Gestational Diabetes


Gestational diabetes is high blood sugar that starts or is first diagnosed during pregnancy. During your pregnancy, hormonal changes can cause the body to be less sensitive to the effect of insulin. These changes can lead to high blood sugar and diabetes. High blood sugar levels in pregnancy are dangerous for both mother and baby. Between 2 and 5 percent of expectant mothers develop gestational diabetes, making it one of the most common health problems during pregnancy. Blood glucose levels return to normal after pregnancy in most women with gestational diabetes.
Gestational diabetes rarely causes symptoms. For that reason, we routinely recommend a glucose screening test (also called a glucose challenge test or GCT) between 24 and 28 weeks of pregnancy to check for gestational diabetes.

Screening and testing
The glucose challenge test (GCT) does not diagnose gestational diabetes. It is a screening. If your screening result is outside of the normal range it does not mean you have gestational diabetes, it means that you will need further testing for a final diagnosis.
About one third of women who test positive on the screening GCT actually have the condition. To find out if you are one of them, you’ll have to undergo a longer, more definitive exam called a glucose tolerance test (GTT).

Early screening for gestational diabetes
Any woman can develop gestational diabetes, but some women are at higher risk. We may recommend that you be screened earlier than 24 weeks if you have a history of one of the common risk factors for gestational diabetes.
www.MayoClinic.com lists the following risk factors on their website:

  • Being older than age 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 pre-diabetes – a precursor to Type 2 diabetes – or if a close family member, such as a parent or sibling, has Type 2 diabetes. You are 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
    • if you had an unexplained stillbirth
  • Being overweight. You are more likely to develop gestational diabetes if you are significantly overweight with a body mass index (BMI) of 30 or higher.
  • Race. For reasons that are not clear, women who are African American, Hispanic, American Indian or Asian are more likely to develop gestational diabetes.

In a study released in 2009, Catherine Kim, MD, MPH at the University of Michigan, Ann Arbor reported that women having at least one sibling with diabetes had a higher risk of gestational diabetes than if only one or both parents had diabetes.
If your early screening results are normal, you will be re-screened at 24 to 28 weeks.

Pre-pregnancy diabetes
If you have already been diagnosed with diabetes, you won’t need to be screened when pregnant. We will coordinate your care with your doctor to manage your diabetes during pregnancy.
Treatment of gestational diabetes
Diet is the preferred treatment in gestational diabetes whether or not medication is needed to maintain blood sugars in the normal range. Dietary control will focus on the reduction in fat intake and the substitution of complex carbohydrates for refined sugar.
Two approaches are recommended:

  • Decreasing the proportion of carbohydrates to 40% in a daily regimen of three meals and three or four snacks
  • Or lowering the glycemic index so that carbohydrates make up approximately 60% of the daily intake

We follow the ADA recommendations that women diagnosed with gestational diabetes receive nutritional counseling by a registered dietitian, with individualization of the nutrition plan based on height and weight.
Physical activity is a helpful add-on therapy when normal blood sugar levels are not achieved by diet alone. When diet and exercise fail to maintain normal blood sugar levels, oral hypoglycemic agents or injectable insulin is used.
Your care will be coordinated with the diabetic teaching center, a dietician, and a maternal-fetal medicine specialist in cooperation with the midwives.