Gestational Diabetes

Gestational Diabetes and Postnatal Care

Expectant women can help control gestational diabetes by eating healthy foods, exercising and, if necessary, taking medication. Controlling blood sugar can prevent a difficult birth and keep you and your baby healthy.

In gestational diabetes, blood sugar usually returns to normal soon after delivery. But if you’ve had gestational diabetes, you’re at risk for type 2 diabetes. You’ll continue working with your health care team to monitor and manage your blood sugar.

Risk factors

Any woman can develop gestational diabetes, but some women are at greater risk. Risk factors for gestational diabetes include:

Age greater than 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 prediabetes — slightly elevated blood sugar that may be a precursor to type 2 diabetes — or if a close family member, such as a parent or sibling, has type 2 diabetes. You're 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 (4.1 kilograms) or if you had an unexplained stillbirth.

Excess weight. You're more likely to develop gestational diabetes if you're significantly overweight with a body mass index (BMI) of 30 or higher.

Nonwhite race. For reasons that aren't clear, women who are black, Hispanic, American Indian or Asian are at higher risk to develop gestational diabetes.

Complications that may affect your baby

If you have gestational diabetes, your baby may be at increased risk of:

Excessive birth weight. Extra glucose in your bloodstream crosses the placenta, which triggers your baby's pancreas to make extra insulin. This can cause your baby to grow too large (macrosomia). Very large babies — those that weigh 9 pounds or more — are more likely to become wedged in the birth canal, sustain birth injuries or require a C-section birth.

Early (preterm) birth and respiratory distress syndrome. A mother's high blood sugar may increase her risk of early labor and delivering her baby before the baby's due date. Or her doctor may recommend early delivery because the baby is large. Babies born early may experience respiratory distress syndrome — a condition that makes breathing difficult. Babies with this syndrome may need help breathing until their lungs mature and become stronger. Babies of mothers with gestational diabetes may experience respiratory distress syndrome even if they're not born early.

Low blood sugar (hypoglycemia). Sometimes babies of mothers with gestational diabetes develop low blood sugar (hypoglycemia) shortly after birth because their own insulin production is high. Severe episodes of hypoglycemia may provoke seizures in the baby. Prompt feedings and sometimes an intravenous glucose solution can return the baby's blood sugar level to normal.

Type 2 diabetes later in life. Babies of mothers who have gestational diabetes have a higher risk of developing obesity and type 2 diabetes later in life.

Treatment

It’s essential to monitor and control your blood sugar to keep your baby healthy and avoid complications during pregnancy and delivery. You’ll also want to keep a close eye on your future blood sugar levels. Your treatment strategies may include:

Monitoring your blood sugar. While you’re pregnant, your health care team may ask you to check your blood sugar four to five times a day — first thing in the morning and after meals — to make sure your level stays within a healthy range. This may sound inconvenient and difficult, but it’ll get easier with practice.

Healthy diet. Eating the right kinds of food in healthy portions is one of the best ways to control your blood sugar and prevent too much weight gain, which can put you at higher risk of complications. Doctors don’t advise losing weight during pregnancy — your body is working hard to support your growing baby. But your doctor can help you set weight gain goals based on your weight before pregnancy.

Exercise. Regular physical activity plays a key role in every woman’s wellness plan before, during and after pregnancy. Exercise lowers your blood sugar by stimulating your body to move glucose into your cells, where it’s used for energy. Exercise also increases your cells’ sensitivity to insulin, which means your body will need to produce less insulin to transport sugar.

Medication. If diet and exercise aren’t enough, you may need insulin injections to lower your blood sugar. Between 10 and 20 percent of women with gestational diabetes need insulin to reach their blood sugar goals. Some doctors prescribe an oral blood sugar control medication, while others believe more research is needed to confirm that oral drugs are as safe and as effective as injectable insulin to control gestational diabetes.

Close monitoring of your baby. An important part of your treatment plan is close observation of your baby. Your doctor may monitor your baby’s growth and development with repeated ultrasounds or other tests. If you don’t go into labor by your due date — or sometimes earlier — your doctor may induce labor. Delivering after your due date may increase the risk of complications for you and your baby.

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