Gestational diabetes

By Mayo Clinic Staff

Gestational diabetes is diabetes that's first diagnosed during pregnancy. Pregnancy sometimes is called gestation. Like other types of diabetes, gestational diabetes affects how the body's cells use sugar, also called glucose. Gestational diabetes causes high blood sugar that can affect a pregnancy and a baby's health.

The good news is that you may be able to control gestational diabetes. Eat healthy foods, exercise and, if needed, take medicine. Controlling blood sugar can help keep you and your baby healthy, and it may help prevent some problems during delivery.

For most people who have gestational diabetes, blood sugar goes back to its usual level soon after a baby is born. But if you've had gestational diabetes, you have a higher risk of getting type 2 diabetes. That means you'll need to be tested for changes in blood sugar more often.

Most of the time, gestational diabetes doesn't cause symptoms that are easy to notice. Being thirsty and urinating more often are possible symptoms.

If possible, seek healthcare when you start to think about trying to get pregnant. Then your healthcare professional can check your risk of gestational diabetes and your overall wellness. Once you're pregnant, your healthcare professional will check you for gestational diabetes as part of your prenatal care.

If you have gestational diabetes, you'll need checkups more often. These extra checkups are most likely to be during the last three months of pregnancy. Your healthcare professional will check your blood sugar level and your baby's health.

Experts don't yet know why some people get gestational diabetes and others don't. Extra weight before pregnancy often plays a role.

Hormones, mainly insulin, keep blood sugar at the right level in the body. But during pregnancy, hormone levels change. Those changes may make it harder for the body to use blood sugar as it should. This makes blood sugar rise.

Risk factors for gestational diabetes include:

• Being overweight or obese.
• Not being physically active.
• Having prediabetes.
• Having had gestational diabetes during an earlier pregnancy.
• Having a hormone condition called polycystic ovary syndrome.
• Having a parent or sibling with diabetes.
• Having delivered a baby weighing more than 9 pounds (4.1 kilograms).
• Being of a certain race or ethnicity, such as Black, Hispanic, American Indian and Asian.

If high blood sugar isn't controlled, it can cause health problems for you and your baby. This includes an increased risk of needing surgery to deliver the baby. That surgery is called a C-section.

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

• High birth weight. If your blood sugar level is high, it may cause your baby to grow too large. Babies who weigh 9 pounds or more are more likely to become stuck in the birth canal, have birth injuries or need a C-section delivery.
• Early birth. High blood sugar may raise the risk of labor and delivery before your pregnancy due date. This is called preterm birth. Or you could need an early delivery because the baby is large.
• Trouble breathing. Babies born early may have a condition that makes breathing hard, called respiratory distress syndrome.
• Low blood sugar. Sometimes babies have low blood sugar, called hypoglycemia, shortly after birth. Severe hypoglycemia may cause seizures. Being fed right away and sometimes getting glucose through a vein can raise the baby's blood sugar level.
• Obesity and type 2 diabetes later in life. Babies have a higher risk of being obese and having type 2 diabetes later in life.
• Stillbirth. Gestational diabetes that is not treated could result in a baby's death either before or shortly after birth.

Gestational diabetes may raise your risk of:

• High blood pressure and preeclampsia. Gestational diabetes raises the risk of high blood pressure. It also raises the risk of a serious complication of pregnancy that causes high blood pressure and other symptoms, called preeclampsia. These conditions can threaten your life and your baby's life.
• Having a surgical delivery. You're more likely to have a C-section if you have gestational diabetes.
• Future diabetes. If you have gestational diabetes, you're more likely to get it again during a future pregnancy. You also have a higher risk of getting type 2 diabetes as you get older.

There is no sure way to prevent gestational diabetes. But having healthy habits before pregnancy can help. If you've had gestational diabetes, these healthy choices also might lower your risk of getting diabetes again. That includes developing gestational diabetes during another pregnancy and developing type 2 diabetes in the future.

• Eat healthy foods. Choose a variety of foods high in fiber and low in fat and calories. Focus on fruits, vegetables and whole grains. Eat healthy portion sizes.

• Keep active. Exercising before and during pregnancy can help protect you from getting gestational diabetes. Aim for 30 minutes of moderate activity on most days of the week. Take a brisk daily walk. Ride a bike. Swim laps.

  Short bursts of activity add up. These might include parking further away from the store when you run errands or taking short walks throughout the day.

• Start pregnancy at a healthy weight. If you're planning to get pregnant, losing extra weight before you do may help you have a healthy pregnancy. Make lasting changes to your eating habits, such as eating more vegetables and fruits.
• Don't gain more weight than recommended. Gaining some weight during pregnancy is healthy. But gaining too much weight too quickly can raise your risk of gestational diabetes. Ask your healthcare professional what a good amount of weight gain is for you.

If you're at average risk of gestational diabetes, you'll likely have a screening test for gestational diabetes during the second trimester. That test often happens between 24 and 28 weeks of pregnancy.

If you're at high risk of diabetes, you may have the screening test earlier in pregnancy. Some pregnant people at high risk for gestational diabetes have the test during their first prenatal visit.

Factors that could put you at high risk of gestational diabetes include being overweight or obese before pregnancy; having a parent or sibling with diabetes; or having had gestational diabetes during an earlier pregnancy.

Screening tests for gestational diabetes most often include:

• Initial glucose challenge test. You drink a syrupy glucose solution. One hour later, you have a blood test to measure your blood sugar level. A blood sugar level of 190 milligrams per deciliter (mg/dL), or 10.6 millimoles per liter (mmol/L), means you have gestational diabetes.

  A blood sugar level below 140 mg/dL (7.8 mmol/L) usually is thought to be within the standard range on a glucose challenge test. But this may vary by clinic or lab.

  If your blood sugar level is higher than expected, you'll need another glucose tolerance test to find out if you have gestational diabetes.

• Follow-up glucose tolerance testing. This test is like the first test. But the sweet drink has even more sugar. Your blood sugar is checked every hour for three hours. If two of the blood sugar readings are higher than expected, that means you have gestational diabetes.

Treatment for gestational diabetes includes:

• Lifestyle changes.
• Blood sugar monitoring.
• Medicine, if needed.

Keeping your blood sugar level in a good range helps keep you and your baby healthy. It also may help you avoid some problems during pregnancy and delivery.

Your lifestyle is an important part of keeping your blood sugar in a healthy range. Because your body is working hard to support your growing baby, it's not a good idea to lose weight during pregnancy. But your healthcare professional can help you set weight gain goals based on your weight before pregnancy.

Healthy lifestyle choices include:

• Healthy diet. A healthy diet focuses on foods that are high in nutrition and fiber and low in fat and calories. It includes fruits, vegetables, whole grains and lean protein. A healthy diet limits refined carbohydrates. These include white bread, white rice and sweets.

  A registered dietitian or a certified diabetes care and education specialist can help you with meal planning. Those plans usually are based on a pregnant person's weight, pregnancy weight gain goals and blood sugar level. The amount of exercise you get, foods you like to eat and your budget also should be part of the planning.

• Staying active. Regular physical activity plays a key role in every wellness plan before, during and after pregnancy. Exercise lowers your blood sugar. And regular exercise can help ease some common discomforts of pregnancy. These might include back pain, muscle cramps, swelling, constipation and sleep problems.

  With your healthcare professional's OK, try to do 30 minutes of moderate exercise most days of the week. If you haven't been active before, start slowly and build up little by little. Walking, cycling and swimming are good choices during pregnancy. Everyday activities such as housework and gardening also count.

While you're pregnant, your healthcare team may ask you to check your blood sugar level four or more times a day. Most people need to do that first thing in the morning and after meals. This is to make sure your blood sugar stays within a healthy range.

If diet and exercise aren't enough to keep your blood sugar in a healthy range, you may need insulin shots to lower your blood sugar. A small number of people with gestational diabetes need insulin to reach their blood sugar goals.

Some healthcare professionals prescribe medicine taken by mouth to manage blood sugar levels. Others believe that more research is needed to make sure those types of medicines are as safe and work as well as insulin shots for gestational diabetes.

Throughout your pregnancy, your healthcare professional may check your baby with ultrasounds or other tests. If you don't go into labor by your due date, your healthcare professional may start labor. This is called inducing labor. Delivering after your due date could raise the risk of health problems for you and your baby. In some situations, the healthcare team may suggest inducing labor before a pregnancy due date.

Your healthcare professional checks your blood sugar after delivery and again in 6 to 12 weeks. This is to make sure that your blood sugar has returned to the standard range. If your blood sugar level is back in that range, you'll need to have your diabetes risk checked at least every three years.

If tests show that you have prediabetes, talk with your healthcare professional about steps you can take to help prevent it from turning into type 2 diabetes. If test results show you have type 2 diabetes, work with your healthcare team to make a plan to control it.

It can be stressful to know you have a condition that may affect your baby. The steps that help control blood sugar, such as healthy eating and exercising, may help relieve stress too. They also can nourish your baby and help prevent type 2 diabetes in the future.

It also may ease your stress to learn more about gestational diabetes. Talk to your healthcare team or read books and articles about this condition. You may find a support group for people with gestational diabetes helpful. Ask your healthcare team for guidance.

You'll likely find out you have gestational diabetes from routine screening test during your pregnancy. Your healthcare professional may refer you to other health professionals who specialize in diabetes. These might include an endocrinologist, a certified diabetes care and education specialist, and a registered dietitian.

You may want to ask a family member or friend to go to your appointment with you to help remember all the information you get.

Here's some information to help you get ready for your appointment.

When you make the appointment, ask if you need to fast before lab tests or if you need to do anything else to prepare. Make a list of:

• Any symptoms you have. Include those that might not seem linked to gestational diabetes.
• Key personal information, including major stresses or recent life changes other than being pregnant.
• All medicines, vitamins or supplements you take, including the doses and how often you take them.
• Questions to ask your healthcare professional.

Some basic questions to ask include:

• What can I do to help control my condition?
• Can you suggest a registered dietitian or certified diabetes care and education specialist who can help me plan meals, create an exercise program and learn ways to cope?
• Will I need medicine to control my blood sugar?
• For what symptoms should I seek medical attention?
• Are there brochures or other printed materials I can take? What websites do you recommend?

Your healthcare professional might have questions for you, including:

• Have you been more thirsty than usual or urinated more than usual? If so, when did these symptoms start? How often do you have them?
• Do you have a parent or sibling who has diabetes?
• Have you been pregnant before? Did you have gestational diabetes during your earlier pregnancies?
• Did you have other problems in earlier pregnancies?
• If you have other children, how much did each weigh at birth?