Care of gestational diabetes

How to Treat Gestational Diabetes

Gestational Diabetes

Because gestational diabetes can hurt you and your baby, it is critical to start treatment quickly.

Treatment for gestational diabetes aims to keep blood glucose levels equal to those of pregnant women who don't have gestational diabetes. The treatment always includes special meal plans and scheduled physical activity, and it may also include daily blood glucose testing and insulin injections.

If you're testing your blood glucose, the American Diabetes Association suggests the following targets for women who develop gestational diabetes during pregnancy. More or less stringent glycemic goals may be appropriate for each individual.

Before a meal (preprandial): 95 mg/dl or less
One hour after a meal (postprandial): 140 mg/dl or less
Two hours after a meal (postprandial): 120 mg/dl or less

If you’re diagnosed with gestational diabetes, you will need help from your doctor, nurse educator and other members of your health care team so that your treatment can change as needed. For you as the mother-to-be, proper treatment helps lower the risk of a cesarean section birth that very large babies may require.

Sticking with your treatment plan will give you a healthy pregnancy and birth, and may help your baby avoid poor health in the future.

Keeping worry in perspective

While gestational diabetes is a cause for concern, the good news is that you and your health care team—your doctor, obstetrician, nurse educator and dietitian—work together to lower your high blood glucose levels. And with this help, you can turn your concern into a healthy pregnancy for you and a healthy start for your baby.

Looking ahead

Gestational diabetes usually goes away after pregnancy. But once you've had gestational diabetes, your chances are two in three that it will return in future pregnancies. In a few women, however, pregnancy uncovers type 1 or type 2 diabetes. It is hard to tell whether these women have gestational diabetes or have just started showing their diabetes during pregnancy, but they will need to continue diabetes treatment after pregnancy.

Many women who have gestational diabetes go on to develop type 2 diabetes years later. There seems to be a link between the tendency to have gestational diabetes and type 2 diabetes since both involve insulin resistance. However, certain basic lifestyle changes may help prevent diabetes after gestational diabetes. Learn about prevention.

Lower your risk by losing weight

Are you more than 20% over your ideal body weight? Losing even a few pounds can help you avoid developing type 2 diabetes.

Making healthy food choices

Follow simple daily guidelines like eating a variety of foods including fresh fruits and vegetables, limiting fat intake to 30% or less of daily calories and watching your portion sizes. Healthy eating habits can go a long way in preventing diabetes and other health problems.

Exercising

Regular exercise allows your body to use glucose without extra insulin. This helps combat insulin resistance and is what makes exercise helpful to people with diabetes. However, it is important to check with your doctor before starting an exercise program.

Gestational diabetes - Diagnosis and treatment

Diagnosis

If you're at average risk of gestational diabetes, you'll likely have a screening test during your second trimester — between 24 and 28 weeks of pregnancy.

If you're at high risk of diabetes — for example, if you're overweight or obese before pregnancy; you have a mother, father, sibling or child with diabetes; or you had gestational diabetes during a previous pregnancy — your health care provider may test for diabetes early in pregnancy, likely at your first prenatal visit.

Routine screening for gestational diabetes

Screening tests may vary slightly depending on your health care provider, but generally include:

Initial glucose challenge test. You'll drink a syrupy glucose solution. One hour later, you'll 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), indicates gestational diabetes.

A blood sugar level below 140 mg/dL (7.8 mmol/L) is usually considered within the standard range on a glucose challenge test, although this may vary by clinic or lab. If your blood sugar level is higher than expected, you'll need another glucose tolerance test to determine if you have gestational diabetes.
Follow-up glucose tolerance testing. This test is similar to the initial test — except the sweet solution will have even more sugar and your blood sugar will be checked every hour for three hours. If at least two of the blood sugar readings are higher than expected, you'll be diagnosed with gestational diabetes.

More Information

Glucose challenge test
Glucose tolerance test
Nonstress test

Treatment

Treatment for gestational diabetes includes:

Lifestyle changes
Blood sugar monitoring
Medication, if necessary

Managing your blood sugar levels helps keep you and your baby healthy. Close management can also help you avoid complications during pregnancy and delivery.

Lifestyle changes

Your lifestyle — how you eat and move — is an important part of keeping your blood sugar levels in a healthy range. Health care providers usually don't advise losing weight during pregnancy — your body is working hard to support your growing baby. But your health care provider can help you set weight gain goals based on your weight before pregnancy.

Lifestyle changes include:

Healthy diet. A healthy diet focuses on fruits, vegetables, whole grains and lean protein — foods that are high in nutrition and fiber and low in fat and calories — and limits highly refined carbohydrates, including sweets. A registered dietitian or a certified diabetes care and education specialist can help you create a meal plan based on your current weight, pregnancy weight gain goals, blood sugar level, exercise habits, food preferences and budget.
Staying active. Regular physical activity plays a key role in every wellness plan before, during and after pregnancy. Exercise lowers your blood sugar. As an added bonus, regular exercise can help relieve some common discomforts of pregnancy, including back pain, muscle cramps, swelling, constipation and trouble sleeping.

With your health care provider's OK, aim for 30 minutes of moderate exercise on most days of the week. If you haven't been active for a while, start slowly and build up gradually. Walking, cycling and swimming are good choices during pregnancy. Everyday activities such as housework and gardening also count.

Blood sugar monitoring

While you're pregnant, your health care team may ask you to check your blood sugar four or more times a day — first thing in the morning and after meals — to make sure your level stays within a healthy range.

Medication

If diet and exercise aren't enough to manage your blood sugar levels, you may need insulin injections to lower your blood sugar. A small number of women with gestational diabetes need insulin to reach their blood sugar goals.

Some health care providers prescribe an oral medication to manage blood sugar levels. Other health care providers believe more research is needed to confirm that oral medications are as safe and as effective as injectable insulin to manage gestational diabetes.

Close monitoring of your baby

An important part of your treatment plan is close observation of your baby. Your health care provider may check your baby's growth and development with repeated ultrasounds or other tests. If you don't go into labor by your due date — or sometimes earlier — your health care provider may induce labor. Delivering after your due date may increase the risk of complications for you and your baby.

Follow-up after delivery

Your health care provider will check your blood sugar level after delivery and again in 6 to 12 weeks to make sure that your level has returned to within the standard range. If your tests are back in this range — and most are — you'll need to have your diabetes risk assessed at least every three years.

If future tests indicate type 2 diabetes or prediabetes, talk with your health care provider about increasing your prevention efforts or starting a diabetes management plan.

More Information

Labor induction

Request an Appointment at Mayo Clinic

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Coping and support

It's stressful to know you have a condition that can affect your unborn baby's health. But the steps that will help control your blood sugar level — such as eating healthy foods and exercising regularly — can help relieve stress, nourish your baby and help prevent type 2 diabetes in the future.

You may feel better if you learn as much as you can about gestational diabetes. Talk to your health care team, or read books and articles about gestational diabetes. You may find a support group for people with gestational diabetes helpful. Ask your health care team for suggestions.

Preparing for your appointment

You'll likely find out you have gestational diabetes from routine screening during your pregnancy. Your health care provider may refer you to additional health professionals who specialize in diabetes, such as an endocrinologist, a certified diabetes care and education specialist, or a registered dietitian. One or more of these care providers can help you learn to manage your blood sugar level during your pregnancy.

You may want to take a family member or friend along to your appointment, if possible. Someone who accompanies you may remember something that you missed or forgot.

Here's some information to help you get ready for your appointment and know what to expect from your health care provider.

What you can do

Before your appointment:

Be aware of pre-appointment restrictions. When you make your appointment, ask if you need to fast for lab tests or do anything else to prepare for diagnostic tests.
Make a list of symptoms you're having, including those that may seem unrelated to gestational diabetes. You may not have noticeable symptoms, but it's good to keep a log of anything unusual you notice.
Make a list of key personal information, including major stresses or recent life changes.
Make a list of all medications, including over-the-counter drugs and vitamins or supplements you're taking.
Make a list of questions to help make the most of your time with your health care provider.

Some basic questions to ask your health care provider include:

What can I do to help control my condition?
Can you recommend a registered dietitian or certified diabetes care and education specialist who can help me plan meals, an exercise program and coping strategies?
Will I need medication to control my blood sugar?
What symptoms should prompt me to seek medical attention?
Are there brochures or other printed materials I can take? What websites do you recommend?

What to expect from your doctor

Your health care provider is also likely to have questions for you, especially if it's your first visit. Questions may include:

Have you experienced increased thirst or excessive urination? If so, when did these symptoms start? How often do you have them?
Have you noticed other unusual symptoms?
Do you have a parent or sibling who's ever been diagnosed with diabetes?
Have you been pregnant before? Did you have gestational diabetes during your previous pregnancies?
Did you have other problems in previous pregnancies?
If you have other children, how much did each weigh at birth?

By Mayo Clinic Staff

Associated Procedures

Products & Services

Gestational diabetes in pregnancy | OneTouch®

Gestational Diabetes

What Causes Gestational Diabetes?

Doctors don't know exactly what causes gestational diabetes, but they have some ideas about it.

The placenta supports and nourishes the baby as it grows. Hormones from the placenta help the baby develop. But these same hormones also block the action of insulin, reducing its effectiveness. Gestational diabetes occurs when your body is no longer able to produce and use all the insulin it needs during pregnancy, resulting in high blood glucose levels if left untreated.

Some women are at higher risk of developing gestational diabetes. The following factors increase the risk of developing gestational diabetes:

Being overweight before pregnancy
Too much weight gain during pregnancy (more than the recommended amount)
Age over 25
History of gestational diabetes
Presence of diabetes in close relatives
African American, Asian, Hispanic or Native American

How is gestational diabetes diagnosed?

Most women who receive good medical care during pregnancy are regularly screened for gestational diabetes between the 24th and 28th weeks of pregnancy. If you are at high risk of developing gestational diabetes, your doctor may test you earlier and/or more than once during your pregnancy.

As part of the Gestational Diabetes Test, your doctor will ask you to drink a sugary drink, and you will have a blood sample taken before and after you drink the drink. If the results show that the blood glucose level at the specified time is above the recommended limits, the diagnosis of gestational diabetes is confirmed. Your doctor will tell you about a plan for treating gestational diabetes.

Why is it important to treat gestational diabetes?

A mother instinctively protects her child. It is important for the health of both mother and child that treatment for gestational diabetes be started as soon as the diagnosis is made. If left untreated, gestational diabetes can cause problems that include the following:

An increased chance of having a large baby weighing more than 4 kg - this condition is called macrosomia. It increases the likelihood
- complications and injuries during vaginal delivery;
- caesarean section. (K-section)
Your baby is at high risk for preterm labor and breathing problems (respiratory distress)
Your baby is at high risk for low blood sugar (hypoglycemia) shortly after birth
You are more likely to have preeclampsia (high blood pressure and liver or kidney problems)

Following your doctor's instructions and carefully managing your gestational diabetes can greatly reduce your risk of developing these complications.

What to expect if you are diagnosed with gestational diabetes?

If you have been diagnosed with gestational diabetes:

Your doctor will recommend a healthy carbohydrate-controlled diet and exercise. In many cases, these measures will be sufficient to control blood glucose levels throughout pregnancy.
You may need help from a dietitian in developing a healthy eating plan. A nutritionist can teach you how to control the amount and types of carbohydrates in your food so that you can manage your blood glucose levels while still meeting the needs of your growing child. You may also be asked to keep a food journal and monitor your weight.
You may need to check your blood glucose daily with a glucometer. Ask your doctor or diabetes consultant to recommend a glucometer that is right for you. Checking and tracking your blood glucose levels will help you and your doctor manage your gestational diabetes.

As a rule, blood glucose levels should be checked at least 4 times a day, usually on an empty stomach, and then 1-2 hours after a meal. Your doctor or healthcare professional will tell you how often you should test and what your target blood glucose range is. Remember to record your blood glucose measurements, including the time and results of the test, before or after a meal, and how long after a meal the test was taken.

Light exercise during pregnancy will help your body make better use of its own insulin and help control blood glucose levels. Types of exercise that can be safely performed by pregnant women include brisk walking and swimming. Talk to your doctor for advice on safe exercise during pregnancy.

At your appointment, the midwife can check your blood pressure and take a urine sample. You will also talk to your doctor about your blood glucose test results, how you eat, how much exercise you do, and how much weight you have gained. Your growing child will also be closely monitored. All this will help determine if the prescribed treatment plan for gestational diabetes is working and if it needs to be adjusted.

If dietary changes and exercise don't help control your blood glucose, your doctor may prescribe medication—pills or insulin—for the rest of your pregnancy.

Medication (pills, insulin)

Just because your doctor prescribes pills or insulin doesn't mean you can't manage your gestational diabetes. In some cases, your body may simply not be able to produce enough insulin on its own that your body needs as your baby grows. It is very important to follow your doctor's recommendations to protect yourself and your baby. You may be able to stop taking antidiabetic drugs after the baby is born.

If your doctor prescribes insulin for gestational diabetes, you can get it by injection or by other means, such as an insulin pump. Someone in your family can learn this with you and help you take your insulin as prescribed by your doctor. Fortunately, today, thanks to insulin syringes with small, thin needles, injections are virtually painless. Your doctor will tell you when and how much insulin you should take each time, and may recommend adjusting your insulin intake during your pregnancy.

Refs:

² IDF Diabetes Atlas (Version 8) (2017). International Diabetes Federation: Brussels, Belgium. Online version dated May 5, 2018 at http://diabetesatlas.org/IDF_Diabetes_Atlas_8e_interactive_EN/

You may be interested

What is diabetes?

Gestational diabetes in pregnancy - treatment and diagnosis of diabetes in pregnant women in Moscow, Clinical Hospital on Yauza

Consult a gynecologist

Service in two languages: Russian, English.
Leave your phone number and we will call you back.

Contents

IMPORTANT!

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Specialists of the Yauza Clinical Hospital diagnose and treat diabetes in pregnant women and its complications. For a comfortable pregnancy and the safety of the expectant mother and baby, we exercise strict control over the blood sugar level of a pregnant woman, if necessary, prescribe a specially designed diet and medications.

Make an appointment with a gynecologist

About 7% of pregnant women have manifestations of gestational diabetes. In 50% of cases, the disease is asymptomatic
Gestational diabetes in pregnancy significantly increases the risk of pregnancy complications for both mother and fetus
Perinatal mortality increases by 2-3% with a combination of diabetes mellitus and pregnancy

Pregnancy diabetes (gestational diabetes) is an increase in blood glucose that first occurs during pregnancy but is not high enough to warrant a diagnosis of diabetes mellitus. These are hidden disorders of carbohydrate metabolism that threaten to develop into diabetes mellitus.

Pregnant blood glucose norm

During pregnancy, all women experience changes in insulin sensitivity and glucose tolerance. This is fine. The difference between the norm and pathology in the degree of change.

Blood tests for diabetes in pregnancy - norm and pathology

If a fasting venous blood test shows a glucose level of more than 5.1 mmol/l, this is normal for pregnant women.
From 5.1 to 7.0 mmol / l - gestational diabetes.
If 7.0 mmol / l or more - diabetes mellitus.
Testing capillary blood (taken from a finger) for the diagnosis of gestational diabetes mellitus is not recommended.
If during an oral glucose tolerance test (when 75 g of glucose is taken orally during the study) after an hour the glucose level is more than 10.0 mmol/l, and after two hours the blood glucose level is in the range of 7.8-8.5 mmol/l - then for pregnant women this is a normal indicator.

To better understand what gestational diabetes, or diabetes in pregnancy, is, you need to talk a little about hormonal changes in the body in pregnant women.

Causes of gestational diabetes

Hormonal changes that occur during pregnancy are associated with increased production of large amounts of steroid hormones. Some of them, such as cortisol and progesterone, have a significant effect on cell receptors, increasing their resistance to insulin.
This leads to an increase in blood glucose levels and requires a significant increase in insulin production by the pancreas. In cases where the compensatory capacity of the pancreas is not enough, sugar metabolism gets out of control and a condition called gestational diabetes or gestational diabetes develops.
This condition occurs quite often. Between 3 and 10% of pregnant women develop pathological insulin resistance leading to gestational diabetes.
Unlike diabetes mellitus diagnosed before pregnancy, pathological insulin resistance that occurs during pregnancy does not cause fetal malformations and in most cases does not require insulin treatment. But, nevertheless, uncompensated gestational diabetes can significantly complicate the course of pregnancy.

Specialists of the Yauza Clinical Hospital diagnose, treat and prevent diabetes in pregnant women and its complications, such as impaired fetal growth. The doctors of the Clinical Hospital on the Yauza strictly control the blood sugar level of a pregnant woman, if necessary, prescribe a specially designed diet. This ensures a comfortable pregnancy and the safety of the expectant mother and baby.

Pregnancy diabetes - consequences for the child

Large disproportionate fruit. The most important and common complication of gestational diabetes is fetal growth failure. Developing in conditions of increased blood glucose levels, which penetrate the fetoplacental barrier, the fetus is forced to compensate for the increased sugar level with its own insulin. Due to the fact that the structure of insulin and growth hormone are very similar, high levels of insulin stimulate the growth of the fetus. The problem is that a large fetus develops. In such a fetus, body proportions differ from those of normally developing newborns, in which the volume of the head is larger than the volume of the shoulder girdle. In fetuses with uncompensated gestational diabetes, the size of the shoulder girdle predominates, and the size of the abdomen increases. This leads to the fact that during childbirth after the fetus's head passes through the birth canal, the shoulders can get stuck (shoulder dystocia) and the child, along with the mother, can be severely injured or die.

Polyhydramnios or oligohydramnios. In addition, in gestational diabetes, the balance of the amount of amniotic fluid can be disturbed and either polyhydramnios or oligohydramnios develops. This is a serious risk factor for intrauterine fetal death or premature birth.

Lung underdevelopment. In gestational diabetes, the lungs of the fetus mature later, as the production of surfactant (a special lubrication of the inner walls of the alveoli, where oxygen is exchanged in the lungs) is disrupted. Therefore, premature birth in gestational diabetes is especially dangerous.

Hypoglycemia and metabolic disorders in the fetus. Due to the constant increased production of its own insulin during pregnancy, immediately after birth, the child is in a state of hypoglycemia with electrolyte imbalance, which threatens his life.

All this dictates the need for the earliest possible detection of gestational diabetes in pregnant women, the blood sugar level of a pregnant woman and to prevent the development of complications.

Diagnosis of diabetes in pregnant women at the Yauza Clinical Hospital

Signs of diabetes in pregnant women

Gestational diabetes in pregnancy is not usually associated with the classic symptoms of diabetes, such as thirst or excessive urination (polyuria).

Pregnancy tests for diabetes mellitus

First phase. At the first visit of a pregnant woman to a doctor at any time, she is tested for glucose levels in venous blood - fasting glucose, regardless of food intake, glycated hemoglobin. This is the first phase of research to detect diabetes mellitus or gestational diabetes in pregnant women. If diabetes mellitus is detected, the patient is referred for observation and treatment to an endocrinologist.

Second phase. At 24-28 weeks of gestation, all patients who do not show any abnormal carbohydrate metabolism at the first examination are called for a glucose tolerance test (OGTT) to detect "hidden diabetes". This is done because the occurrence of gestational diabetes is associated with the development of insulin resistance under the influence of hormones produced by the placenta. Therefore, in the vast majority of cases, gestational diabetes develops in the second half of pregnancy after 24 weeks, when there is a peak in the production of placental hormones.

Glucose tolerance test

It is carried out to detect pathological insulin resistance, characteristic of latent diabetes in pregnant women. Pregnant women undergo a two-hour test, only in the laboratory.
During the 3 days leading up to the test, the woman should eat her usual diet, including carbohydrates (>150 g of carbohydrates per day), maintain her usual physical activity. The evening before testing, dinner should include 30-50 grams of carbohydrates.
On the day of the study, before the analysis, you should not smoke and take medications that can affect the level of glucose (vitamins, glucocorticoid hormones, iron preparations, which include carbohydrates, beta-agonists, beta-blockers). You can drink water.
Venous blood is taken on an empty stomach (after 8-14 hours of fasting, usually in the morning, before breakfast).
Then the patient takes a glucose solution (75 g).
And they take blood in an hour and two after the sugar load. Normally, the level of glucose in the blood after a sugar load should not exceed an hour later - 10 mmol / l, after 2 hours - 8.5 mmol / l.
If manifest diabetes mellitus is detected, the patient is referred to an endocrinologist, gestational diabetes mellitus is treated by an obstetrician-gynecologist or therapist.

Glucose tolerance test contraindications

Strict bed rest prescribed for a pregnant woman (until doctor's permission).
Pronounced toxicosis of pregnant women (with nausea and vomiting).
Acute infectious or inflammatory disease.
Exacerbation of chronic pancreatitis.
Dumping syndrome (syndrome of resected stomach).

Prenatal diabetes monitoring

Blood glucose monitoring, self-monitoring diary

When diagnosing gestational diabetes, it is necessary to establish strict control of sugar levels throughout the subsequent pregnancy and during childbirth. To do this, regularly examine the blood for sugar (glucose). In addition, the patient conducts self-monitoring using a glucometer.

It is recommended that a pregnant woman keep a diary of observations in which to record:

blood glucose level (normal <5.1 mmol/l),
the presence of ketone bodies in the urine, which is determined by test strips sold in a pharmacy (normally, ketone bodies are absent),
blood pressure readings (normal <130|80 mmHg),
fetal movements,
body weight,
diet.

Expert ultrasound

Conducting an expert ultrasound examination reveals signs of intrauterine suffering of the fetus (diabetic fetopathy), polyhydramnios. Most often, this is a sign of chronically elevated blood glucose levels, penetrating into the blood of the fetus. This requires urgent correction of the diet and normalization of the level of glycemia (blood sugar). If necessary, insulin therapy.

Make an appointment

Treatment of gestational diabetes

Diet for gestational diabetes

In most cases, it is sufficient to follow a special diet recommended by a nutritionist based on the body mass index of the pregnant woman and her taste preferences. The effectiveness of diet therapy is determined by the maintenance of normal blood glucose levels. Diet in pregnancy diabetes recommends:

Avoid simple carbohydrates - sweets, pastries, white bread, honey, sugar, jam, sweet drinks and fruits, ice cream.
Limit complex carbohydrates - cereals (semolina, rice - exclude), potatoes, corn, legumes, durum wheat pasta. Distribute their intake evenly over several meals throughout the day to eliminate starvation (causes the formation of ketone bodies).
Eat enough protein - meat, fish, seafood, poultry, mushrooms, eggs, hard cheese, dairy and sour-milk products of medium fat content (3-5%).
It is necessary to enrich the diet with fiber and vitamins - greens, vegetables (except for boiled carrots and beets), sweet and sour berries (excluding grapes).
Correctly choose fats, do not exceed their amount recommended by the doctor - vegetable oils (add to ready meals), nuts, seeds. Animal fats (butter, sausages) - limit.
When cooking, boil, stew, steam and bake dishes. Don't fry. Do not deep fry.

A detailed menu for a pregnant woman with gestational diabetes will be compiled by a doctor, taking into account the individual characteristics of each particular woman.
It is not worth using table No. 9 in its pure form for pregnant women with diabetes mellitus due to a significant restriction of its calorie content.
In detail, what you can eat with diabetes in pregnant women will be told by the doctor at an in-person consultation.

Pharmacotherapy

In cases where the diet fails to achieve the desired control of the level of glycemia in the blood, there are signs of a negative effect on the fetus - they resort to prescribing drugs - insulin. In case of diabetes in pregnant women, antidiabetic drugs in tablets should not be used. Insulin therapy is prescribed by an endocrinologist. Pregnant women with diabetes who are on insulin therapy are jointly managed by an endocrinologist, an internist and an obstetrician-gynecologist.

Physical activity

Patients are recommended regular physical activity - walking in the fresh air (at least 150 minutes per week), swimming.

Prenatal diabetes - childbirth

With a compensated course of gestational diabetes, normal development of the fetus and the condition of the woman, childbirth is carried out in time in a natural way. The question of early delivery, caesarean section may arise if there are relevant indications from the mother or fetus.

Specialists of the Yauza Clinical Hospital have included mandatory fetal development screenings and tests to diagnose sugar metabolism disorders in the pregnancy monitoring program. Recommendations are given on a special diet for women with manifestations of gestational diabetes. If necessary, strict glycemic control is carried out throughout pregnancy, ensuring its successful completion and the birth of a healthy child.

Make an appointment