Gestational Diabetes: What is it and how to manage it?

You may or may not have heard of people developing diabetes during pregnancy. It is likely that you're reading this article because you or someone you know have this condition. According to American Diabetes Association, during pregnancy – usually around the 24th week – many women develop gestational diabetes. The prevalence of gestational diabetes is as high as 9.2% reported by CDC (Centers for Disease Control and Prevention).

A diagnosis of gestational diabetes doesn't mean that you had diabetes before you conceived, or that you will have diabetes after giving birth. However, this may still be shocking when you first heard the news, but don't get frustrated, because this is completely controllable. Keep on reading and you will learn how to avoid those complications, maintain a smooth pregnancy and deliver a healthy baby.

What is Gestational Diabetes?

Pregnant women who have never had diabetes before but who have high blood glucose (sugar) levels during pregnancy are said to have gestational (jes-stay-shuh-nal) diabetes.

What Causes Gestational Diabetes?

We don't know what causes gestational diabetes, but we have some clues. The placenta supports the baby as it grows. Hormones from the placenta help the baby develop. But these hormones also block the action of the mother's insulin in her body. This problem is called insulin resistance. Insulin resistance makes it hard for the mother's body to use insulin. She may need up to three times as much insulin.

Gestational diabetes starts when your body is not able to make and use all the insulin it needs for pregnancy. Without enough insulin, glucose cannot leave the blood and be changed to energy. Glucose. The food you eat gets digested and broken down into a sugar your body's cells can use. This is glucose, one of the simplest forms of sugar builds up in the blood to high levels.

You can also watch is educational video from ADA to learn more about what it is.

Gestational Diabetes. https://www.youtube.com/watch?v=A-8de9LuVJQ&feature=youtu.be

Who is at risk of Gestational Diabetes?

According to Mayo Clinic, any woman can develop gestational diabetes, but some women are at greater risk. Risk factors for gestational diabetes include:

• Age greater than 25. Women older than age 25 are more likely to develop gestational diabetes.

• Family or personal health history. Your risk of developing gestational diabetes increases if you have prediabetes — slightly elevated blood sugar that may be a precursor to type 2 diabetes — or if a close family member, such as a parent or sibling, has type 2 diabetes. You're also more likely to develop gestational diabetes if you had it during a previous pregnancy, if you delivered a baby who weighed more than 9 pounds (4.1 kilograms) or if you had an unexplained stillbirth.

• Excess weight. You're more likely to develop gestational diabetes if you're significantly overweight with a body mass index (BMI) of 30 or higher.

• Nonwhite race. For reasons that aren't clear, women who are black, Hispanic, American Indian or Asian are at higher risk to develop gestational diabetes. A recent study has shown Asian women with BMI <20 at age of 20 also have increased risk of Gestational Diabetes.

How do I know if I have Gestational Diabetes?

Your doctor will test you for gestational diabetes between 24 and 28 weeks of pregnancy. Tests include the glucose challenge test and the oral glucose tolerance test (OGTT). If the results of the glucose challenge test show high blood glucose, you will return for an OGTT test to confirm the diagnosis of gestational diabetes.

What happens to me and my baby if I have UNCONTROLLED Gestational Diabetes?

An extra large baby.

Diabetes that is not well controlled causes the baby’s blood sugar to be high. The baby is “overfed�? and grows extra large. Besides causing discomfort to the woman during the last few months of pregnancy, an extra large baby can lead to problems during delivery for both the mother and the baby. The mother might need a C-Section to deliver the baby. The baby can be born with nerve damage due to pressure on the shoulder during delivery.

C-Section (Cesarean Section)

A C-section is an operation to deliver the baby through the mother’s belly. A woman who has diabetes that is not well controlled has a higher chance of needing a C-section to deliver the baby. When the baby is delivered by a C-section, it takes longer for the woman to recover from childbirth.

High Blood Pressure / Preeclampsia (pree-e-klamp-see-uh)

When a pregnant woman has high blood pressure, protein in her urine, and often swelling in fingers and toes that doesn’t go away, she might have preeclampsia. It is a serious problem that needs to be watched closely and managed by her doctor. High blood pressure can cause harm to both the woman and her unborn baby. It might lead to the baby being born early and also could cause seizures or a stroke (a blood clot or a bleed in the brain that can lead to brain damage) in the woman during labor and delivery. Women with diabetes have high blood pressure more often than women without diabetes.

Low Blood Sugar (Hypoglycemia)

People with diabetes who take insulin or other diabetes medications can develop blood sugar that is too low. Low blood sugar can be very serious, and even fatal, if not treated quickly. Severe low blood sugar can be avoided if women watch their blood sugar closely and treat low blood sugar early. If a woman’s diabetes was not well controlled during pregnancy, her baby can very quickly develop low blood sugar after birth. The baby’s blood sugar must be watched for several hours after delivery.

Is Gestational Diabetes permanent?

Gestational diabetes (GDM), or diabetes during pregnancy, is when women have diabetes during pregnancy. They've never had diabetes before, and it goes away after pregnancy as the hormone changes after delivery. But, unfortunately, that's not the end of the story.

Once you've had GDM your chances are 2 in 3 that it will return in future pregnancies. And women who have had GDM are more than 7 times as likely to develop type 2 diabetes as women who didn't have diabetes in pregnancy.

There are many other health conditions that raise your risk, including:

• High

• Unhealthy cholesterol

• High blood pressure

• Smoking

• Not getting enough physical activity

• Unhealthy eating

What to do if I have Gestational Diabetes?

Managing gestational diabetes includes following a healthy eating plan and being physically active. If your eating plan and physical activity aren’t enough to keep your blood glucose in your target range, you may need insulin. According to the Mayo Clinic, only 10 to 20 percent of women with gestational diabetes need insulin to help control their blood sugar. 80% of pregnant women with gestational diabetes is able to control the blood sugar by dietary modification.

Tips for managing Gestational Diabetes include the following:

1. Medical Nutrition Therapy (MNT)

The goals for Medical Nutrition Therapy (MNT) for gestational diabetes include goals for a typical pregnancy (adequate nutrients to support maternal weight gain and fetal growth and development). In addition, MNT should focus on maintaining maternal blood glucose control and preventing ketosis (a condition caused by cells lack of blood sugar as fuel).

Food intake (specifically energy and carbohydrates) should be distributed into small, frequent meals and snacks (e.g., 3 meals, 2-4 snacks each day). An evening snack usually needed to prevent ketosis overnight.

The California Sweet Success program suggests:

To manage the increased carbohydrate sensitivity seen during pregnancy and achieve good blood sugar control, total carbohydrate intake should be a minimum of 175 grams per day and less than 45% of energy. However, the total daily carbohydrate levels and distribution should be individualized to tolerance and preference. You should also consume adequate protein, fat and other micronutrients for optimal fetal development.

Therefore, talk to your dietitian to personalize your nutrition plan is recommended.

2. Exercise Regularly

Exercise is another way to keep blood sugar under control. It helps to balance food intake. After checking with your doctor, you can exercise regularly during and after pregnancy. Get at least 30 minutes of moderate-intensity physical activity at least five days a week. This could be brisk walking, swimming, or actively playing with children.

3. Monitor Blood Sugar Often

Because pregnancy causes the body’s need for energy to change, blood sugar levels can change very quickly. Check your blood sugar often, as directed by your doctor.

4. Take Insulin, If Needed

Sometimes a woman with gestational diabetes must take insulin. If insulin is ordered by your doctor, take it as directed in order to help keep blood sugar under control.

How do I lower risk for type 2 diabetes after delivery?

• Lose weight. Are you more than 20% over your ideal body weight? Losing even a few pounds can help you prevent type 2 diabetes.

• Make healthy food choices. Follow simple daily guidelines, like eating enough fresh vegetables and fruits, and whole grains. Limit fat to 30% or less of your daily calories, and watch your portion sizes. Healthy eating habits can go a long way in preventing diabetes and other health problems.

• Stay active. Regular exercise can help prevent type 2 diabetes. Plus it can help you lose weight, manage stress, and feel better. Learn more about physical activity

• Breastfeed. If you can, breastfeed your baby. Breastfeeding can provide both short- and long-term benefits to both your baby and to you.

• Talk to your doctor and dietitians. Be sure to tell your health care providers that you've had GDM.

• Get tested. If you had GDM, you should be tested for diabetes 6–12 weeks after you give birth and at least every 3 years after that.

Additional Resources for women who have Gestational Diabetes.

1. CDC: Gestational Diabetes and Pregnancy Brochure

https://www.cdc.gov/pregnancy/documents/Diabetes_and_Pregnancy508.pdf

2. Myplate for Gestational Diabetes

https://www.cdappsweetsuccess.org/Portals/0/Documents/Nutrition/CDAPPMyPlate31418ENGLISH.pdf

Lian Liu, MPH, RD

Registered Dietitian with background in nutrition and pharmaceutical science and 10+ years experiences in research, clinical, health education and coaching.

Everyone has a unique nutritional needs and preferences, I help you identify the best suitable nutrition solution to help align your body and mind

References:

1. American Diabetes Association: Gestational Diabetes. http://www.diabetes.org/diabetes-basics/gestational/

2. Mayo Clinic: Gestational diabetes. https://www.mayoclinic.org/diseases-conditions/gestational-diabetes/symptoms-causes/syc-20355339

3. CDC: Pregnancy/Gestational. https://www.cdc.gov/pregnancy/diabetes-gestational.html

4. NIH NIDDK: Gestational Diabetes. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/gestational

5. Yachi Y, Tanaka Y, Nishibata I, Sugawara A, Kodama S, Saito K, Sone H. Low BMI at age 20 years predicts gestational diabetes independent of BMI in early pregnancy in Japan: Tanaka Women's Clinic Study. Diabet Med. 2013 Jan;30(1):70-3. doi: 10.1111/j.1464-5491.2012.03712.x. PubMed PMID: 22612636.

6. CDAPP Sweet Success Guidelines for Care ©2015.