What Is Gestational Diabetes?

Gestational diabetes is a pregnancy-related condition that makes your blood sugar go to higher-than-normal levels even though you haven’t had a problem with high blood sugar or diabetes before pregnancy. Doctors diagnose an estimated 5.8-9.2% of all pregnant people in the United States with gestational diabetes.

Gestational diabetes doesn’t usually cause symptoms, but it can increase your risk of a high birth weight baby, which can complicate your delivery. Your healthcare provider (usually an obstetrician, or a doctor who specializes in treating pregnant people) will test you for gestational diabetes between 24 and 28 weeks of your pregnancy and can recommend treatments if you are diagnosed.  

Symptoms

Gestational diabetes doesn’t usually cause any symptoms. However, if you experience symptoms, you may notice you are thirstier than usual or have to urinate more often. However, these symptoms may be more difficult to notice as they are also common symptoms of pregnancy.

A healthcare provider will usually detect the condition through blood testing at or after 24 weeks gestation. They may recommend earlier testing if you have significant risk factors or symptoms.

Causes

Researchers don’t know the exact reason why pregnant people get gestational diabetes. The condition affects the body’s ability to make and use insulin as well. Insulin is a hormone produced by your pancreas that allows your body to use glucose (sugar) for energy.

One hypothesis is the hormones an expectant parent makes could affect their insulin’s ability to use blood sugar for energy. This effect is known as insulin resistance, which means the body doesn’t respond to insulin as effectively. Another hypothesis is that a pregnant person’s body may not be able to make enough insulin to keep up with the body’s needs. Without enough insulin, blood sugar levels can rise higher.

Risk Factors 

Researchers have identified connections between the following factors and an increased risk of gestational diabetes:

• Being pregnant at age 35 or older 
• Having a family history of gestational diabetes or diabetes 
• Having gestational diabetes during a previous pregnancy 
• Having a history of having a baby weighing 9 pounds or more 
• Hypothyroidism 
• Obesity 

If you are at risk for gestational diabetes, talk to your obstetrician about when you should be tested for gestational diabetes. They may recommend testing you earlier to monitor your blood sugar. 

How Is Gestational Diabetes Diagnosed? 

The U.S. Preventive Services Task Force recommends obstetricians screen all pregnant people for gestational diabetes beginning at 24 weeks pregnant or after. A healthcare provider will start with the 1-step approach and use the 2-step approach if you have an abnormal result.

1-step Approach

During the 1-step approach, your healthcare provider will have you fast (not eat for eight hours) before drinking a 75-gram glucose (sugar) solution. After consuming the solution, they will draw your blood twice (after one hour and two hours) to measure your blood sugar level. If your blood sugar level is higher 140 mg/dL at either time, you likely have gestational diabetes. They will test you using the 2-step approach.

2-step Approach

During the 2-step approach, you drink a 50-gram glucose drink after not fasting. A healthcare provider then measures your blood sugar at one, two, and three hours:

• At one hour: If your glucose level is equal to or greater than 180 mg/dL, you have gestational diabetes and no further testing is needed.
• At two hours: Your blood sugar is too high if your glucose level is equal to or greater than 155 mg/dL.
• At three hours: Your blood sugar is too high if your glucose level is equal to or greater than 140 mg/dL.

If you have two blood sugar measurements that are too high, your healthcare provider will diagnose you with gestational diabetes.

Treatments for Gestational Diabetes 

Treatments for gestational diabetes are usually lifestyle-related with the goal of keeping your blood sugar levels low:

Treatments include:

• Eating a healthy diet: You should not restrict calories, but your healthcare provider may recommend eating a certain amount of carbohydrates, which can help you keep your blood sugar from getting too high. 
• Engaging in physical activity: With your doctor’s okay, you can also engage in regular physical activity, such as walking. Physical activity can help lower your blood sugar and help insulin work better in your body. 
• Taking medications: If your blood sugar doesn’t stay lower with these treatments, your doctor may prescribe medications to lower your blood sugar. These include administering insulin or taking the medication Glucophage (metformin). 

Your blood sugar levels will usually go back to normal if you had gestational diabetes during pregnancy after you give birth. However, an estimated 50% of those with gestational diabetes will develop type 2 diabetes in their lifetimes.

How to Prevent Gestational Diabetes 

Preventing gestational diabetes actually starts before you conceive. Maintaining a healthy weight through eating nutritious foods and exercising can help reduce your risks. However, you shouldn’t try to lose weight when you become pregnant—this could be harmful to you and your baby’s health.

Comorbid Conditions

Treating gestational diabetes is important because those with gestational diabetes are at greater risk for some maternal health conditions, including:

• Larger-than-average newborn, which can increase risks for shoulder and birth injuries 
• Low blood sugar at birth for baby  
• Preeclampsia, a condition that causes high blood pressure in pregnancy  

Having a history of gestational diabetes can increase your risk for type 2 diabetes later in life. If you do have gestational diabetes, talk to your obstetrician about how you can safely reduce your type 2 diabetes risks after your pregnancy.

Living With Gestational Diabetes 

It’s natural to feel concerned if your doctor diagnoses you with gestational diabetes. However, diagnosing the condition means they can closely monitor your blood sugar and prescribe treatments, if needed, to keep your blood sugar levels at a healthy level. Maintaining your regular doctor’s visits is important to monitoring your condition and determining if you need to take medications.