We get a LOT of queries on pregnancy and diabetes -- not least gestational diabetes, the kind that pops up during pregnancy in women who have not had diabetes prior. To help answer the many questions that come our way, we’ve put together the following guide to key gestational diabetes topics.
Please note that we also published a fact-filled doctor/patient interview on pregnancy with existing type 1 and type 2 diabetes recently here. Be sure to check that out too!
Know a lot about these topics yourself? Please add your 2 cents in the comments section below.
What is Gestational Diabetes?
Simply put, gestational diabetes is a form of elevated blood sugar that women get specifically during pregnancy, when the placenta makes hormones that can lead to a buildup of sugar in the blood. If you are unlucky enough to have a pancreas that can’t make enough insulin to handle that onslaught of hormones, your blood sugar levels will rise and can cause gestational diabetes.
You might be surprised to hear that the medical community does not agree on an exact level of blood glucose that determines gestational diabetes.
The American Diabetes Association (ADA) currently defines gestational diabetes as:
- Fasting glucose level of 92 mg/dl (5.3 mmol/L in European unites) or higher
- One-hour post-meal glucose level of 180 mg/dL (7.8 mmol/L) or higher
- Two-hour post-meal glucose level of 153 mg/dL (6.7 mmol/L) or higher
But the UK’s National Institute for Health and Care Excellence (NICE) recently altered the threshold for diagnosis to a looser standard of 5.6-mmol/L (101 mg/dL) fasting glucose, which reduces the “unmanageable numbers of women falling into the category of gestational diabetes,” European authorities state.
Either way, the ADA explains: “Gestational diabetes usually appears roughly halfway through pregnancy, as the placenta puts out large amounts of ‘anti-insulin’ hormones. Women without known diabetes should be screened for gestational diabetes 24 to 28 weeks into their pregnancies. (If high blood glucose levels are detected earlier in pregnancy, the mother-to-be may actually have type 2 diabetes, rather than gestational.)”
The ADA estimates that gestational diabetes occurs in 9.2 percent of pregnancies.
What’s the Diabetes and Pregnancy Risk?
The bad news is: if left untreated, extreme high blood sugar levels can cause damage to the baby's brain that can lead to developmental delay and a host of other problems.
As reported by the “What to Expect” folks, “if excessive sugar is allowed to circulate in a mother's blood and then enter the fetal circulation through the placenta, the potential problems for both mother and baby are serious.”
Poorly controlled diabetes during pregnancy can also lead to potential problems for the baby after birth, such as jaundice, breathing difficulties and low blood sugar levels. Later in life, he or she may be at an increased risk for obesity and type 2 diabetes.
The good news is: “These potential negative effects don't apply to moms who get the help they need to keep their blood sugar under control.” And there is lots of help available!
Note that since gestational diabetes is considered a pregnancy complication, women who have it are more likely to be induced, since most doctors won't let their pregnancies progress past their due dates.
Signs and Symptoms of Gestational Diabetes
How do you know if you might have gestational diabetes?
The tricky part is, most women don’t have obvious symptoms, so it can easily go undetected. The basic symptoms are similar to those that appear with the onset of any kind of diabetes:
- Unusual thirst
- Frequent and copious urination
- Sugar in the urine (detected by a lab test)
A Test for Gestational Diabetes?
The most common test is a fasting test called an oral glucose tolerance test (OGTT). This measures how well your body’s cells are able to absorb glucose, or sugar, after you ingest a given amount of a sugary drink. The test can take place in your doctor’s office or a local lab.
To prepare for it, you need to abstain from food for at least 8 hours before the scheduled test. You can drink water, but no other beverages, including coffee and caffeinated tea, as these can interfere with the results.
When you arrive at the test site, the technician will take a blood sample to measure your baseline glucose level. This part of the test is also called a fasting glucose test.
After that, you’re asked to drink a solution that contains ~75 grams of sugar. And an hour later, you’ll give a second blood sample to see the effect on blood sugar level.
If your result is positive (a high glucose number after one hour) your doctor may ask for a test at the two and three-hour marks as well to best determine how well your body can handle a sugar challenge.
Gestational Diabetes Diet (aka What to Eat)
Because diet/meal plan is a mainstay of controlling glucose levels, experts encourage women to see a professional dietitian to help them craft a meal plan suited to them individually -- based on weight, height, physical activity, and their own level of glucose intolerance.
But even if you don’t have access to a pro, here are some general dietary guidelines, compiled by registered dietitian Julie Redfern:
- Eat a variety of foods, distributing calories and carbohydrates evenly throughout the day. Make sure both your meals and your snacks are balanced. The American Diabetes Association recommends that you eat three small-to-moderate-size meals and two to four snacks every day, including an after-dinner snack.
- Curb your carb intake. Limit foods and beverages that contain simple sugars such as soda, fruit juice, flavored teas and flavored waters, and most desserts – or avoid them altogether. These foods can quickly elevate your blood sugar.
- Milk is high in lactose, a simple sugar, so you may need to limit the amount you drink. If you're looking for a new beverage of choice, try club soda with a squeeze of lemon or orange, or unsweetened decaffeinated iced tea.
- It's best to include complex carbs (those containing more fiber) and spread them out over the day. Pair lean protein with carbohydrates at all meals and snacks. Protein helps to make you feel fuller, sustain energy, and give you better blood sugar control.
- Don't skip meals. Be consistent about when you eat meals and the amount of food you eat at each one. Your blood sugar will remain more stable if your food is distributed evenly throughout the day and consistently from day to day.
- Eat a good breakfast. Your blood glucose levels are most likely to be out of whack in the morning. To keep your level in a healthy range, you may have to limit carbohydrates (breads, cereal, fruit, and milk), boost your protein (eggs, cheese, peanut butter, nuts) , and possibly avoid fruit and juice altogether.
- Include high-fiber foods, such as fresh fruits and vegetables, whole grain breads and cereals, and dried peas, beans, and other legumes. These foods are broken down and absorbed more slowly than simple carbohydrates, which may help keep your blood sugar levels from going too high after meals.
Some Great Advice on Managing Gestational Diabetes
It is true that women who experience gestational diabetes have a seven times greater risk of developing type 2 diabetes by the time their child turns 10, compared with women who didn’t have it.
But at the same time, a combination of good diet, exercise and glucose-lowering medications can keep both mother and baby healthy and safe.
Here are some excellent tips we’ve garnered from various experts:
Try CGM: Like your sisters with type 1 and type 2 diabetes, tight glucose control can be aided by using a continuous glucose monitor (CGM). For this, you’ll likely need to see a healthcare professional who specializes in diabetes, an endocrinologist or diabetes educator.
Create a Team: “Stay calm, find an amazing endocrinologist and also connect with inspirational and supportive women who have been through it,” recommends Noor Alramahi, a type 1 diabetes advocate in Palo Alto, CA, who had a healthy diabetic pregnancy with twins. She adds that this is important because the psychological aspect is often the biggest challenge.
Don’t Stress Over Single Highs: Noor also says, “Before pregnancy and in the family planning stages doctors and healthcare providers put a lot of emphasis on the potential complications of a ‘high risk’ pregnancy, so much so that when you do get pregnant that’s all you can think about, like I did, every time my numbers were not perfect (70-120). The stress over that made it a lot worse than it really was. I was lucky to have an amazing endo who kept reminding me that it’s fine to have high numbers here and there as long as I don't keep them high, and that the stress might do more damage than the occasional off-target glucose result.”
Know Your Food: Brooke Gibson, founder of the Bay Area support group Sugar Mommas who has had four healthy diabetic pregnancies herself, emphasizes how important it is to control your diet and exercise as much as possible to keep your blood sugars under good control. “Talk to a nutritionist to learn about different foods and how they can affect your blood sugar.”
Follow Up After Baby: Dr. Kristin Castorino, who cares for pregnant woman with diabetes at the Sansum Center in Santa Barbara notes, “About half of women who have gestational diabetes will eventually develop type 2, so it’s important after delivery to continue to make changes to you and your family’s routines around food and activity to be on a healthier life path. The National Diabetes Prevention Program is proven to help prevent T2. Many YMCAs or health care centers have started local programs.”
On Coping with Gestational Diabetes
San Diego-based mom and writer Elise Blaha Cripe chronicled her experiences with gestational diabetes on her blog. She shares some important practical things she learned:
- eating vegetables (especially green ones!) with meals helps keep my blood sugar down
- most fruits are out aside from berries
- walks after meals help keep numbers low
- strenuous exercise can make numbers higher
- stress plays a HUGE factor in blood sugar levels
- a glass of milk or a small bit of carbohydrates right before bed can help my body regulate sugars overnight
She also puts the whole gestational diabetes experience into perspective this way:
“I have found that in the scheme of things, gestational diabetes, while annoying, is no big deal. Best case, I change my diet, eat healthy, exercise, gain an appropriate amount of weight & maintain correct blood sugar levels. Worst case, I am unable to manage my blood sugar with diet and exercise & need to take medication. But here's the thing, as long as it's properly managed, I should be blessed with a healthy baby. There can be complications of course. But there can always be complications. This is birth. This is life.”
“Once I embraced that, this whole thing became easier.”
Thank you Elise, et al!
Some Resources on Gestational Diabetes
“Gestational Diabetes During Pregnancy” -- an online guide from the authors of the “What to Expect” books.
“Managing Your Gestational Diabetes” -- guidebook by famous diabetes and pregnancy expert Dr. Lois Jovanovic.
“Gestational Diabetes: Your Survival Guide” -- a handbook by Dr. Paul Grant, consulting diabetologist at the John Radcliffe Hospital, Oxford, UK.
Diabetic Mommy -- an online blog and community site run by a mom with type 2 diabetes.
“The Ultimate Gestational Diabetes Cookbook” -- a popular resource by chef Ted Alling.