Whether a woman is already living with diabetes and decides to have a child or she develops gestational diabetes during pregnancy, women with diabetes can, and do, have healthy babies.  However, because mother and baby are both at risk for complications, these pregnancies are deemed “high risk”. Both mother and baby will need to be closely monitored throughout the pregnancy by a specialist called a perinatologist. Thanks to a special collaboration with UCSF and Marin General Hospital, Braden Diabetes Center patients can now be followed by a perinatologist without leaving Marin.

Weight gain and hormonal changes are a normal part of pregnancy. These changes cause a woman’s body to make less insulin, a hormone that helps the body use glucose for energy and maintain healthy levels of blood glucose. What’s more, the body uses insulin less effectively during pregnancy, a condition known as insulin resistance.  By late pregnancy, all women experience a degree of insulin resistance. 9.2% of these women will develop gestational diabetes.1

Pregnant women are routinely tested for gestational diabetes some time between weeks 24 and 28 of pregnancy.  If a woman is diagnosed with gestational diabetes, she must take immediate action to manage her blood sugar. Her OB/GYN or nurse midwife will likely collaborate with an endocrinologist, a diabetes educator, and a dietitian to help her with meal planning. It’s essential to have a blood glucose test 6 to 12 weeks post-partum to see if blood glucose is still elevated. Most women’s blood glucose levels return to normal. However, in 5 to 10 percent of women, blood glucose levels do not return to normal, and they are then diagnosed with diabetes.

If gestational diabetes is not well managed, mother and baby will both have high blood glucose. This can lead to a variety of complications:

Risks to the Mother

  • High blood pressure or “preeclampsia”Gestational diabetes raises the risk of high blood pressure and preeclampsia, a serious complication of pregnancy that can threaten the lives of both mother and baby.
  • Developing type 2 diabetes later in lifeOnce a woman has had gestational diabetes, she is more likely to get it again during a future pregnancy. She is also at risk for developing diabetes as she gets older and should talk to a diabetes educator or dietitian about preventive measures.
  • Cesarean DeliveryInfants born to women with gestational diabetes can be larger than average (macrosomia), weighing 9 or more pounds. Such babies often need to be delivered by cesarean. 

Risks to the Baby

  • Macrosomia: If a mother has un-managed gestational diabetes, the excess glucose in her blood will find its way to the baby’s bloodstream. This stimulates the baby’s pancreas to make insulin to manage the glucose.  Some of that extra glucose will also be stored as fat. For this reason, infants born to women with gestational diabetes may have a larger than normal body—a condition called macrosomia.
  • Hypoglycemia at birth: Babies born to women with gestational diabetes may be born with low blood glucose, or hypoglycemia, as well as other risks/complications, which can precipitate the need for closer hospital attention.
  • Respiratory distress syndrome
  • Risk of stillbirth
  • Jaundice: Jaundice is a medical condition that causes yellowing of the skin or whites of the eyes due to an excess of bilirubin, an orange-yellow pigment formed in the liver. Jaundice is more common in newborns of mothers who had diabetes during their pregnancy. Newborns with jaundice need to be treated with light therapy in the neonatal intensive care unit (NICU).
  • Weight problems later in life: Babies born to women with gestational diabetes are statistically more likely to be overweight as adults and may eventually develop type 2 diabetes themselves.

Whether a woman has type 1 or type 2 diabetes, she will need to plan her pregnancy and work closely with her doctor to closely manage her blood glucose before conceiving. Gestational diabetes does not occur until the third trimester, when the fetus is fully formed. When a woman with un-managed diabetes gets pregnant, she can expose her baby to high blood glucose and ketones, a toxic byproduct of excess blood glucose, early in her first trimester. This increases the risk of birth defects and miscarriage, because the first 7 weeks are when the baby’s organs are forming. That’s why it’s essential to bring diabetes under good management at least three to six months before conception, and maintain excellent blood glucose management throughout pregnancy. 

Women with diabetes who become pregnant face some of the same risks as women with gestational diabetes: High blood pressure, preeclampsia, and possible cesarian delivery if the baby is too large. In addition, women who have diabetes and choose to get pregnant are at risk for these complications:

  • Stillbirth
  • Worsening of diabetes-related eye problems
  • Worsening of diabetes-related kidney problems
  • Infections of the urinary bladder and vaginal area

Women who were diagnosed with diabetes before getting pregnant should already have a testing regimen. The American Diabetes Association recommends testing 3 or more times a day for both people with type 1 diabetes and people with type 2 diabetes who are insulin-dependent.  If you have Type 2 diabetes and are insulin-dependent, or if you have type 1 diabetes, ask your doctor whether you need to change your testing regimen.

Diagnostic Testing

These tests are used in combination to determine whether a woman has gestational diabetes.

  • The fasting blood glucose test measures blood glucose after a period of fasting, usually in the morning. If the glucose is between 100 and 125, the diagnosis is impaired fasting glucose (IFG), or prediabetes.
  • The oral glucose tolerance (OGT) test measures the blood glucose level during fasting and again two hours after the ingestion of a glucose drink.  If the fasting blood glucose is in the normal range but the glucose level is high after the sugary drink, the diagnosis is gestational diabetes.  People who have elevated numbers for both IFG and IGT have the highest risk for developing type 2 diabetes.
  • The A1C test is first used to diagnose prediabetes, gestational diabetes, and type 1 and type 2 diabetes. Once a person has been diagnosed, their doctor will periodically prescribe an A1C test to determine how well they are managing their diabetes. This blood test provides information about a person’s average blood glucose levels over the three months just prior to testing. An A1C test result is reported as a percentage: A normal A1C level is below 5.7 percent. A number between 5-7 and 6.4 is indicative of prediabetes. Scores of 6.5 and indicate diabetes.

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