Pregnant women who have never had diabetes before but who have high blood glucose (sugar) levels during pregnancy are said to have gestational diabetes. It is estimated that gestational diabetes affects 20% of pregnancies.
How gestational diabetes can affect your baby
However, untreated or poorly controlled gestational diabetes can hurt your baby. When you have gestational diabetes, your pancreas works overtime to produce insulin, but the insulin does not lower your blood glucose levels. Although insulin does not cross the placenta, glucose and other nutrients do. So extra blood glucose goes through the placenta, giving the baby high blood glucose levels. This causes the baby’s pancreas to make extra insulin to get rid of the blood glucose. Since the baby is getting more energy than it needs to grow and develop, the extra energy is stored as fat.
This can lead to macrosomia, or a “fat” baby. Babies with macrosomia face health problems of their own, including damage to their shoulders during birth. Because of the extra insulin made by the baby’s pancreas, newborns may have very low blood glucose levels at birth and are also at higher risk for breathing problems. Babies with excess insulin become children who are at risk for obesity and adults who are at risk for type 2 diabetes.
Diabetes can also cause increased risk of birth defects such as heart, kidney or spine defects; these occur most often in women who were diabetic prior to pregnancy. Hydramnios or too much fluid around the baby may occur, which can lead to preterm delivery. Respiratory distress syndrome can make it harder for baby to breathe after birth; this risk is more common in babies of mothers with diabetes.
Because gestational diabetes can hurt you and your baby, you need to start treatment quickly. Treatment for gestational diabetes aims to keep blood glucose levels equal to those of pregnant women who don’t have gestational diabetes. Treatment for gestational diabetes always includes special meal plans and scheduled physical activity. You will meet with the diabetic educator and nutritionist to come up with a meal and exercise plan. Your treatment will also include daily blood glucose testing.
If you’re testing your blood glucose, the American Diabetes Association suggests the following targets for women who develop gestational diabetes during pregnancy. More or less stringent glycemic goals may be appropriate for each individual.
- Before a meal (preprandial): 95 mg/dl or less
- 1-hour after a meal (postprandial): 140 mg/dl or less
You will need help from your doctor, nurse educator, and other members of your health care team so that your treatment for gestational diabetes can be changed as needed. For you as the mother-to-be, treatment for gestational diabetes helps lower the risk of a cesarean section birth that very large babies may require.
Keeping worry in perspective
While gestational diabetes is a cause for concern, the good news is that you and your health care team – your doctor, obstetrician, nurse educator, and dietitian – work together to lower your high blood glucose levels. And with this help, you can turn your concern into a healthy pregnancy for you, and a healthy start for your baby.
Gestational diabetes – Looking ahead
Gestational diabetes usually goes away after pregnancy. But once you’ve had gestational diabetes, your chances are 2 in 3 that it will return in future pregnancies. In a few women, however, pregnancy uncovers type 1 or type 2 diabetes. It is hard to tell whether these women have gestational diabetes or have just started showing their diabetes during pregnancy. These women will need to continue diabetes treatment after pregnancy.
Many women who have gestational diabetes go on to develop type 2 diabetes years later. There seems to be a link between the tendency to have gestational diabetes and type 2 diabetes. Gestational diabetes and type 2 diabetes both involve insulin resistance. Certain basic lifestyle changes may help prevent diabetes after gestational diabetes.