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Diabetes & Pregnancy Home:  Preconception planning | Pregnancy in diabetes | Gestational Diabetes


Gestational Diabetes
     What is gestational diabetes?
Important steps:
Meal plan
Frequent monitoring
Insulin administration and dosage adjustment
Hypoglycemia control and treatment

Gestational Diabetes

About three to five percent of all pregnant women develop gestational diabetes during pregnancy. It is different from type 1 diabetes, in which the body produces no insulin and insulin must be injected, and from the more common type 2 diabetes. Patients with type 2 diabetes suffer from varying levels of insulin resistance and may control blood glucose levels through diet and exercise, with oral medication, or with insulin injections.

Gestational diabetes usually develops about midway through a pregnancy, at about 20 to 24 weeks, and is caused by the changes in hormones in your body during pregnancy. In addition to supplying your baby with nutrients and water from your circulation, the placenta produces a number of hormones vital to the pregnancy. Some of these have a blocking effect on insulin. As the placenta grows larger, the more hormones are produced, and the greater the insulin resistance becomes. In most women, the pancreas is able to make additional insulin to overcome this insulin resistance. When the pancreas makes all the insulin it can, and there still isn't enough to overcome the effect of the placenta's hormones, gestational diabetes results.

Any woman might develop gestational diabetes during pregnancy. Factors that have been identified as increasing the risk for gestational diabetes are obesity, a family history of diabetes, having given birth to a very large infant previously, having had a stillbirth or a child with a birth defect, or having too much amniotic fluid. Women older than 25 are at greater risk than younger ones.

Gestational diabetes usually clears up as soon as the baby is born, since when the placenta is removed, the hormones it was producing - which were causing the insulin resistance -- are also removed. Once again your insulin is permitted to work normally without resistance, and you should no longer have any problems with blood glucose levels.

Although this type of diabetes disappears when the baby is born, some women who have gestational diabetes go on to develop diabetes when they get older. Some studies have reported that almost 40 percent of women who have gestational diabetes will go on to develop type 2 diabetes. So, if you have gestational diabetes, you will need to be screened for type 2 diabetes every year.

One of the major concerns about diabetes in pregnancy is the harmful effect that high blood glucose levels can have on the developing baby. In women who don't have their blood glucose levels controlled at near normal levels during the first trimester, there is a higher incidence of miscarriage and birth defects. However, since gestational diabetes doesn't appear until well after that critical period, there is little likelihood of those types of problems in gestational diabetes.

Although most women with this condition are treated with diet, some may need insulin. Gestational diabetes can't be treated with pills because it is not known what effects those medications may have on the baby.

Your healthcare provider may recommend that you see a diabetes specialist, and you will need to take additional steps to control your blood glucose levels for the duration of your pregnancy. The following steps can help you achieve a smooth pregnancy and a healthy baby:

  • Following an appropriate meal plan
  • Frequent self-monitoring of blood glucose (SMBG)
  • Administering insulin injections and knowing how to adjust the doses depending on results of SMBG
  • Controlling/treating hypoglycemia
  • Adding or maintaining an appropriate level of physical activity  

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Important steps to achieve a smooth pregnancy

1) Following an appropriate meal plan

Your eating patterns are especially important now, since you want to control blood glucose levels and also assure that both you and your baby are getting adequate nutrition during your pregnancy. Your doctor will provide you with a personalized meal plan as part of your diabetes self-management program. This plan will be geared toward helping you maintain normal blood glucose levels. It will incorporate these fundamental patterns that have been proven to help keep glucose under control in people with diabetes:  

  • Avoid sugar and foods high in sugar
  • Emphasize complex carbohydrates, such as vegetables, cereal, grains, beans, peas, and other starchy foods
  • Emphasize foods high in fiber
  • Keep your diet low in fat
  • Have bedtime snacks that include both protein and complex carbohydrate

Related information Diet for diabetes

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2) Frequent self-monitoring of blood glucose (SMBG)

The only way to tell if you are succeeding in controlling your blood glucose is to monitor your levels, and to do it frequently. This is called self-monitoring of blood glucose, or SMBG. Pregnant women are advised to monitor at least four times a day, and sometimes as often as 10 times a day. It requires a drop of your blood (from a fingerstick) and a home glucose monitor. Since your need for this will be temporary, inquire about renting the equipment from your local pharmacy or diabetes supplier.

Your doctor and diabetes specialist will teach you about this important aspect of your self-management.

Related information Glucose testing | Monitoring devices

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3) Administering insulin injections and knowing how to adjust the doses depending on the results of SMBG

If you are unable to control your glucose levels with diet and exercise, you may need to take insulin. Pregnant women cannot take oral anti-diabetes medications, since the safety of those medications during pregnancy has not been established. You should use only human insulin, since the use of insulin analogs has not been adequately tested in pregnant women.

Your body's need for insulin is going to steadily increase throughout your pregnancy. Your insulin dose may have to be adjusted upward periodically; it may also have to be recalculated as you and your baby get bigger. Your doctor will be watching this area carefully and will want to see your SMBG results for guidance.

In order to maintain tight control, you will need to know how to adjust your dosage depending on the results of your frequent monitoring. Again, your healthcare provider or pharmacist can help you master this process.

Related information Insulin | Insulin delivery device | Latest development

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4) Controlling/treating hypoglycemia

When people with diabetes undertake a program to achieve tight control of their blood glucose levels, they increase the risk of severe hypoglycemia, or low blood glucose. There is no evidence that hypoglycemia is a risk to the developing baby, but it can be a problem for you. Therefore, be sure to keep ready sources of carbohydrates with you at all times. It would also be a good idea for you, your family, and perhaps a close co-worker to learn how to administer glucagon injections in case of a hypoglycemic crisis.

Related information Hypoglycemia | Emergency products

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5) Adding or maintaining an appropriate level of physical activity

A moderate exercise program will help maintain control of blood glucose levels while also making you feel better. It will help get you in shape for delivery, too. If you've already been exercising, you can probably continue it, although you should avoid sports or exercises where you might fall. Bicycling, jogging, and cross-country skiing are good exercises to continue during your pregnancy.

If you aren't exercising regularly, now is a good time to start, but check with your doctor about your planned activity and start slowly. Vigorous walking is an excellent way to start. Even if you are having some problems during your pregnancy, light exercise such as leisurely walking is still a good idea.

You'll need to plan your periods of activity along with your food intake and insulin injections. If you're on insulin, you'll need to take a few precautions:

  • Be aware of the risk of hypoglycemia, and take a high-sugar snack along with you.
  • It may be necessary to eat small snacks between meals.
  • If you exercise right after a meal, have a snack after the exercise.
  • If you exercise two hours or more after a meal, eat the snack before the exercise.
  • One serving of fruit will maintain blood sugar for most short-term activities (about 30 minutes).
  • One serving of fruit plus a serving of starch will be enough for activities that last longer (an hour or more).
  • Don't reduce your insulin intake before exercising.
  • Don't inject insulin into a part of the body that will be exercised; for example, if you'll be walking, avoid injecting into your leg.

Related information  Diabetes and exercise

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How much weight to gain?

Your doctor has already given you guidelines for gaining weight during your pregnancy. Caloric input and nutrition are especially important for you and your baby.

The "optimal" weight gain depends on your weight when you became pregnant. If your weight was in a good range for your body size, then a weight gain of 24 to 27 pounds is recommended. If you are 20 or more pounds above your desirable level, you should gain 24 pounds.

If you gain too much weight, the extra fat requires the body to produce more insulin to try to keep blood sugar levels normal. But if your body is incapable of producing more insulin, then your blood glucose levels will rise above acceptable levels.

Related information Impact on baby | Labor and delivery | Glucose control during labor and delivery

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