Gestational Diabetes–Good OB Care Makes a Difference in High-Risk Pregnancy

Over the nine months of your pregnancy, you are likely to experience some physical and emotional bumps in the road. Most women are not caught off guard by feelings of fatigue and the discomforts of morning sickness during the early weeks. These sensations usually improve. The middle months pass as you make plans and preparations for your child’s arrival.

As you begin your third trimester, your doctor will schedule a few tests to make sure your body is adapting well to the changes that pregnancy brings. Your 28-week appointment will include a screening test of your blood sugar (glucose) level. We will give you a drink that contains a certain amount of sugar, and then your blood sugar is tested one hour after you drink it (1 hour glucose tolerance test).  Women who have risk factors for diabetes will be tested earlier in pregnancy.

About 90% of pregnant women will have a normal test. If your blood glucose test is abnormal, we will schedule a 3-hour Glucose Tolerance Test. This test identifies whether you are developing diabetes because of your pregnancy. If this test is abnormal—and you have never had diabetes before—the condition is called gestational diabetes (GD).

What Causes Gestational Diabetes?

Your body makes insulin (a hormone) to control the amount of sugar in your blood. As your pregnancy progresses, higher levels of pregnancy hormones can interfere with insulin production. If your body cannot produce enough insulin to overcome this problem, your blood sugar level rises above the normal range. Usually, your blood sugar levels return to normal after delivery, but you may have a higher risk for Type 2 diabetes later in life. If you continue to have high blood sugar levels, you may have actually had undiagnosed diabetes before you were pregnant. This is why we do another 2-hour glucose tolerance test at your postpartum visit if you had gestational diabetes during your pregnancy.

What are Risk Factors for Gestational Diabetes?

Women who have had GD with a previous pregnancy or had a baby larger than 9 pounds are more at risk. Your risk is also higher if you are overweight, physically inactive, have polycystic ovary syndrome (PCOS), high blood pressure, or heart disease. A woman with no risk factors can also develop GD.

What Happens After an Abnormal Test?

As you read on, you will realize that although you may feel fine, GD can cause serious problems for you and your baby. You will need some extra prenatal care to manage this condition. But be assured that most women who develop GD can have a good pregnancy outcome, a healthy baby, and a return to normal blood sugar levels after their delivery with good prenatal care and following her medical team’s recommendations.

Our goal is to help you maintain your blood glucose at a normal level throughout the remainder of your pregnancy. Birmingham women have excellent resources available for managing GD. We will refer you to our maternal-fetal medicine specialist here at Brookwood. Dr. Gonzales and his nurse practitioners will teach you how to manage your blood glucose through diet.

With GD, your body cannot produce enough insulin to keep up with sudden surges of blood sugar after you eat. It does much better if the carbohydrates in your diet are spread evenly throughout the day and accompanied by protein. You may eat 6 or more smaller meals and healthy snacks each day. Regular exercise also improves blood glucose levels. A short 15 minute walk after eating can be especially helpful to your body to process the food that you have eaten. The nurses will teach you how to test your blood sugar several times each day. Your doctor may prescribe an oral medication or insulin to help control your blood sugar. With good teaching, support, and dietary changes, most women do not require medication or insulin.

We will also monitor your baby’s health and growth with some specific tests. We will teach you how to monitor “kick counts” of your baby’s activity each day beginning at 28 weeks.

How Does Gestational Diabetes Affect Mother’s Health?

The excess sugar in your blood will also pass to your baby, and the baby’s weight will increase. With a larger baby, labor can be more difficult. Cesarean delivery is needed more often. There is a higher risk of serious tears in the tissues around the birth canal and of heavy bleeding after delivery. Women with GD may develop high blood pressure during pregnancy. They are also at higher risk for pre-eclampsia. A woman with pre-eclampsia has high blood pressure along with other signs of serious illness. If the condition is worsening, the baby may need to be delivered prematurely.

If you have had GD, you are at higher risk for GD in a future pregnancy. Because you also have higher risk of developing type 2 diabetes later on, your health care provider will need to monitor blood glucose regularly throughout your life, along with blood pressure and other signs of heart health. Pre-eclampsia increases the risk of a future stroke or heart disease. Keep your doctor informed of all past pregnancy complications, so we can help better manage your current health.

Does Gestational Diabetes Affect Your Baby?

With GD, a baby is at higher risk for several complications. A large baby’s difficult passage through the birth canal may result in a shoulder injury. The newborn may have unstable blood sugar levels shortly after birth while adjusting to the sudden loss of excess blood sugar from mom. This is a serious condition called hypoglycemia. The baby may also have breathing problems or jaundice requiring neonatal ICU admission. Later, these children have higher risk of weight control problems and diabetes.

Happy Endings

The goal of therapy is to keep your blood glucose level as normal as possible throughout each day. If we accomplish this, the risks to you and your baby are usually low. Most often, the rest of your pregnancy will progress normally with a few adjustments. You may experience feelings of disappointment or anxiety after learning you have GD. Please share your concerns with us.  Your team of doctors and nurses at Sparks & Favor are working together to help you and your baby. Over the remaining weeks of your pregnancy, the lifestyle changes you make are likely to become routine, and they may lead to better health habits for life. Together we will look forward to the arrival of your healthy baby.