will check your blood
    pressure and test a sample of your urine. You will also discuss your blood
    sugar levels, what you have been eating, how much you have been exercising, and
    how much weight you have gained.
  • Taking diabetes medicine and insulin shots.
    The first way to treat gestational diabetes is by changing the way you eat and
    exercising regularly. If your blood sugar levels are too high, you may need diabetes medicine or insulin shots.

During labor and delivery

Most women who have
gestational diabetes are able to have their babies vaginally. Just because you
have gestational diabetes does not mean that you will need to have a
cesarean section (C-section).

Because a
baby that has grown too large can be difficult to deliver safely, your doctor
will do fetal ultrasounds to check the size of your baby. If your
doctor thinks that your baby is in danger of being too large, he or she may
decide to induce labor or do a C-section.

During labor and delivery, you and your baby are monitored closely. This
includes:

  • Checking your blood
    sugar level regularly. If your level gets too high, you may
    be given small amounts of insulin through a vein (intravenously, or IV). If
    your level drops too low, you may be given IV fluid that contains glucose.
  • Checking your baby’s heart rate and how well your baby’s heart
    responds to movement.
    Fetal heart monitoring helps your doctor know how your
    baby is doing during labor. If the baby is large or does not seem to be doing
    well, you may need to have a C-section to deliver your baby.

After delivery

After delivery, you and your baby
still need to be monitored closely.

  • For the first few hours, your blood sugar
    level may be tested every hour. Usually blood sugar levels quickly return to
    normal.
  • Your baby’s blood sugar level will also be watched. If
    your blood sugar levels were high during pregnancy, your baby’s body will make
    extra insulin for several hours after birth. This extra insulin may cause your
    baby’s blood sugar to drop too low (hypoglycemia).
    If your baby’s blood sugar level drops too low, he or she may need extra sugar,
    such as a sugar water drink or glucose given intravenously.
  • Your
    baby’s blood may also be checked for low calcium, high
    bilirubin, and extra red blood cells.

What to think about

Most of the time, the blood
sugar levels of women who have gestational diabetes return to normal in a
few hours or days after delivery.

If you have had gestational diabetes,
you are at risk for having it again in a future pregnancy. You are also at
risk of type 2 diabetes, a permanent type of diabetes. The
healthy choices and changes you made during your pregnancy, if continued, will
help you prevent diabetes in the future. If you are worried about type 2
diabetes in yourself or in your child, talk to your doctor about your concerns.

Most doctors will
recommend that you
breastfeed, if possible, for the health benefits for you and your baby. For example, breastfeeding can
help keep your child at a healthy weight, which may reduce his or her
chances of developing diabetes. It provides antibodies to strengthen your baby’s immune system. And it lowers your baby’s risk for many types of infections. Also, it may lower your chances of developing diabetes later in life.

Prevention

In some women,
gestational diabetes cannot be prevented. But you may
be able to lower your chance of getting gestational diabetes by staying at a
healthy weight and not gaining too much weight during pregnancy. Regular
exercise can also help keep your blood sugar level within a target range and
prevent gestational diabetes.

If you have had gestational
diabetes, you are at risk for having it again in a future pregnancy. You are
also at risk for
type 2 diabetes, a permanent type of diabetes. One of
the best ways to prevent developing gestational diabetes again is to stay at a
healthy weight.

If you have had gestational diabetes, avoid
medicines that increase
insulin resistance, such as nicotinic acid and
glucocorticoid medicines (for example, prednisone and dexamethasone).

Home Treatment

You are the most important person in
determining whether you will have a healthy pregnancy.
Gestational diabetes, like any form of diabetes,
cannot be successfully treated with medicines alone.

Your doctor,
diabetes educator, registered dietitian, and other health professionals
can help you learn how to care for yourself and protect your baby from
problems. If you learn as much as you can about gestational diabetes, you will
have the knowledge you need to have a healthy pregnancy. As you understand how
food and exercise affect your blood sugar, you can better control your blood
sugar level and help prevent problems from gestational diabetes.

Home treatment for gestational diabetes includes changing the way you
eat, exercising regularly, and checking your blood sugar.

Eating healthy foods

Changing what, when, and how much you eat can help
keep your blood sugar level in a target range. After you are diagnosed with gestational
diabetes, you may meet with a registered dietitian to decide on an
individualized healthy eating plan. Your dietitian may ask you to write down
everything you eat and to keep track of your weight. He or she will also teach
you how to count
carbohydrates in order to spread them
throughout the day.

Getting regular exercise

Regular, moderate
exercise during pregnancy helps your body use
insulin better, which helps control your blood sugar
level. Often, exercising and eating well can treat gestational diabetes. Try to
do at least 2½ hours a week of moderate exercise.footnote 3 One way to do this is to be active
30 minutes a day, at least 5 days a week. It’s fine to be active in blocks of
10 minutes or more throughout your day and week.

If you have never
exercised regularly or were not exercising before you became pregnant, talk
with your doctor before you start exercising. Exercise that does not place too
much stress on your lower body-such as using an arm ergometer, a machine that
just works your arm muscles; or riding a recumbent bicycle, a type of bike with
a seat that looks like a chair-are especially good for pregnant women. You may
also want to try special exercise classes for pregnant women or other
low-impact activities such as swimming or walking.

If exercise and changing the way you eat keep your
blood sugar within a target range, you will not need to take diabetes medicine. If you need to take insulin, make sure you have a
quick-sugar food, such as 3 or 4 glucose tablets or 3 pieces of hard candy, with you when you exercise in case
you have
symptoms of low blood sugar. Symptoms of low blood sugar include sweating, blurred vision, and confusion. If you think that your
blood sugar is low, stop exercising, check your blood sugar level, and eat the
snack.

Checking your blood sugar

An
important part of treating gestational diabetes is checking your blood sugar
level at home. Every day, you will do a
home blood sugar test one or more times. It may be overwhelming to
test your blood sugar so often. But knowing that your level is within a target range
can help put your mind at ease. Talk to your doctor about how often to test your blood sugar.

Other aspects of your care

  • As you get closer to your due date, you may have a harder time staying in your target blood sugar range. You may need to take diabetes medicine or insulin.
  • If you were overweight before you became pregnant, do not
    try to lose weight while you are pregnant. Ask your doctor how much weight you
    should gain during your pregnancy.
  • Your doctor may have you check
    kick counts and let him or her know if you think your
    baby has been moving less than usual.
  • If you take insulin, it can cause your blood sugar to
    drop below the target range. Even though very low blood sugar is rare in women
    who have gestational diabetes, it is important to know the
    symptoms of low blood sugar and have quick-sugar foods
    with you at all times.

Medications

Most women can treat
gestational diabetes by changing the way they eat and
exercising more often. If these changes do not keep your blood sugar level
within a target range, you may
need to take diabetes medicine, for example glyburide, insulin, or metformin. You may also need to take insulin if your
doctor thinks that your baby is getting too large.

If you need to
take insulin, you will learn how to give yourself an insulin shot.

What to think about

How much insulin you need depends on how much you weigh
and on how close you are to your due date. Some women need more insulin as they
get closer to their delivery date, because the
placenta makes more and more hormones that make it
harder and harder for insulin to do its job. In rare cases, a woman with
gestational diabetes has to stay in the hospital for a short time to get her
blood sugar level within a target range.

Other Places To Get Help

Organization

American Diabetes Association (ADA)
www.diabetes.org

Related Information

References

Citations

  1. U.S. Preventive Services Task Force (2014). Screening for gestational diabetes mellitus. https://www.uspreventiveservicestaskforce.org/uspstf/uspsgdm.htm. Accessed January 16, 2014.
  2. American Diabetes Association (2017). Standards of medical care in diabetes-2017. Diabetes Care, 40(Suppl 1): S1-S135. https://care.diabetesjournals.org/content/40/Supplement_1. Accessed December 15, 2016.
  3. U.S. Department of Health and Human Services (2008). 2008 Physical Activity Guidelines for Americans (ODPHP Publication No. U0036). Washington, DC: U.S. Government Printing Office. Available online: https://www.health.gov/paguidelines/guidelines/default.aspx.

Other Works Consulted

  • American College of Obstetricians and Gynecologists (2001, reaffirmed 2010). Gestational diabetes. ACOG Practice Bulletin No. 30. Obstetrics and Gynecology, 98: 525-538.
  • American College of Obstetricians and Gynecologists (2005, reaffirmed 2012). Pregestational diabetes mellitus. ACOG Practice Bulletin No. 60. Obstetrics and Gynecology, 105(3): 675-685.
  • American College of Obstetricians and Gynecologists (2013). Gestational diabetes mellitus. ACOG Practice Bulletin No. 137. Obstetrics and Gynecology, 122(2): 406-416. DOI: 10.1097/01.AOG.0000433006.09219.f1. Accessed November 16, 2016.
  • American College of Obstetricians and Gynecologists (2015). Physical activity and exercise during pregnancy and the postpartum period. ACOG Committee Opinion No. 650. Obstetrics and Gynecology, 126(6): e135-e142. DOI: 10.1097/AOG.0000000000001214. Accessed November 16, 2016.
  • American Diabetes Association (2017). Standards of medical care in diabetes-2017. Diabetes Care, 40(Suppl 1): S1-S135. https://care.diabetesjournals.org/content/40/Supplement_1. Accessed December 15, 2016.
  • Cunningham FG, et al. (2010). Diabetes. In Williams Obstetrics, 23rd ed., pp. 1104-1125. New York: McGraw-Hill.
  • U.S. Preventive Services Task Force (2014). Screening for gestational diabetes mellitus. https://www.uspreventiveservicestaskforce.org/uspstf/uspsgdm.htm. Accessed January 16, 2014.

Credits

ByHealthwise Staff
Primary Medical Reviewer Kathleen Romito, MD – Family Medicine
Adam Husney, MD – Family Medicine
Specialist Medical Reviewer Rebecca Sue Uranga, MD – Obstetrics and Gynecology
Femi Olatunbosun, MB, FRCSC – Obstetrics and Gynecology

Current as ofMay 23, 2017