How Does Gestational Diabetes (GD) Affect Your Pregnancy and Baby?

Has your doctor diagnosed you with gestational diabetes (GD or GDM)? While it might feel overwhelming at first, gestational diabetes is much more common than you might think.

Know that with careful monitoring and treatment, gestational diabetes can be managed, and you can have a safe and healthy pregnancy.

What is gestational diabetes?

Gestational diabetes is a form of diabetes that appears only during pregnancy.

Between 6 and 9 percent of pregnant women develop gestational diabetes, according to the Centers for Disease Control and Prevention (CDC).

What causes gestational diabetes?

Insulin is a hormone produced in the pancreas that regulates the body's metabolism of fats and carbs. It also helps the body turn sugar into energy.

Gestational diabetes occurs when hormones from the placenta block the effect of insulin, preventing the body from regulating the increased blood sugar of pregnancy effectively.

This causes hyperglycemia (or high levels of sugar in the blood), which can damage the nerves, blood vessels and organs in your body when left unmanaged.

When does gestational diabetes usually begin?

Gestational diabetes is usually diagnosed between week 24 and week 28, but it may develop earlier on in pregnancy.

Who is most at risk for gestational diabetes?

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

• You are overweight. Having a BMI of 30 or more going into pregnancy is one of the most common risk factors for gestational diabetes.
• You are older. Doctors have noted that women over the age of 25–30 have a higher risk of developing GDM, with that risk increasing as you get older.
• You have a family history. If diabetes runs in the family, especially in any of your first-degree relatives, you may be more at risk of GDM. 
• You have a personal history of GDM. If you had gestational diabetes during a previous pregnancy, research suggests you're more likely to have it again in a subsequent pregnancy.
• You received a pre-diabetes diagnosis. If your blood sugar levels were slightly elevated before pregnancy (for example, if your hemoglobin A1C was greater than or equal to 5.7 percent, or if you were told you have an impaired fasting glucose level), you may be at higher risk of GDM.
• You have been put on bed rest. Some research has shown that because bed rest restricts activity levels, it's more likely to lead to additional pregnancy weight gain and, consequently, GDM.
• You have a medical condition associated with the development of diabetes. This could include metabolic syndrome, polycystic ovary syndrome, hypertension or cardiovascular disease.
• You're pregnant with multiples. Carrying more than one baby may increase your risk for GDM.

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 a practical approach. 

What are the symptoms of gestational diabetes?

Most women with gestational diabetes have no symptoms, though a few may experience:

• Unusual thirst
• Frequent urination in large amounts (distinguished from the also frequent but usually light urination of early pregnancy)
• Fatigue (which may be difficult to differentiate from normal pregnancy fatigue)
• Sugar in the urine (detected at a routine practitioner visit)

How is gestational diabetes diagnosed?

You’ve probably noticed by now that your doctor asks for a urine sample at every office visit. That’s in part to check for sugar in your urine, which can be a sign of gestational diabetes (though one positive screening doesn’t necessarily mean you have gestational diabetes).

In addition, the U.S. government now recommends that all pregnant women receive specific screening for gestational diabetes. Between week 24 and 28 of pregnancy, your practitioner will give you a glucose screening test, where you'll drink a sugary liquid and have your blood drawn an hour later. If you have risk factors for gestational diabetes, you may also undergo this test earlier in pregnancy. 

If your bloodwork picks up high sugar levels, your doctor will have you take a three-hour glucose tolerance test to determine whether you have gestational diabetes.

How does gestational diabetes affect me and my baby?

With proper treatment and regular monitoring by your practitioner, gestational diabetes can be managed and is not harmful to you or your baby. But if GDM is not treated, and excessive sugar circulates in a mother's blood and the baby's, the potential problems for both mother and baby are serious.

Women who have uncontrolled GDM are at risk for having a bigger baby (a condition called macrosomia), making delivery more difficult and C-section more likely. They are also at risk for preeclampsia and stillbirth.

And because gestational diabetes is considered a pregnancy complication, pregnant women who have it may be more likely to be induced, since most doctors won't let their pregnancies progress past their due dates.

Uncontrolled diabetes could also lead to potential problems for the baby after birth, such as jaundice, breathing difficulties and low blood sugar levels. Later in life, the baby may be at an increased risk for obesity and type 2 diabetes.

But remember, following your doctor's recommendations to manage blood sugar levels can help prevent these potential negative effects.

What you can do to prevent gestational diabetes?

The following steps can have a big impact on reducing your risk of developing both gestational diabetes and type 2 diabetes, both before you conceive and during your pregnancy:

• Stay active. With the motivation of your baby on the way, now's an excellent time to start or maintain a fitness routine. Working out under your practitioner's guidance — even a 15-minute walk after lunch and dinner — allows your body to burn glucose even without the insulin your body should normally produce. It’s a great way to keep your blood sugars in check.
• Eat a healthy diet. Fill your grocery list (and your plate) with a mix of fruits and vegetables; healthy protein; and complex carbs. Think whole grains, legumes, nuts, seeds, tofu, fish, lean red meat, poultry and low-fat dairy.
• Gain pregnancy weight steadily. With the help of your practitioner, aim to gain the recommended amount of weight during pregnancy.

Even if you adopt these healthy habits, it's (frustratingly) still possible to develop gestational diabetes — especially if you have a family history of the disease. Keeping them up, however, will help you manage the condition.

How is gestational diabetes treated? 

Fortunately, you can ward off the potential risks associated with diabetes in pregnancy by monitoring your blood sugar levels.

If you’re diagnosed with GDM, doctors and researchers recommend the following:

• Monitor your blood sugar level several times a day. Check first thing in the morning to get your fasting rate and then an hour after you eat each meal to make sure your blood sugar stays in a healthy range (suggested by your doctor). Most doctors recommend buying a diabetes kit, which includes needles to prick your finger and a little machine that reads your blood sugar. It’s the most accurate way to tell how your body is processing various foods. 
• Meet with a registered dietitian. He or she can help you review healthy food options and make a meal plan. Many women stick to their gestational diabetes eating style long after birth because it's rich in nutrients and designed to keep your blood sugar (and energy levels) stable.
• Keep a food log. After each meal, write down what you ate along with your blood glucose number. This helps you to better understand which foods are spiking your glucose levels so you can make adjustments going forward.
• Get moving. Go for a walk or take the stairs after a meal to lower your glucose levels.

Diet and exercise are often enough to control gestational diabetes — but if they don’t, your doctor may suggest that you take supplementary insulin to control it.

Supplementary insulin can be given in shots or through the oral drug glyburide (a diabetes medication that helps the pancreas produce insulin).

Your doctor may suggest additional fetal monitoring in your third trimester, including either nonstress tests and/or biophysical profiles, to make sure your baby’s heart rate, amniotic fluid levels and movements are normal.

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 it’s important to make healthy habits routine during pregnancy and keep a check on your health after your pregnancy is over.

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

• Keep up with doctor visits. Make sure your primary care physician and/or OB/GYN reevaluates you after your postpartum visit — at six weeks and then again every year — to check your fasting glucose and HbA1c (glycated hemoglobin) levels.
• Talk to a registered dietitian. An R.D. help you to develop an eating plan that will help keep glucose levels in a healthy range.
• Continue to choose healthy foods. Opt for wholesome picks like vegetables, beans, nuts, seeds, fruit, lean meats, dairy and whole grains. (A dietitian can help you to come up with a grocery list that fits your budget, too!)
• Consider breastfeeding longer, if you're able. Breastfeeding may decrease your risk of developing type 2 diabetes after gestational diabetes. There are several possible explanations, including that breastfeeding women have lower levels of glucose circulating in their blood.
• Fit in fitness. Although your newborn will undoubtedly take up a lot of your attention, try to get in as much doctor-approved exercise as possible. It's important to take some time to care for yourself during the postpartum period (and parenthood in general!).

How does GD affect your baby after birth?

Babies who are born to mothers with gestational diabetes should be tested for low blood sugar (hypoglycemia), 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.

If you had gestational diabetes, your baby could be at a higher risk for health problems later in life, including type 2 diabetes, according to the CDC. As he grows, practicing those same good eating and exercise habits you learned during pregnancy as a family will help protect his health — and yours.