Gestational Diabetes

Gestational diabetes (GD) develops in about 10% of pregnant women who have never been diagnosed with Type 1 or Type 2 diabetes. It occurs when too much sugar circulates through your blood, either because your body can’t produce enough insulin or doesn’t use insulin effectively. Screening and management help decrease the many risks associated with GD.

GD screening is an essential part of prenatal care. The glucose challenge test is typically completed between 24 and 28 weeks’ gestation. You drink a very sugary solution, and the lab checks your blood glucose one hour later. This identifies how well your body manages a quick influx of sugar. With screening, diagnosis and treatment, GD is manageable throughout pregnancy.

Five Reasons Gestational Diabetes Is a Big Deal

1. Increases the risk for Type 2 diabetes

Most of the time, GD resolves after pregnancy. However, about 50% of women are diagnosed with Type 2 diabetes later in life. T2D is an expensive, complicated disease that affects every aspect of your health. Babies born to moms with GD are also more likely to develop T2D later in life.

2. Increases risk for preeclampsia

Preeclampsia is dangerously high blood pressure that can lead to problems for you and your baby. Moms risk developing seizures or heart complications. In addition, high blood pressure restricts blood flow to your baby during pregnancy, which can cause preterm birth or growth restriction.

3. Excessive fetal growth

Consistently high blood sugars stimulate the developing fetus to grow, grow, grow. It’s not uncommon for these babies to weigh 10-12 pounds (or more) at birth, which increases the likelihood your baby will get “stuck” during delivery or causes other complications. Risks to mom include significant birth canal trauma, excessive blood loss and the need for a c-section. Oxygen deprivation during labor is the biggest threat to your baby; this can cause severe brain damage or even death.

4. Increases preterm delivery risk

Sometimes preterm labor happens naturally. Other times, your health care team may recommend early delivery to decrease the risk of more catastrophic complications. This may occur if you have poorly controlled diabetes, preeclampsia, or if your baby is showing signs of distress. Early labor induction or c-section are not recommended for women with well-controlled GD.

5. NICU care is more likely, even for full-term babies.

These babies may look big and healthy, but several complications can occur. There are many ways to treat these common conditions, but no one wants their baby to need NICU care.

• Low blood sugars – Blood sugar instability after birth is the most common reason GD babies transfer to the NICU. Their bodies have a difficult time adjusting when their sugar supply is cut off at delivery. They need IV fluids and time to help their bodies adjust.
• Poor feeding ability – Frequently, these babies are neurologically immature compared to babies whose mothers did not have GD. They may have trouble coordinating their suck-swallow-breathe pattern or tire quickly during feedings. They may need IV fluids, a feeding tube or both until they are able to complete all feedings by breast or bottle.
• Breathing difficulties – A vital substance called surfactant lubricates the smallest airways (alveoli), which keeps them open and able to exchange oxygen and carbon dioxide. Uncontrolled GD decreases your baby’s ability to make surfactant, which can lead to difficulty keeping their airways open. Respiratory distress syndrome (RDS) can develop shortly after birth, and these babies transfer to the NICU for breathing support and close monitoring.

Women with GD can and do have healthy pregnancies. The complications discussed occur more often when GD is poorly controlled. If you are diagnosed with GD, learn as much as possible and work with your OB/GYN or midwife to develop a treatment plan. Healthy food choices, physical activity and blood sugar monitoring are important; medications such as metformin or insulin are used when lifestyle changes can’t keep blood sugars in the optimal range.

Joleen Sams is a family nurse practitioner who lives in Shawnee. Her two beautiful children are in grade school, and most of the time you’ll find her running around the metro for their activities. Joleen helps families thrive by providing easy-to-understand, fact-based health information. 

As always, please consult your health care provider with any questions or concerns.