Key Points About Diabetes During Pregnancy
Diabetes is a condition in which the body can’t produce enough insulin, or it can’t use it normally.
There are 3 types of diabetes: Type 1, tType 2, and gestational diabetes.
Nearly all pregnant women without diabetes are screened for gestational diabetes between 24 and 28 weeks of pregnancy.
Treatment for diabetes focuses on keeping blood sugar levels in the normal range.
Women with gestational diabetes are more likely to develop Type 2 diabetes in later life. Follow-up testing is important.
How Can I Prepare For Pregnancy If I Have Diabetes
If you have diabetes, keeping your blood glucose as close to normal as possible before and during your pregnancy is important to stay healthy and have a healthy baby. Getting checkups before and during pregnancy, following your diabetes meal plan, being physically active as your health care team advises, and taking diabetes medicines if you need to will help you manage your diabetes. Stopping smoking and taking vitamins as your doctor advises also can help you and your baby stay healthy.
Complications That May Affect You
If you have gestational diabetes, youre more likely to get it again during a future pregnancy. You also have a higher risk of type 2 diabetes as you get older. Testing may be done a few months after the delivery to make sure your blood sugar levels have returned back to normal. Talk to your doctor if you experience symptoms of Type II diabetes.
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How Is Diabetes During Pregnancy Managed
Special testing and monitoring of the baby may be needed for pregnant diabetics, especially those who are taking insulin. This is because of the increased risk for stillbirth. These tests may include:
Fetal movement counting. This means counting the number of movements or kicks in a certain period of time, and watching for a change in activity.
Ultrasound. This is an imaging test that uses sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to look at blood flow through blood vessels.
Nonstress testing. This is a test that measured the babys heart rate in response to movements.
Biophysical profile. This is a measure that combines tests such as the nonstress test and ultrasound to check the baby’s movements, heart rate, and amniotic fluid.
Doppler flow studies. This is a type of ultrasound that uses sound waves to measure blood flow.
Causes And Symptoms Of Gestational Diabetes
The exact cause of gestational diabetes is unknown, says Dr. Henderson, but gestational diabetes is similar to type 2 diabetes in that its due to insulin resistance, not lack of insulin .
The placenta produces many hormones that can lead to increased insulin resistance, meaning they interfere with insulins ability to carry glucose into the cell, says Dr. Henderson. When the pancreas cant produce enough insulin to overcome this resistance, blood glucose becomes elevated.
Women who are overweight or obese, have a family history of obesity, previously had a large baby, previously had a diagnosis of gestational diabetes or have a first degree relative with diabetes are at increased risk, she adds. Some racial or ethnic groups are at a higher risk as well, including women that are Asian, Black, American Indian and Hispanic, according to the Centers for Disease Control and Prevention .
Most women with gestational diabetes actually dont display any symptoms at all. Occasionally, if the blood glucose is especially high, they may notice increased thirst and increased urination, says Dr. Henderson.
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How Is Gestational Diabetes Managed
If youre diagnosed with gestational diabetes, you may need more frequent checkups during your pregnancy. Your healthcare provider will check your blood sugar levels regularly. You may need to monitor your blood sugar at home with a tool called a glucose meter.
Some women need medication to manage gestational diabetes. But most women can keep their blood sugar levels under control with diet and exercise.
How Does Gd Affect Your Baby After Birth
Babies who are born to mothers with gestational diabetes should be tested for low blood sugar , even if they have no symptoms, with a simple blood test after birth. This happens immediately after delivery, while you and baby are still in the hospital.
After birth, its essential to keep the focus you had during pregnancy on a healthy lifestyle for your whole family you may find that it helps you stick to your resolutions as well.
Teach your child good eating and exercise habits early on: If you had gestational diabetes, your baby could be at a higher risk for health problems, including obesity as a child or teen and an increased risk for type 2 diabetes later in life, according to the CDC.
To help avoid a type 2 diabetes diagnosis for your child, aim to ensure that he or she:
- Eats nutritious meals. The same diet you follow during pregnancy and beyond is good for your child, too. When he gets old enough, have him help you in the kitchen children who help prepare dishes are more likely to eat them.
- Gets plenty of exercise as he grows. Start by taking walks. As he gets older, toddler soccer and other activities are a great way to get him interested in healthy movement.
- Maintains a healthy weight. Talk to his pediatrician to make sure his BMI is on target, and talk openly to him about healthy weight and the increase in obesity he might notice in school.
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Gestational Diabetes Causes And Risk Factors
Gestational diabetes develops when your body isnt able to produce enough of the hormone insulin during pregnancy. Insulin is necessary to transport blood glucose into the cells. Without enough insulin, you can build up too much glucose in your blood, leading to a higher-than-normal blood glucose level and perhaps gestational diabetes.
The elevated blood glucose level in gestational diabetes is caused by hormones released by the placenta during pregnancy. The placenta produces a hormone called the human placental lactogen , also known as human chorionic somatomammotropin . Its similar to growth hormone , but it actually modifies the mothers metabolism and how she processes carbohydrates and lipids. HPL actually raises maternal blood glucose level and makes a woman’s body less sensitive to insulinless able to use it properly. If the body doesnt use insulin as it should, then the blood glucose levels will rise. The HPL hormone increases the blood glucose level so that the baby can get the nutrients it needs from the extra glucose in the blood.
At 15 weeks, another hormonehuman placental growth hormonealso increases and causes maternal blood glucose level to rise. This hormone is also supposed to help regulate the mothers blood glucose level to be sure that the baby gets the right amount of needed nutrients.
While doctors arent clear about why some women develop gestational diabetes and others don’t, there are several risk factors that make it more likely to occur:
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.
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What Clinical Trials Are Open
Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank:Boyd E. Metzger, MD, Northwestern University Feinberg School of Medicine
How Can I Prevent Gestational Diabetes
There are no guarantees when it comes to prevention, but the more healthy habits you can adopt before pregnancy, the better. If youve had gestational diabetes, these healthy choices may also reduce your risk of having it again in future pregnancies or developing type 2 diabetes in the future.
- Eat healthy foods Choose foods high in fiber and low in fat and calories. Focus on fruits, vegetables and whole grains. Strive for variety to help you achieve your goals without compromising taste or nutrition. Watch portion sizes.
- Keep active exercising before and during pregnancy can help protect you from developing gestational diabetes. Aim for 30 minutes of moderate activity on most days of the week. Take a brisk daily walk. Ride your bike. Swim laps. Short bursts of activity such as parking further away from the store when you run errands or taking a short walk break all add up too.
- Start pregnancy at a healthy weight if youre planning to get pregnant, losing extra weight beforehand may help you have a healthier pregnancy. Focus on making lasting changes to your eating habits that can help you through pregnancy, such as eating more vegetables and fruits.
- Dont gain more weight than recommended gaining some weight during pregnancy is normal and healthy. But gaining too much weight too quickly can up your risk of gestational diabetes. Ask your doctor what a reasonable amount of weight gain is for you.
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If I Have Gestational Diabetes How Will It Be Treated
Treating gestational diabetes comes down to one key factor: controlling your blood sugar. The goal is to manage your blood glucose level so that it doesnt go too high and stay high. This is accomplished by eating wisely, remaining physically active, and if needed taking medication to help keep your blood sugar levels in your target range.
The importance of treating gestational diabetes gained attention following the Hyperglycemia and Adverse Pregnancy Outcomes trial, which demonstrated a direct link between continuous treatment of the maternal glucose levels and reducing negative outcomes.2
- Eating Wisely. Meals will require more thought, indeed a lot more thought, than must be necessary if you have gestational diabetes. You’ll need to pay attention to what you eat, how much you eat, and when you eat. A registered dietitian or certified diabetes educator can help you create a meal plan thats full of good-for-you and good-for-the-baby foods. The goal of the meal plan is to make it easier to control your blood glucose level so it stays in your target range. Your meal plan will reflect your likes and dislikes, and will take into account your overall health and physical activity level.For more information on what goes into the meal plan and what you can eat, read our article on the healthy meal planning with diabetes.
How Does Gestational Diabetes Affect Me And My Baby
With proper treatment and regular monitoring by your practitioner, gestational diabetes can be managed and is not harmful to you or your baby. But if GDM is not treated, and excessive sugar circulates in a mother’s blood and the baby’s, the potential problems for both mother and baby are serious.
Women who have uncontrolled GDM are at risk for having a too-large baby , making delivery more difficult and C-section more likely. They are also at risk for preeclampsia and stillbirth.
And because gestational diabetes is considered a pregnancy complication, pregnant women who have it may be more likely to be induced, since most doctors won’t let their pregnancies progress past their due dates.
Uncontrolled diabetes could also lead to potential problems for the baby after birth, such as jaundice, breathing difficulties and low blood sugar levels. Later in life, baby may be at an increased risk for obesity and type 2 diabetes.
But keep in mind, these potential negative effects don’t apply to moms who follow their doctors’ recommendations to keep their blood sugar under control.
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Possible Complications For The Baby
Unlike type 1 diabetes, gestational diabetes generally occurs too late to cause birth defects. Birth defects usually originate sometime during the first trimester of pregnancy. The insulin resistance from the contra-insulin hormones produced by the placenta does not usually occur until approximately the 24th week. Women with gestational diabetes mellitus generally have normal blood sugar levels during the critical first trimester.
The complications of GDM are usually manageable and preventable. The key to prevention is careful control of blood sugar levels just as soon as the diagnosis of diabetes is made.
Infants of mothers with gestational diabetes are vulnerable to several chemical imbalances, such as low serum calcium and low serum magnesium levels, but, in general, there are two major problems of gestational diabetes: macrosomia and hypoglycemia:
Blood glucose is monitored very closely during labor. Insulin may be given to keep the mother’s blood sugar in a normal range to prevent the baby’s blood sugar from dropping excessively after delivery.
Work With Your Health Care Team
Regular visits with members of a health care team who are experts in diabetes and pregnancy will ensure that you and your baby get the best care. Your health care team may include
- a medical doctor who specializes in diabetes care, such as an endocrinologist or a diabetologist
- an obstetrician with experience treating women with diabetes
- a diabetes educator who can help you manage your diabetes
- a nurse practitioner who provides prenatal care during your pregnancy
- a registered dietitian to help with meal planning
- specialists who diagnose and treat diabetes-related problems, such as vision problems, kidney disease, and heart disease
- a social worker or psychologist to help you cope with stress, worry, and the extra demands of pregnancy
You are the most important member of the team. Your health care team can give you expert advice, but you are the one who must manage your diabetes every day.
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Short Term Effects For The Baby
Short term effects include:
Each of these effects is possible in non gestational diabetes pregnancies as well, but the risk is higher in gestational diabetic pregnancies.
Keeping The Risks In Perspective
It is natural to find these possibilities worrying but try to keep things in perspective. Firstly, every pregnancy carries some risks. Secondly, although you cant remove these risks altogether, there are ways that you can reduce them.
Talk to your midwife if you have any of the risk factors for gestational diabetes but you have not been tested. If you are diagnosed, the best thing you can do is follow your healthcare professionals advice on how to manage your condition and go to all your extra antenatal care appointments.
Remember, most women who develop diabetes in pregnancy have healthy pregnancies and healthy babies, especially if their condition is diagnosed and properly managed.
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How Can Diabetes Affect My Baby
A babys organs, such as the brain, heart, kidneys, and lungs, start forming during the first 8 weeks of pregnancy. High blood glucose levels can be harmful during this early stage and can increase the chance that your baby will have birth defects, such as heart defects or defects of the brain or spine.
High blood glucose levels during pregnancy can also increase the chance that your baby will be born too early, weigh too much, or have breathing problems or low blood glucose right after birth.
High blood glucose also can increase the chance that you will have a miscarriage or a stillborn baby.1 Stillborn means the baby dies in the womb during the second half of pregnancy.
How Does Gestational Diabetes Affect You And Your Baby’s Health
If your blood sugar levels remain high during your pregnancy, this may lead to pregnancy problems such as a large baby, miscarriage or stillbirth. Having a large baby can lead to complications and injury during the birth.
If you have gestational diabetes, you are at higher risk of developing high blood pressure while you are pregnant and a 50% increased risk of developing type 2 diabetes in the future. Your baby is also at greater risk of developing type 2 diabetes in later life.
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