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Why Do You Get Gestational Diabetes


Can Gestational Diabetes Cause Problems During Pregnancy

Yes. If not treated, GDM can cause pregnancy complications, including: 

Gestational diabetes also can cause health complications for your baby after birth, including:

  • Breathing problems, including respiratory distress syndrome . This is a breathing problem caused when babies dont have enough surfactant in their lungs. Surfactant is a protein that keeps the small air sacs in the lungs from collapsing.
  • Jaundice. This is a medical condition in which a babys eyes and skin look yellow. A baby has jaundice when his liver isn’t fully developed or isnt working well.  
  • Low blood sugar
  • Obesity later in life

Whats The Connection Between Gestational Diabetes And Insulin


All types of diabetes are related to the hormone insulin. It regulates the amount of glucose in your blood by allowing sugar to move from the blood and into your cells.

Insufficient insulin or ineffective use of insulin by your bodys cells leads to high glucose levels in the blood. As you gain weight, your body uses insulin less effectively, so it needs to produce more in order to regulate the sugar in your blood. Learn more about the effects of insulin.

In addition, when youre pregnant your placenta produces insulin-blocking hormones. This makes sugar stay in your blood longer after a meal. Your baby gets nutrients from your blood, so its beneficial during pregnancy for nutrients to be in your blood longer so your baby can access them. A certain level of insulin resistance is normal during pregnancy.

Your glucose levels could get too high during pregnancy if:

  • you were already insulin-resistant before becoming pregnant
  • your blood glucose levels were already high before becoming pregnant
  • you have conditions that put you at greater risk for becoming insulin resistant

If your glucose levels become too high, youll be diagnosed with gestational diabetes.


Causes And Risk Factors Of Gestational Diabetes

Similar to type 2 diabetes, gestational diabetes develops when the body is no longer able to respond effectively to insulin a condition called insulin resistance.

When the body’s cells don’t properly absorb glucose, the simple sugar builds up in the bloodstream, resulting in elevated levels of glucose on blood tests.

Gestational diabetes is caused by the effects of placental hormones, says Kevin Borst, DO, an endocrinologist at Cleveland Clinic in Ohio. These can increase insulin resistance in susceptible individuals. It is not fully understood why some women dont tolerate these hormones well and ultimately develop gestational diabetes.


These hormones include:

  • Human placental lactogen
  • Placental insulinase

What’s more, other changes during pregnancy such as eating more, exercising less, and having larger fat deposits can contribute to insulin resistance.

Still, some women without any of these risk factors may go on to develop gestational diabetes due to their intolerance of the placental hormones, Dr. Borst explains.

Living With Gestational Diabetes


Many women with gestational diabetes are able to control their blood sugar levels with lifestyle changes, including diet and physical activity; however, some women will need to inject insulin for better control. 

Ask your doctor to refer you to a registered dietitian to learn about healthy eating during pregnancy. Physical activity during pregnancy can also help control your blood sugar level.

Sometimes healthy eating and physical activity are not enough to manage blood sugar levels. In this case, your health-care provider may recommend insulin injections or pills for the duration of your pregnancy. Medication will help keep your blood sugar level within your target range.

Your health-care team will teach you how to check your blood sugar with a blood glucose meter to better track and manage your gestational diabetes. This will help to keep you and your baby in good health.


Why You Get Gestational Diabetes

How to Control Gestational Diabetes Naturally

You may be more likely to get this disease if:

  • You were overweight before you got pregnant; extra weight makes it harder for your body to use insulin.
  • You gain weight very quickly during your pregnancy
  • You have a parent, brother, or sister with type 2 diabetes
  • Your blood sugar levels are high, but not high enough for you to be diagnosed with diabetes; this is called prediabetes.
  • You had gestational diabetes in a past pregnancy
  • You are over age 25
  • You gave birth to a baby weighing more than 9 pounds
  • You had a baby who was stillborn
  • You have a condition called polycystic ovary syndrome
  • You’re African-American, American Indian, Hispanic, or Pacific Islander

Continued

How Does Gestational Diabetes Affect Any Future Pregnancies

If you have had gestational diabetes you are more likely to have it again in future pregnancies. For that reason, a test for gestational diabetes will be performed early in any future pregnancy. If this test gives a result within the recommended range, then another pregnancy OGTT will be done again later in the pregnancy to make sure your blood glucose levels are still in the recommended range.


How Do You Know If You Have Gestational Diabetes

Your health care provider tests you for gestational diabetes with a prenatal test called a glucose tolerance test. You get the test at 24 to 28 weeks of pregnancy. If your provider thinks youre at risk for GDM, you may get the test earlier.

If your glucose screening test comes back positive, you get another test called a glucose tolerance test to see for sure if you have gestational diabetes. 


How Does Gestational Diabetes Develop

Your body makes insulin to help keep your blood glucose at the right level. Your blood glucose levels become higher if your body doesnt make enough insulin or if your insulin does not work as well as it should. 

During pregnancy, hormones are made by the placenta to help the baby develop and grow. These hormones, however, stop the mothers insulin from working properly. This is called insulin resistance. As the pregnancy develops and the baby grows bigger, the mothers body has to make more insulin to keep her blood glucose at the optimal level.

Later in pregnancy the amount of insulin needed to keep blood glucose levels optimal is two to three times higher than usual. If the mother is unable to produce enough insulin to meet this demand then her blood glucose levels rise and gestational diabetes develops.

The babys response to the higher glucose levels is to make more insulin. This can lead to the baby becoming larger than usual and cause problems during and after birth. 


Who’s At Risk Of Gestational Diabetes

Any woman can develop gestational diabetes during pregnancy, but you’re at an increased risk if:

  • your body mass index is above 30 use the healthy weight calculator to work out your BMI
  • you previously had a baby who weighed 4.5kg or more at birth
  • you had gestational diabetes in a previous pregnancy
  • 1 of your parents or siblings has diabetes
  • you are of south Asian, Black, African-Caribbean or Middle Eastern origin

If any of these apply to you, you should be offered screening for gestational diabetes during your pregnancy.


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.


Will Gestational Diabetes Go Away

Most likely, after you deliver your baby, gestational diabetes should go away. About six weeks after delivery, your doctor will check your blood glucose level to see if its in the normal range again.

However, because you had gestational diabetes, youre at a higher risk for having it again in another pregnancy. Youre also at a higher risk for developing type 2 diabetes. To learn how to prevent type 2 diabetes, read our article on prevention.

  • American Diabetes Association.  Standards of Medical Care in Diabetes2018. Diabetes Care. 2018;41:S137-S143. 
  •  International Association of Diabetes and Pregnancy Study Group Recommendations on the Diagnosis and Classification of Hyperglycemia in Pregnancy. Diabetes Care. 2010;33:676682
  • Metzger BE, Lowe LP, Dyer AR, et al, for the HAPO Study Cooperative Research Group. Hypergylycemia and adverse pregnancy outcomes. N Engl J Med. 2008 May 8; 358:1991-2002.
  • Ottawa Histology website.  The placenta.  Available at:  http://www.courseweb.uottawa.ca/medicine-histology/English/Reproduction/Placenta/Default.htm.  Accessed April 30, 2009.
  • 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.

    How Your Body Uses Sugar

    Hypoglycemia Gestational Diabetes Test


    To understand what causes gestational diabetes, it can help to understand how your body uses glucose.

    Your blood sugar levels are a measurement that shows how much glucose is in your blood. Glucose is a sugar that you get from food and drink. Your body needs glucose to provide energy. Your glucose levels change throughout the day.

    “My health was fine until about 26 weeks into my pregnancy. Then at a routine appointment they noticed glucose in my urine, so they said they needed to do a test to rule out gestational diabetes. They told me I had it and asked me to attend the diabetic clinic the following day.” 

    Gemma

    Glucose levels are kept at safe limits in your body by a hormone called insulin. If your glucose level is too high, you may become unwell. When your glucose level is high , insulin allows the extra glucose to be stored in your cells to use later.

    When you are pregnant, your body produces high levels of hormones and some of these hormones stop insulin working as well as it normally does. Usually, the body responds by increasing the amount of insulin it produces. However, some women do not produce enough extra insulin or the extra insulin produced is not working well enough for glucose to be stored in the cells. This leads to higher blood glucose levels which is called gestational diabetes.

    NICE . Diabetes in pregnancy: management from preconception to the postnatal period. National Institute for health and care excellence https://www.nice.org.uk/guidance/ng3

    Causes Of Gestational Diabetes

    Breadcrumb

    Researchers dont understand exactly why some women develop gestational diabetes and others dont. But we do know that you are at increased risk if:

    • you had gestational diabetes in a previous pregnancy
    • you had a large baby in a previous pregnancy
    • yourbody mass index  is in the obese category
    • you have a parent, brother, sister or child with diabetes
    • you are of black Caribbean, black African, South Asian or Middle Eastern origin
    • you have polycystic ovary syndrome.

    Your midwife will ask about these risk factors at your booking appointment. If any apply to you, youll be offered a test for gestational diabetes when you’re between 24 and 28 weeks pregnant. 

    If you’ve had gestational diabetes before, you’ll be offered a test soon after your booking appointment. Youll also be offered another test at 24 to 28 weeks if the first test is normal.

    Find out more about testing for gestational diabetes.

    Are There Effective Treatments For Gestational Diabetes That Reduce The Risk Of Poor Outcomes

    If you have GDM, treatment with diet changes, exercise, and sometimes medicine, is necessary to maintain healthy blood sugar levels. With effective treatment, it is possible for someone with GDM to reduce the risk of having complications from the condition, such as a big baby. Importantly, when the risk of complications from GDM is reduced with treatment, then there is less potential benefit from labor induction for gestational diabetes.

    How Gestational Diabetes Can Affect Your Baby

    When you have gestational diabetes, you must tightly control your blood glucose level. Talk to your healthcare professional regarding your individual blood glucose goals. Poorly controlled blood glucose levelsthat stay too high for too longcan cause complications for your baby. 

    Just because youve been diagnosed with gestational diabetes, that isnt a guarantee that your baby will have all of these complications. This is a list of what may happen if you dont manage gestational diabetes.

    Heres how gestational diabetes can affect your baby at birth and right after birth:

    Heres how gestational diabetes can affect your child later on:

    • Development problems: Researchers have noticed that children whose mothers had gestational diabetes are at a higher risk for developmental problems, such as language development and motor skill development.
    • Type 2 diabetes: Babies born of mothers with gestational diabetes are at a higher risk for developing type 2 diabetes later in life.

    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.

    What Can I Do To Make Living With Gestational Diabetes Easier

    Make diabetes management part of your daily routine. Create a schedule and stick to it. Try to:

    • Check your blood glucose levels at the same time each day.
    • Choose three days each week to get 30 minutes of light exercise.
    • Plan small, balanced meals ahead of time.
    • Talk with your healthcare provider or a diabetes educator about other tips for daily diabetes management.

    A note from Cleveland Clinic

    Gestational diabetes develops in pregnant women when theres too much glucose in their blood. GD is usually diagnosed during the middle stage of pregnancy with a few simple blood tests. If left untreated, GD can cause health complications for the mother and the baby. Most women can manage gestational diabetes with diet and exercise. Some will need medication. Gestational diabetes increases your risk of developing Type 2 diabetes later in life. Talk to your healthcare provider about ways to reduce your risk of diabetes before, during and after pregnancy.

    Last reviewed by a Cleveland Clinic medical professional on 01/14/2021.

    References

    Screening Of Gestational Diabetes

    Unfortunately, not all pregnant women are routinely screened for gestational diabetes in the UK.

    Women who have increased risk factors are usually screened with an oral glucose tolerance test , or oral glucose challenge at around 24-28 weeks of pregnancy.

    During routine midwife appointments, if high glucose levels are found in urine samples, the midwife may refer women for an OGTT, or an earlier test for those who are in the higher risk groups.

    Tips On How To Pass The Glucose Tolerance Test During Pregnancy

    People sometimes ask how to pass the glucose tolerance test. But heres the truth: theres no passing or failing. If youre diabetic, the test will find outand truly, thats important for you and your baby, so you can get the treatment you need to prevent problems. And if youre not, youre not. So no trying to cheat the system here.

    But we do have some tips for taking the glucose tolerance test:

    • Schedule your appointment for first thing in the morning: Youre not likely to worry about the fact that youre fasting while youre asleep. Then, you can get up, go immediately to your appointment and be done before lunch time.
    • Really do the fasting: It may seem like no biggie to have a midnight snack or a little bite of breakfast. But resist the urge! You really dont want to end up with inaccurate or inconclusive results and have to do this gestational diabetes test all over again.
    • Drink water: Yes, youre allowed to have small sips of water while youre fasting. Hey, at least its something!
    • Keep yourself busy: Bring plenty to keep you occupieda book, magazines, podcasts and/or music with earbuds. Three hours in a waiting room is really not fun without distractions.
    • Make your meal plan: Youre going to be ravenous and want to eat ASAP after that last blood draw. Plot out the nearest place to grab a quick snack or meal afterward. Or better yet, pack snacks and leave them in your bag or your car to grab as soon as you leave.

    Who Is Most At Risk For Gestational Diabetes

    Gestational Diabetes: Causes, Symptoms, and Treatments ...

    While researchers aren’t certain why some women get gestational diabetes while others dont, they do know that you may be at an increased risk if:

    In the U.S., about 90 percent of pregnant women have at least one risk factor for gestational diabetes, which is why universal screening is thought to be the most practical approach.

    Evidence From Randomized Controlled Trials

    Biesty et al. published a Cochrane review in which they searched for randomized controlled trials that compared planned early birth at or near term versus expectant management for people with GDM. Unfortunately, they found only one randomized controlled trial to include in the review .

    Side note: In an earlier version of this Evidence Based Birth® article, we cited another trial on this topic , but that study was not included in the Cochrane review because it included women with pre-existing Type 2 diabetes as well as those with GDM.

    The GINEXMAL Trial

    The large Alberico et al. trial took place at eight hospitals across Italy, Slovenia, and Israel. The participants all had GDM as diagnosed by the International Association of Diabetes and Pregnancy Study Groups criteria and no other maternal or fetal medical problems. The IADPSG diagnostic criteria are described in our Signature Article on Diagnosing GDM. In the GINEXMAL trial, 214 participants were randomly assigned to an induction of labor between 38 weeks, 0 days and 39 weeks, 0 days of pregnancy . The other 211 participants were assigned to wait for labor to start on its own until 41 weeks, 0 days, as long as no medical problems developed . They received fetal monitoring tests twice per week until birth.

    For mothers, there was no difference between groups in the risk of Cesarean, birth with forceps/vacuum, postpartum hemorrhage, intensive care, or intact perineum. No deaths occurred among mothers or babies in the study.

    After The Baby Is Born

    Once the baby is born, daily monitoring of the mothers blood sugar levels is no longer required and any medications for lowering blood sugar levels can be stopped.

    In the majority of hospitals, additional to the routine newborn checks, babies born to diabetic mothers are usually monitored for hypoglycaemia . Each hospital is different as to how they monitor the blood sugar levels, but the procedure is the same.

    A midwife or nurse will heel prick the baby to obtain enough blood to be tested on a blood glucose test monitor, the same as used to monitor our own blood sugar levels throughout pregnancy.

    The number of tests taken can vary and the times taken, but your hospital will have a policy which they will follow.

    If the babys blood sugar levels are too low, then top up feeds will be given to help raise levels. If this does not raise levels sufficiently then glucose solution or gel may be given, or if there is a greater concern, they may need to be given an intravenous fusion of glucose.

    Gestational Diabetes Tests And Diagnosis

    Gestational diabetes usually happens in the second half of pregnancy. Your doctor will check for it between weeks 24 and 28, or sooner if you’re at high risk.

    Your doctor will give you a glucose tolerance test: Youâll drink 50 grams of glucose in a sweet drink, which will raise your blood sugar. An hour later, youâll take a blood glucose test to see how your body handled all that sugar. If the results show that your blood sugar is higher than a certain level, youâll need a 3-hour oral glucose tolerance test, meaning youâll get a blood glucose test 3 hours after you drink a 100-gram glucose drink. Your doctor can also test you by having you fast for 12 hours, then giving you a 75-gram glucose drink and a 2-hour blood glucose test.

    If youâre at high risk but your test results are normal, your doctor might test you again later in your pregnancy to make sure you still donât have it.

    Who Gets Gestational Diabetes And Why Do I Have To Be Tested

    Approximately 2-5% of pregnant women develop gestational diabetes; this number may increase to 7-9% of mothers who are more likely to have risk factors. The screening for this disease usually takes place between your 24th and 28th week of pregnancy.

    Doctors test for gestational diabetes during this time because the placenta is producing large amounts of hormones that may cause insulin resistance. If the results indicate elevated levels, further testing would be done to confirm a gestational diabetes diagnosis.

    How Is Gestational Diabetes Managed After Pregnancy

    Research has shown that women with gestational diabetes have a 3 to 7 percent chance of developing type 2 diabetes within five to 10 years which is why its so important to make those healthy habits routine during pregnancy and keep a check on your health even after your pregnancy is over.

    Here are a few ways to stay healthy after baby is born:

    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.

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