Gestational Diabetes

  • Medical Author:
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

  • Medical Editor: Charles Patrick Davis, MD, PhD
    Charles Patrick Davis, MD, PhD

    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

What are the signs and symptoms of gestational diabetes?

Gestational diabetes typically does not cause any noticeable signs or symptoms. This is why screening tests are so important. Rarely, an increased thirst or increased urinary frequency may be noticed.

Is there a test to diagnose gestational diabetes?

Gestational diabetes is diagnosed with blood tests. Most pregnant women are tested between the 24th and 28th weeks of pregnancy, but if you have risk factors, your doctor may decide to test earlier in the pregnancy.

Blood testing confirms the diagnosis. A screening glucose tolerance test involves drinking a sugary beverage and having your blood drawn an hour later to test the glucose levels an hour later. If the screening test is not normal, you may need additional testing will generally be necessary. Another type of test is an oral glucose challenge test (OGTT). For this test your baseline blood glucose level is checked and then measured at 1, 2, and sometimes 3 hours after consuming a sugary drink. A blood glucose level of 140mg/dL or higher on this test will identify 80% of women with gestational diabetes. When that cutoff is lowered to 130mg/dL, the identification rate increases to 90%. Women who had a level of blood glucose greater than 130 mg/dL are typically recommended to take another diabetes screening test that requires fasting (not eating anything) before the test.

Glycosylated hemoglobin, or hemoglobin A1c, is another test that may be performed. This test is used to monitor long-term blood glucose levels in people with diabetes. The hemoglobin A1c level offers a measure of the average blood glucose level over the past few months.

What is the treatment for gestational diabetes?

It is important to receive proper treatment for gestational diabetes because research studies have shown that the incidence of problems and complications is decreased when blood glucose levels are normalized. Treatment for gestational diabetes involves attention to maintaining a proper diet. Regular exercise can also contribute to tight glucose control. Nutritional modification is the mainstay of therapy, and many women will achieve adequate glucose control by following a nutritional plan.

Testing your blood glucose levels at home at specific times or after meals will be recommended to determine if your glucose levels are within acceptable limits. Testing at least four times per day is typical. You may also be asked to test your urine for ketones, substances that are produced when your body metabolizes fat. Ketones are elevated when the body is unable to use glucose for energy.

If diet and exercise are not sufficient to maintain tight control of your blood glucose levels, it may be necessary to institute insulin therapy. Insulin is the only officially approved medication for treating gestational diabetes in the U.S.; however, oral agents are used by many doctors to control the blood sugar in selected patients. As the pregnancy progresses, insulin requirements may change, and insulin doses may need to be adjusted.

Is there a special diet for a woman with gestational diabetes?

While there is no one specific diet that is recommended for all women with gestational diabetes, following a meal plan can help keep your blood sugar levels under control and avoid complications.

  • A nutritionist may be helpful in designing a meal plan that takes into account individual schedules and preferences.
  • Eating a variety of foods is recommended, and it is better to eat smaller portions throughout the day (e.g. 3 small to moderate meals and 2-4 snacks) rather than just a few large meals.
  • Many women with gestational diabetes will be advised to eat fewer carbohydrates than in their normal diet and to eat complex carbohydrates that contain fiber. It’s important to limit consumption of foods containing large amounts of simple sugars.
  • High-fiber foods like fresh fruits and vegetables, as well as whole-grain products, are not only nutritious but also effective in keeping blood sugar levels stable.
  • Skipping meals is not recommended because this leads to undesirable fluctuations in blood sugar levels.

Can gestational diabetes be prevented?

Gestational diabetes cannot always be prevented; however, obesity is a prime determinant for developing the disease. Maintaining a healthy weight and following a good nutritional plan both before and during pregnancy can decrease your chances of developing gestational diabetes. Maintaining a healthy weight can also decrease your chances of developing type 2 diabetes following pregnancy.

What is the outlook (prognosis) for gestational diabetes?

Most women with gestational diabetes who receive treatment go on to deliver healthy babies. The risk of complications increases when blood glucose levels are not properly controlled. While some women with gestational diabetes will develop type 2 diabetes following delivery, this risk can be reduced by following a good nutritional plan, exercising, and maintaining a healthy weight.

REFERENCES:

American Diabetes Association. "Gestational Diabetes."

Medically Reviewed by a Doctor on 12/5/2016

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