Gestational diabetes has become increasingly common in the pregnant moms I see. What I am seeing in my practice and that of my colleagues mirrors what is happening on a national scale: Gestational diabetes is a growing health problem for American women.
In fact, a recent report by the U.S. Centers for Disease Control and Prevention found that the overall rate of gestational diabetes increased 30 percent from 2016 to 2020, with the rate rising with increasing maternal age and pre-pregnancy body mass index (BMI).
These are troubling statistics because gestational diabetes carries long-term health risks for moms and their babies. Fortunately, there are steps some women can take to lower their risk of developing gestational diabetes, and there are ways moms who do develop this condition can minimize their chances of complications.
What is gestational diabetes?
When a woman is pregnant, she enters a natural state of insulin resistance through no fault of her own – blame hormones! These changes in hormone levels contribute to insulin resistance, which is essentially an inability of the body to make enough insulin to keep blood sugar levels in a safe range. For most pregnant women, the pancreas helps offset insulin resistance. But for some women, the pancreas isn't able to overcome the insulin resistance that is caused by the hormonal changes due to pregnancy. Those women develop gestational diabetes.
Gestational diabetes typically develops around the 24th week of pregnancy.
Do people with gestational diabetes have symptoms?
Many women with gestational diabetes never have symptoms. Some may notice increased thirst and increased urination – but both increased thirst and urination are common issues during pregnancy, even for those without gestational diabetes.
Who is at risk of gestational diabetes?
Many factors can increase a woman's risk of developing gestational diabetes. Risk factors include:
- Obesity or being overweight
- Gestational diabetes in a previous pregnancy
- A diagnosis of prediabetes
- High blood pressure and high cholesterol
- A diagnosis of polycystic ovarian syndrome
- Inactivity/lack of exercise
- Poor diet, especially one high in sugar and processed foods
- Family history of diabetes
- Age: Risk increases as the mother is older.
- Race: People who are Black and/ or Hispanic are at particularly high risk of gestational diabetes.
Can gestational diabetes be prevented?
People who are thinking about becoming pregnant should have a conversation with their ob-gyn about their plans. It's important to discuss medical history, family history and risk factors for gestational diabetes.
I also encourage those planning to become pregnant to stay on top of their preventive care prior to becoming pregnant. That means having bloodwork performed, as needed, to check blood sugar levels and cholesterol levels, for example. If blood sugar is found to be high before conceiving, women can work with their physician to control blood sugar to lower the risk of developing gestational diabetes.
Having a healthy pre-pregnancy weight can lower risk of developing gestational diabetes. Exercise is important. Having an active lifestyle can decrease insulin resistance, thereby lowering the risk of gestational diabetes. I also encourage those planning a pregnancy to eat well. Focus on fruits, vegetables and other non-processed foods. Avoid sugary snacks and sugary drinks.
How is gestational diabetes diagnosed and treated?
Screening for gestational diabetes is a regular part of prenatal care. Moms with risk factors may be tested early in pregnancy. Those without risk factors likely will be tested around weeks 26-28.
The test involves drinking a sugary liquid and then having a blood test an hour later. If the results are normal, no further testing is needed. If the results show high levels of blood sugar, patients will have a three-hour oral glucose tolerance test. Results of that determine whether the mom is diagnosed with gestational diabetes.
Women diagnosed with gestational diabetes will be urged to eat a healthy diet, exercise and check their blood sugar levels at home. If eating well and exercise don't help keep blood sugar levels within healthy ranges, medication will be prescribed, most commonly insulin. Managing gestational diabetes can help lower risk of complications.
What are the possible complications of having gestational diabetes?
Gestational diabetes goes away after the baby is born as hormones return to pre-pregnancy levels – but this condition can lead to complications for mom and baby both before and after pregnancy and birth.
Possible effects on baby can include:
- Being born large, or macrosomia
- Being born pre-maturely
- Birth injuries, including shoulder dystocia. This occurs when the baby's shoulders get stuck during a vaginal delivery because they are too broad.
- Breathing problems at birth
- Low blood sugar, or hypoglycemia, which can lead to fetal seizures
- Jaundice. Jaundice, or yellowing of the skin, is a sign there's too much bilirubin in the baby's blood.
- Low levels of calcium and magnesium
- Developing Type 2 diabetes in the future
- Stillbirth
Possible effects on the mom can include:
- Increased need for requiring a c-section, due to the baby being large. C-sections carry risks, including risk of bleeding. Moms who have c-sections usually take longer to recover from delivery as compared with vaginal deliveries.
- Increased risk of complications during a vaginal birth, including tears in the vagina, fecal incontinence, and anal cuts (fissures).
- Preeclampsia. Preeclampsia, or high blood pressure after 20 weeks of pregnancy, can lead to serious complications, including increased risk of heart attack or stroke later in life.
- Increased risk of developing Type 2 diabetes in the future. Women who develop gestational diabetes should stay in close touch with their ob-gyn after delivery to monitor blood sugar levels.
Gestational diabetes is one of the few pregnancy complications that can affect both mom and baby after pregnancy as well. That is why preventing gestational diabetes, if possible, and treating it if it develops, is vital to minimizing the long-term complications. Pre-natal care is essential, as is eating well, exercising regularly and keeping weight within healthy ranges.