Gestational Diabetes | What You Need To Know

You’ve probably heard of gestational diabetes.

It’s become a common complication of pregnancy and one you might be concerned about developing.

This article covers everything you need to know about gestational diabetes: the causes, the risk factors, and how to manage this condition if you’re diagnosed with it.

What is gestational diabetes?

Gestational diabetes mellitus (GDM) is a form of diabetes that occurs for the first time during pregnancy.

Similar to other types of diabetes, gestational diabetes affects how your body cells use sugar or glucose.

The pancreas produces a hormone called insulin, which is responsible for keeping blood glucose levels stable. Insulin transports glucose from the bloodstream into cells of the body to provide energy.

During pregnancy, your body becomes naturally a little insulin resistant. This is so your bloodstream has more glucose available for your baby.

If this insulin resistance becomes too strong, however, it can cause abnormally high blood sugar levels.

What causes gestational diabetes?

The cause of GDM isn’t really well known. But it’s thought that pregnancy hormones play a role in the development of the condition.

During pregnancy, the placenta produces hormones that help the baby grow and develop.

These hormones also naturally decrease the action of the mother’s insulin; this is called insulin resistance.

Because of this resistance, the need for insulin during pregnancy is two or three times higher than normal.

Consequently, during pregnancy, the mother’s body needs to produce higher amounts of insulin to keep her blood sugar level within the normal range.

If her body is unable to produce more insulin to meet her needs, she might develop gestational diabetes.

Gestational diabetes symptoms

Gestational diabetes usually has no obvious symptoms.

Some women, however, might notice:

• Unusual thirst
• Excessive urination
• Tiredness
• Thrush (yeast infections).

If you have these symptoms, it might be worthwhile to talk to your doctor.

Who is most at risk for gestational diabetes?

It’s worth noting gestational diabetes can occur in women who aren’t overweight or obese.

Here is a list of risk factors for gestational diabetes:

• Having a first-degree relative with type 2 diabetes leads to a lifetime risk of 40% Similarly, 25% to 33% of all type 2 diabetics have a family history of the condition
• Being more than 40 years of age
• Excess body fat, particularly if you’re ‘apple shaped’ with a waist circumference greater than 88 cm
• A sedentary lifestyle, with a diet high in grains and refined carbohydrates (e.g. bread, cereal, pasta)
• Glucose intolerance, abnormal cholesterol (dyslipidemia), high blood pressure (hypertension)
• Prior history of gestational diabetes
• Diagnosed or undiagnosed polycystic ovary syndrome (PCOS)
• Conception with assisted reproduction (IVF, IUI, ICSI, etc)
• Being of Aboriginal or Torres Strait Islander, Pacific Islander, Indian or Chinese, African American, Hispanic American, or Native American descent
• Low birth weight and/or malnutrition in pregnancy can cause metabolic abnormalities in a fetus, which later lead to diabetes.

How can gestational diabetes affect my baby?

If maternal glucose levels are uncontrolled, the baby can suffer from a range of major health issues.

A higher than usual amount of blood sugar passes through the placenta into the fetal circulation. As a result, extra glucose in the fetus is stored as body fat. This can lead to macrosomia or a baby that is considered to be big.

Potential health problems for your baby include:

• Central nervous system defects
• Organ failure
• Cardiac or renal anomalies
• Asphyxia
• Respiratory distress
• Increased blood volume
• Congestive heart failure
• Hypoglycemia (low blood sugar)
• Stillbirth.

If your baby is experiencing fetal distress due to unmanaged GDM, you might need to give birth earlier or have a c-section. This increases the risk of complications for both you and your baby.

Does gestational diabetes make a baby more active?

When you start to feel your baby move, you will notice a pattern of movement that is unique to your baby.

Whether you have GDM or not, if you notice the pattern of movement has changed, or if there is reduced movement, this needs to be reported to your midwife or health care provider.

If left untreated, GDM can result in babies becoming unwell, which can affect their movements.

Women from the Gestational Diabetes UK Facebook group report that when they reduce their carb and sugar intake, they notice a change in fetal movements. Some women have noticed low blood sugar causes reduced movement, while high blood sugar has the opposite effect.

Experts have a theory that some babies of pregnant women with gestational diabetes might be naturally more active in the uterus, and they might be able to compensate for the higher blood sugar levels. This is possibly why these babies are less likely to be larger at birth.

Do women with gestational diabetes birth early?

The complications caused by elevated blood sugar can increase the risk of premature birth.

Studies show the risk of premature birth due to gestational diabetes is greater if a mother develops diabetes before the 24th week of pregnancy. After the 24th week, the chances of preterm birth go down.

A pregnant woman with gestational diabetes is more likely to have high blood pressure. This can affect the baby’s growth, and lead to complications that mean the baby might need to be born early.

GDM also increases the risk of preeclampsia. This is a serious complication of pregnancy leading to high blood pressure and other symptoms that are dangerous for mother and baby.

Women are often induced earlier than their estimated due date because their doctors are concerned about the size of the baby. This is quite contentious; ultrasound isn’t accurate for estimating the weight of babies later in pregnancy.

Read more here in How Accurate Is Ultrasound For Weight?

Induction has an increased risk of c-section and other complications, so managing your GDM is the best way to reduce the chance of experiencing these problems.

How common is gestational diabetes?

Depending on the specific population, for mothers whose bodies can’t control the regulation of glucose, GDM occurs in 3-10% of pregnancies.

Doctor Andrew Orr is one of Australia’s leading Reproductive Medicine and Women’s Health specialists, with over 20 years of experience in treating fertility. Doctor Orr believes the rates of gestational diabetes are probably up to around 50% these days, given how many people are seen with this disease.

Australia now has one of the most overweight populations in the world, and all types of diabetes levels have increased.

This increase is believed to be due to:

• Increased sedentary lifestyles
• Changes in diet (e.g. high sugar and processed foods)
• Continued immigration from high-risk populations
• The epidemic of childhood and adolescent obesity presently evolving.

Gestational diabetes test

To screen for gestational diabetes, a glucose tolerance test (GTT) is performed at 24-28 weeks of pregnancy. If you have any risk factors, you may be screened in early pregnancy and again in late pregnancy.

A three-hour oral GTT is done, via a blood test, in which you need to take nil by mouth for 10 hours prior and then drink a glucose drink. This test used to be a one-hour glucose challenge test, but this is no longer done due to its lower accuracy.

For more information about diagnosis, you may find these articles helpful:

• Glucose Test in Pregnancy – 11 Common Questions
• Is Routine Testing For Gestational Diabetes Necessary?

Gestational diabetes treatment

A diagnosis of GDM can be worrying. Understandably, you might feel as though you’ve done something wrong. Remember, for most women this condition can be managed quite well.

You will have access to a team of health professionals, such as your doctor, endocrinologist, nutritionist, naturopath, or diabetes specialist.

They can help you understand what you need to do and will support you in managing your gestational diabetes.

Bear in mind, different health professionals may well have very different opinions on treatment. It’s common for a pregnant woman to be prescribed high carbohydrate diets, for example, despite it being part of the problem.

Monitoring your blood sugar level is essential. It gives an indication as to whether the changes you have made to your lifestyle are helping, or if further treatment is required.

A diabetes nurse educator can teach you how and when to measure your blood sugar levels and discuss the recommended levels to aim for.

Regular contact with your health care practitioner, diabetes educator, or doctor is recommended.

Insulin injections might be needed to help keep your blood sugar level within the normal range. They’re safe to have during pregnancy; the insulin doesn’t cross the placenta from the mother to the baby.

Your doctor may also prescribe medication that keeps your blood sugar levels stable.

If you’re in Australia, BellyBelly recommends THESE doctors and specialists to help manage your gestational diabetes.

Complementary and alternative therapies for GDM

Historically overlooked by western medicine, alternative or complementary therapies are a fantastic option to complement your original treatments.

Some of these are:

• Traditional Chinese Medicine (TCM)
• Herbal treatments
• Ayurvedic Medicine
• Dietary Supplements
• Aromatherapy
• Relaxation Therapy and Guided Imagery
• Massage Therapy and Reflexology
• Homeopathy
• Biofeedback.

GDM and supplementation

Researchers are looking at the possibility of certain vitamin deficiencies being linked to gestational diabetes.

To cover your bases, it’s ideal to ensure your nutritional status is the best it can be before you conceive your baby.

Take a good quality multivitamin, preferably one from a natural health practitioner. Quality, practitioner-only brands are more potent than supermarket or pharmacy brands.

Make sure you include folate in your diet, as well as plenty of vitamin D and calcium.

Gestational diabetes – what to eat?

If you’re at high risk for developing GDM or have already been diagnosed, the best way forward is to follow a diet that focuses on low GI and low-sugar foods.

The best diet to follow is a sugar and grain-free diet such as Paleo or low carb; you can read more on Diet Doctor. That way you’re cutting out inflammatory foods that spike your blood sugar, and then spike your insulin.

Monitor your fruit intake, and limit it to one serve per day. This helpful chart from Diet Doctor shows which fruits are worse than others.

Does drinking water help gestational diabetes?

Staying well-hydrated is important during pregnancy. Gestational diabetes can increase your risk of becoming dehydrated, so it’s important to keep those fluids up.

Drinking water doesn’t cause high or low blood sugar, but it flushes excess sugar out of your system. Staying hydrated helps control and stabilize your blood sugar levels.

Check out the drinks chart from Diet Doctor (as well as the others).

Aim to drink 8 glasses of water per day and take some form of electrolyte (but avoid sugary sports drinks).

Gestational diabetes and exercise

Exercise during pregnancy is important for many reasons.

Exercise helps to keep your body feeling good. It also helps with your emotional state, and can help to control blood sugar if you have gestational diabetes. It can even shorten your labor.

If you’re not already an active person, try walking or yoga to start with. Swimming is another excellent form of exercise that puts a low strain on your muscles.

Check with your doctor or health care professional before starting a new or particularly strenuous exercise regimen.

Gestational diabetes after birth

After giving birth, breastfeeding is encouraged for all women, not just those with GDM. Breastfeeding has short and long-term health benefits for both you and your baby.

Read more here in Benefits Of Breastfeeding | For Baby and Mother.

If you were having insulin injections during pregnancy, they will no longer be needed. Gestational diabetes usually disappears once you give birth, even if you have a c-section.

Blood sugar levels are measured before breakfast and two hours after meals, to make sure they are within the normal range.

An oral glucose tolerance test is done six to eight weeks after the baby is born, to make sure you no longer have diabetes.

Following the birth, it’s important your baby’s blood sugar levels are measured, too, to make sure the blood sugar isn’t too low.

If it is, it can be treated by feeding your baby breastmilk or formula. Discuss with your baby’s doctor the best option for your baby.

A woman who has gestational diabetes won’t give birth to a baby with diabetes. However, the baby might be at higher risk of developing type 2 diabetes later in life.

For more information, be sure to read Can Diabetes Impact Breastfeeding Success?

Reduce your risk of type 2 diabetes

Women who have gestational diabetes have a one in two chance of developing type 2 diabetes within 10 to 20 years.

Type 2 diabetes can be prevented, so it is important to take steps to reduce your risk.

You should:

• Maintain a healthy eating plan (as mentioned above)
• Maintain a healthy weight for your height
• Engage in regular physical activity
• Have a follow-up blood test (oral GTT) every year to check blood sugar levels
• Breastfeed. Breastfeeding can lower the risk of developing type 2 diabetes later in life by nearly 50%.
• Stop smoking. For non-biased advice and to find out the proven, most effective stop-smoking method, click here.

What about subsequent pregnancies?

Once you have been diagnosed with gestational diabetes, any future pregnancies can be affected.

In future pregnancies, an oral glucose test will be performed early in the pregnancy to check your blood sugar levels are within the normal range.

Should the oral GTT come back normal, a repeat test will be done – usually between 22 and 28 weeks gestation.

Prevention is the best way to deal with gestational diabetes and type 2 diabetes.

Before you conceive, it’s ideal to prepare for pregnancy with nutritious foods, good supplements, exercise, and a healthy lifestyle.

These healthy eating and lifestyle changes should continue into the pregnancy as well, for optimal health and the best outcomes for mother and baby.

Recommended Reading:

The team from That Sugar Film writes about sugar, diet, and gestational diabetes.