How To Manage Gestational Diabetes

Are you pregnant and concerned about or recently diagnosed with gestational diabetes? You're not alone. Gestational diabetes is a common issue during pregnancy, affecting about 5-9% of expectant mothers in the U.S. and 14% worldwide each year. Unfortunately, these numbers are on the rise. So, what exactly is gestational diabetes, and how can you manage it effectively? Let’s dive in!

What is gestational diabetes?

Gestational diabetes is one of the big 3 of pregnancy complications, the others being preeclampsia and placenta previa. It is typically diagnosed around 24 weeks of pregnancy, especially in first-time moms, and can occur in women who did not previously have diabetes. Before we explore gestational diabetes further, let’s take a moment to understand diabetes in general.

Diabetes, particularly type 2, arises when the body either doesn’t produce enough insulin or doesn’t use it effectively. After eating, the glucose broken down from your food circulates in the bloodstream and insulin is produced shortly after to help glucose enter cells to be used for energy or stored. So, think of the cell as a door, insulin as a key, and glucose as the wanted guest that brings all the energy. In patients with diabetes, there is either no key to open up the door (decreased insulin production), or the key no longer fits the lock (insulin resistance). Either way, glucose is left out and remains in the bloodstream, potentially leading to various health issues.

Now, let’s get back to gestational diabetes. This condition mirrors the situation in type 2 diabetes but occurs specifically during pregnancy. Elevated glucose levels in the blood can be harmful not only to you but also to your baby, so understanding and managing gestational diabetes is crucial for the health of both mother and child. The good news is that most of the time, gestational diabetes goes away after the baby is born, and it also manageable and treatable during pregnancy

How do you know I have gestational diabetes?

Certain women are more likely to develop gestational diabetes, with risk factors including age, race, excess body weight, a history of gestational diabetes, and conditions like polycystic ovary syndrome, high blood pressure, or high cholesterol. However, it can sometimes feel like a bit of a lottery. I’ve known dedicated CrossFit enthusiasts who developed gestational diabetes, while others with multiple risk factors mentioned above manage to avoid it. So, if you find yourself facing this diagnosis, try not to be too hard on yourself! Sometimes, it’s just a matter of drawing the short straw.

Screening for gestational diabetes usually takes place around 24 weeks of pregnancy, though it may be done earlier if you’re at higher risk. The screening involves a 1-hour glucose test, where you’ll drink a glucose solution containing 50 grams of sugar—this can be either fasted or non-fasted depending on your provider. A quick note: many women find this drink unpleasant due to its high sugar content and the fact that it’s typically kept warm. Personally, I found it quite refreshing because mine was cold and I have a major sweet tooth, but I digress. After drinking the solution, you’ll wait an hour before having your blood drawn. Your blood sugar level should be below 140 mg/dL to be considered normal. If your result is higher than this, it will indicate a potential risk for gestational diabetes.

If your initial test flags you as potentially having gestational diabetes, you’ll need to return for a 3-hour glucose test. This test involves drinking a glucose solution with 100 grams of sugar, followed by blood draws at 1, 2, and 3 hours after consumption. If your blood sugar level is above 180mg/dL, 160mg/dL and 140 mg/dL at two or more these intervals, respectively, you will be diagnosed with gestational diabetes.

How do I manage and treat gestational diabetes?

Gestational diabetes can be effectively managed through diet, exercise, and, if necessary, insulin treatments. If you’re diagnosed with gestational diabetes, your provider will likely refer you to a nutritionist who can help you develop a tailored diet plan and teach you how to monitor your blood sugar levels at home.

Adjusting to a low-carb diet and regularly checking your blood sugar might feel overwhelming at first. I’ve had several birth doula clients who initially struggled with this transition, but many have later found it to be a blessing in disguise. It often helps them become more attuned to their bodies and their eating habits, so there is a silver lining. There are also numerous online resources and meal service kits specifically designed for gestational diabetes which can simplify this process and support your dietary needs.

In some cases, diet and exercise alone may not be enough to manage your blood sugar levels, and you might need to use insulin. If this happens, remember that it’s a temporary measure and nothing to be ashamed of. Try not to stress; with the right adjustments, you’ll be able to manage your gestational diabetes effectively.

Why is my provider saying I have to be induced or have a C-section because I have gestational diabetes?

One concern with elevated blood sugar levels in a pregnant woman is that, while insulin cannot cross the placenta, glucose can. This means that high blood sugar in the mother can lead to increased blood sugar levels in the baby. In response, the baby’s pancreas produces extra insulin to manage the excess glucose. However, this process can result in the baby having more energy than needed, which is then stored as fat, leading to a condition known as macrosomia or "big baby" (> 8lbs., 13oz).

If your baby is measuring larger than average, your provider might suggest inducing labor before your due date or opting for a cesarean section to minimize risks during delivery, such as shoulder dystocia or postpartum hemorrhage. However, it’s important to note that the American College of Obstetricians and Gynecologists (ACOG) generally advises against inducing labor before 39 weeks if blood sugar levels are well-managed with diet and exercise alone. For those with well-controlled gestational diabetes, induction can typically be delayed until up to 40 weeks and 6 days.

Make sure to discuss all your options with your provider to make well-informed decisions about your delivery plan.

Conclusion

A gestational diabetes diagnosis involves many considerations, but with a solid plan and a supportive birth team, you can manage it effectively! Finding the right provider and care team is crucial to guiding you through this journey. As a birth doula, I’ve supported many clients through gestational diabetes, and I want you to know that you have options and you will get through this!

For more information on how I can support you, visit Doula Services. Let’s work together to ensure a smooth and healthy pregnancy experience!