Gestational Diabetes

What I need to know about Gestational Diabetes

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What is gestational diabetes?

Gestational* diabetes is a type of diabetes that develops only during pregnancy. Diabetes means your blood glucose, also called blood sugar, is too high. Your body uses glucose for energy. Too much glucose in your blood is not good for you or your baby.

Gestational diabetes is usually diagnosed during late pregnancy. If you are diagnosed with diabetes earlier in your pregnancy, you may have had diabetes before you became pregnant.

Treating gestational diabetes can help both you and your baby stay healthy. You can protect your baby and yourself by taking action right away to control your blood glucose levels.

Drawing of a group of pregnant women sitting and talking. One woman has her child in her lap.
Gestational diabetes is a type of diabetes that develops only during pregnancy.

If you have gestational diabetes, a health care team will likely be part of your care. In addition to your obstetrician-gynecologist, or OB/GYN—the doctor who will deliver your baby—your team might include a doctor who treats diabetes, a diabetes educator, and adietitian to help you plan meals.

For Women with Type 1 or Type 2 Diabetes

If you already have type 1 or type 2 diabetes and are thinking about having a baby, talk with your doctor before you get pregnant. Untreated or poorly controlled diabetes can cause serious problems for your baby. Read more in What I need to know about Preparing for Pregnancy if I Have Diabetes at www.diabetes.niddk.nih.gov or call 1–800–860–8747 and request a copy.

*See the Pronunciation Guide for tips on how to say the words in bold type.

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What causes gestational diabetes?

Gestational diabetes happens when your body can't make enough insulin during pregnancy. Insulin is a hormone made in your pancreas, an organ located behind your stomach. Insulin helps your body use glucose for energy and helps control your blood glucose levels.

During pregnancy, your body makes more hormones and goes through other changes, such as weight gain. These changes cause your body's cells to use insulin less effectively, a condition called insulin resistance. Insulin resistance increases your body's need for insulin. If your pancreas can't make enough insulin, you will have gestational diabetes.

All pregnant women have some insulin resistance during late pregnancy. However, some women have insulin resistance even before they get pregnant, usually because they are overweight. These women start pregnancy with an increased need for insulin and are more likely to have gestational diabetes.

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What are my chances of getting gestational diabetes?

Your chances of getting gestational diabetes are higher if you

  • are overweight
  • have had gestational diabetes before
  • have given birth to a baby weighing more than 9 pounds
  • have a parent, brother, or sister with type 2 diabetes
  • have prediabetes, meaning your blood glucose levels are higher than normal yet not high enough for a diagnosis of diabetes
  • are African American, American Indian, Asian American, Hispanic/Latina, or Pacific Islander American
  • have a hormonal disorder called polycystic ovary syndrome, also known as PCOS

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How can I lower my chances of getting gestational diabetes?

If you are thinking about getting pregnant and are overweight, you can lower your chances of getting gestational diabetes by

Taking these steps can improve how your body uses insulin and help your blood glucose levels stay normal.

Once you are pregnant, you should not try to lose weight. You need to gain some weight for your baby to be healthy. However, gaining too much weight too quickly may increase your chances of getting gestational diabetes. Your doctor will tell you how much weight gain and physical activity during pregnancy are right for you.

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When will I be tested for gestational diabetes?

You will probably be tested for gestational diabetes between weeks 24 and 28 of your pregnancy.

If you have a higher chance of getting gestational diabetes, your doctor may test for diabetes during the first visit after you become pregnant. If your blood glucose level is above normal at that time, you may be diagnosed with diabetes rather than gestational diabetes.

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How is gestational diabetes diagnosed?

Doctors use blood tests to diagnose gestational diabetes. All diabetes blood tests involve drawing blood at a doctor's office or a commercial facility. Blood samples are sent to a lab for analysis.

Drawing of a pregnant woman getting a blood test. She is seated and a health care provider is taking blood from her outstretched arm.

Screening Glucose Challenge Test

For this test, you will drink a sugary beverage and have your blood glucose level checked an hour later. This test can be done at any time of the day. If the results are above normal, you may need to have an oral glucose tolerance test.

Oral Glucose Tolerance Test

You will need to fast for at least 8 hours before the test. Fasting means having nothing to eat or drink except water. Your doctor will give you other instructions to follow before the test.

Your fasting blood glucose level will be checked before the test begins. Then you will drink a sugary beverage. Your blood glucose levels will be checked 1 hour, 2 hours, and possibly 3 hours later. Your doctor will use your test results to find out whether you have gestational diabetes.

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How will gestational diabetes affect my baby?

If you have high blood glucose levels because your gestational diabetes is not under control, your baby will also have high blood glucose. Your baby's pancreas will have to make extra insulin to control the high blood glucose. The extra glucose in your baby's blood is stored as fat.

Untreated or uncontrolled gestational diabetes can cause problems for your baby, such as

Drawing of a developing baby inside the womb. An arrow shows that glucose travels through the umbilical cord from the mother to the baby.

Your baby also might be born with jaundice. Jaundice is more common in newborns of mothers who had diabetes during their pregnancy. With jaundice, the skin and whites of the eyes turn yellow. Jaundice usually goes away, but your baby may need to be placed under special lights to help. Making sure your baby gets plenty of milk from breastfeeding will also help the jaundice go away.

Your baby will be more likely to become overweight and develop type 2 diabetes as he or she grows up.

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Will I need extra tests during pregnancy to check my baby's health?

If you have gestational diabetes, your doctor may recommend that you have some extra tests to check your baby's health, such as

Drawing of a smiling pregnant woman talking with her doctor. The doctor is writing in the woman's medical chart.

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How will gestational diabetes affect me?

Gestational diabetes may increase your chances of

Preeclampsia

Preeclampsia occurs during the second half of pregnancy. If not treated, preeclampsia can cause problems for you and your baby that could cause death. The only cure for preeclampsia is to give birth. If you develop preeclampsia late in your pregnancy, you may need to have a cesarean section to deliver your baby early. If you develop preeclampsia earlier, you may need bed rest and medicines, or you may have to be hospitalized to allow your baby to develop as much as possible before delivery.

Depression

Depression can make you too tired to manage your diabetes and care for your baby. If during or after your pregnancy you feel anxious, sad, or unable to cope with the changes you are facing, talk with your health care team. Depression can be treated. Your health care team may suggest ways you can get support and help to feel better. Remember, in order to take care of your baby, you must first take care of yourself.

Checkups

Keep up with your checkups. “Feeling fine” does not mean you should skip any appointments. Women with gestational diabetes often have no symptoms. Your health care team will be on the lookout for any problems from gestational diabetes.

After Giving Birth

Your diabetes will probably go away after your baby is born. However, even if your diabetes goes away after the birth, you

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How is gestational diabetes treated?

Treating gestational diabetes means taking steps to keep your blood glucose levels in a target range. Targets are numbers you aim for. Your doctor will help you set your targets. You will learn how to control your blood glucose using

Drawing of a smiling pregnant woman standing in her kitchen and cutting fruits and vegetables. There are bowls of fresh fruits and vegetables on the counter.
Using a healthy eating plan will help your blood glucose stay in your target range.

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Eating, Diet, and Nutrition

Your health care team will help you make a healthy eating plan with food choices that are good for both you and your baby. These choices are good for you to follow throughout pregnancy and after, as you raise your family.

Using a healthy eating plan will help your blood glucose stay in your target range. The plan will help you know which foods to eat, how much to eat, and when to eat. Food choices, amounts, and timing are all important in keeping your blood glucose levels in your target range.

Read more in What I need to know about Eating and Diabetes atwww.diabetes.niddk.nih.gov.

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Physical Activity

Physical activity can help you reach your blood glucose targets. Talk with your doctor about the type of activity that is best for you. If you are already active, tell your doctor what you do. Being physically active will also help lower your chances of having type 2 diabetes—and its problems—in the future. Now is the time to develop good habits for you and your baby.

Drawing of two pregnant women walking for exercise and carrying water bottles.
Physical activity can help you reach your blood glucose targets.

For more information about physical activity and pregnancy, visitwww.womenshealth.gov/pregnancy.

Insulin Shots

If you have trouble meeting your blood glucose targets, you may need to take a medicine called insulin, along with following a healthy meal plan and being physically active. Your health care team will show you how to give yourself insulin shots. Insulin will not harm your baby.

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How will I know whether my blood glucose levels are on target?

Your health care team may ask you to use a small device called a blood glucose meter to check your blood glucose levels on your own. You will learn

Drawing of a pregnant woman sitting and recording her blood glucose level in a record book. A blood glucose meter and a bottle of medicine are on the table.
Each time you check your blood glucose, write down the results.

You may be asked to check your blood glucose

This chart shows target blood glucose numbers for women who have gestational diabetes.

Target Blood Glucose Numbers (mg/dL) for
Women with Gestational Diabetes
Time of DayTargets
Before meals and when you wake up 95 or lower
1 hour after eating 140 or lower
2 hours after eating 120 or lower

Ask your doctor whether these targets are right for you.

Each time you check your blood glucose, write down the results in a record book. Ask your health care team for a blood glucose record book or use an electronic blood glucose tracking system on the Internet or on your cell phone. Always bring your blood glucose meter and your record book to your checkups so you can talk with your health care team about reaching your target blood glucose levels.

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Will I need to do other tests on my own?

Your health care team may teach you how to test for chemicals called ketones in your morning urine or in your blood. High levels of ketones are a sign that your body is using your body fat for energy instead of the food you eat. Using fat for energy is not recommended during pregnancy. Ketones may be harmful for your baby.

If your ketone levels are high, your doctor may suggest that you change the type or amount of food you eat. Or you may need to change your meal or snack times.

Drawing of a pregnant woman standing near her bathroom sink and testing her ketone levels. She is holding a cup of urine in one hand and a dipstick in the other.

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After I have my baby, how can I find out whether I still have diabetes?

You will need to visit your doctor to have a blood glucose test 6 to 12 weeks after your baby is born to see whether you still have diabetes. For most women, blood glucose levels return to normal after pregnancy. However, in 5 to 10 percent of women with gestational diabetes, blood glucose levels do not return to normal. Testing shows that these women have diabetes, usually type 2 diabetes. They will need to manage their diabetes through diet, physical activity, and medicines if needed.

Even if your blood glucose levels return to normal after your pregnancy, your chances of having diabetes—usually type 2 diabetes—later in life are high. Therefore, you should be tested at least every 3 years for diabetes or prediabetes.

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How can I prevent or delay type 2 diabetes later in life?

You can do a lot to prevent or delay type 2 diabetes by making these lifestyle changes:

These changes can help you enjoy a longer, healthier life. Your health care team can give you information and support to help you make these changes.

By delaying or preventing type 2 diabetes, you will also lower your chances of having heart and blood vessel disease and other problems as you get older.

Talk with your doctor if you are thinking about having another baby. For the safety of your baby, your blood glucose needs to be at healthy levels before you get pregnant again. Your doctor can help ensure you are ready for your next child.

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How can I give my baby a healthy start?

You can give your baby a healthy start by breastfeeding. Breast milk provides the best nutrition for your baby and protection against certain illnesses.

To help prepare for breastfeeding,

After you have your baby, these steps can help you get off to a great start:

Drawing of a woman breastfeeding her baby.

Many leading health organizations suggest that your baby should not have any foods or liquids other than breast milk for the first 6 months. After the first 6 months, babies can begin to eat other foods along with breast milk.

Read more in Breastfeeding and Breast Milk Overview atwww.nichd.nih.gov/health/topics/breastfeeding or visitwww.womenshealth.gov/breastfeeding.

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How can I help my child be healthy in the future?

You can help your child be healthy by showing your child how to make healthy lifestyle choices, including being physically active, limiting screen time in front of the TV or video games, eating a healthy diet, and staying at a healthy weight.

Read more about helping your child learn healthy habits in Helping Your Child, Tips for Parents at www.win.niddk.nih.gov/publications/child.htm.

Drawing of a father helping his daughter learn how to ride a bike. A woman on a bike follows them.
A healthy lifestyle can help your child from becoming overweight or obese and having type 2 diabetes later on.

For more information about diabetes, contact the National Diabetes Information Clearinghouse (NDIC) at 1–800–860–8747 for free copies of these publications, or read them online at www.diabetes.niddk.nih.gov:

Managing Diabetes

Preventing Type 2 Diabetes

The National Diabetes Education Program's publications include a tip sheet for women with a history of gestational diabetes, available at www.yourdiabetesinfo.org or by calling 1–888–693–NDEP (1–888–693–6337):

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Points to Remember

 

Managing
Gestational
Diabetes
A Patient’s Guide to
a Healthy Pregnancy
Gestational diabetes (pronounced jess-TAY-shun-ul die-uh-BEET-eez)
is one of the most common health problems for pregnant women. It affects
about 5 percent1 of all pregnancies, which means there are about 200,000
cases each year. If not treated, gestational diabetes can cause health problems
for mother and fetus.
The good news is that gestational diabetes can be treated, especially if
it’s found early in the pregnancy. There are some things that women with
gestational diabetes can do to keep themselves well and their pregnancies
healthy. Controlling gestational diabetes is the key to a healthy pregnancy.
This booklet gives women who have been diagnosed with this condition the
information they need to talk to health care providers, dietitians, and family
members and friends about gestational diabetes.2 what       is gestational diabetes?
   
        
         
    
      
           
What is  gestational diabetes?
Gestational Diabetes is a kind of diabetes that only pregnant women get.
In fact, the word gestational means “during pregnancy.” If a woman gets
diabetes or high blood sugar when she is pregnant, but she never had it
before, then she has gestational diabetes. Its medical name is gestational
diabetes mellitus (pronounced MELL­eh­tiss) or GDM. To learn what gestational
diabetes is, you need to know a few things about diabetes in general.
What is  diabetes?
Diabetes means your  blood  sugar  is too high.   Diabetes is a disease of
metabolism, which is the way your  body uses food  for  energy and  growth.
Your  stomach and  intestines break down (or  digest) much of  the food  you eat
into a simple sugar  called  glucose (pronounced  GLOO­kos).   Glucose is your
body’s main source of  energy.        
       
      
               
     
          
 
         
    
     
    
                        
        
            
       
           
     
        
       
   
why           didn’t I have diabetes before? 3
After  digestion,  the glucose passes into your  bloodstream,  which is why
glucose is also called  blood  sugar.   This booklet uses the terms glucose 
and  blood  sugar  to mean the same thing.   Once in the blood,  the glucose is
ready for  your body cells to use.   But your  cells need  insulin (pronounced 
IN­suh­lin),  a hormone made by your  body,  to get the glucose.   Insulin “opens”
your  cells so that glucose can get in.   When your  metabolism  is normal,  your
body makes enough insulin to move all the glucose smoothly from  your
bloodstream  into your  cells.
If you have diabetes, your insulin and glucose levels are out­of­balance. Either
your body isn’t making enough insulin, or your cells can’t use insulin the way
they should. Without insulin, the glucose that can’t get into your cells builds
up in your bloodstream. This is called high blood sugar or diabetes. After
a while, there is so much glucose in the blood that it spills over into your urine
and passes out of your body. The medical name for diabetes, diabetes mellitus,
means “sweet urine.”
If not treated, gestational diabetes can lead to health problems, some of them
serious. The best way to promote a healthy pregnancy if you have gestational
diabetes is to follow the treatment plan outlined by your health care provider.
Why  didn’t I have diabetes  before?
Remember that only pregnant women get gestational diabetes. When you’re
pregnant, your body goes through a lot of changes. In this case, being
pregnant changed your metabolism. Now that you’re pregnant, the insulin in
your body can’t do its job. Your body can’t get the sugar out of your blood
and into your cells to use for energy.
Why  isn’t the insulin doing its  job?
The placenta, the system of vessels that passes nutrients, blood, and water
from mother to fetus, makes certain hormones that prevent insulin from
working the way it is supposed to. This situation is called insulin resistance.
To keep your metabolism normal, your body has to make three times its normal
amount of insulin or more to overcome the hormones made by the placenta. why           didn’t I have diabetes before?
     
          
        
       
 
   
   
       
     
          
   
          
         
    
  
   
         
 
     
   
 
       
     
         
        
           
       
     
         
   
           
       
 
              
           
For most women, the body’s extra insulin is enough to keep their blood sugar
levels in the healthy range. But, for about 5 percent of pregnant women, even
the extra insulin isn’t enough to keep their blood sugar level normal. At about
the 20th to the 24th week of pregnancy, they end up with high blood sugar or
gestational diabetes.
It takes time for insulin resistance to affect your body in a way that health care
providers can measure, which is why tests for gestational diabetes are usually
done between the 24th and 28th week of pregnancy.
Who can I go to for help with gestational diabetes?
Women who have gestational diabetes benefit most from a team approach to treatment, with each
team member playing a specific role in the management and treatment of the condition. However,
the specific members of the team will vary.
In general, women have a number of choices in how they get prenatal care. They might go to an
obstetrician/gynecologist (OB/GYN), a nurse­midwife, a family physician, or another health care
provider. These health care providers are usually the first line of defense against gestational
diabetes because they do the initial testing for the condition.
Once you are diagnosed with gestational diabetes, these providers may decide to stay on your
team, working with other providers to manage your care, or they may suggest that one of the
following specialists leads your team:
A maternal­fetal medicine specialist—a doctor who cares for a woman during pregnancy, labor,
and delivery only; or
Another doctor who specializes in treating pregnant women with high­risk conditions.
Should you need more extensive treatment and management to keep your gestational diabetes
under control, it is likely that you will have to see one of these specialists to help ensure a healthy
pregnancy.
You should also have a registered dietitian, a person with a bachelor’s degree or higher in dietetics
who is registered with the American Dietetic Association (ADA), on your team. Your health care
provider can recommend a dietitian, or you can call the ADA at 1­800­366­1655 to find one.
In addition, you may have one or both of the following providers on your team:
A diabetes specialist—a diabetologist (a doctor who specializes in diabetes care), endocrinologist
(a doctor who specializes in treating hormone­related conditions, like diabetes), or another
medical doctor who provides health services specifically for diabetics.
A diabetes educator—a certified diabetes educator (CDE), nurse educator, registered nurse (RN),
or another health care provider who can explain gestational diabetes and help you manage your
condition during your pregnancy.
Keep in mind that your treatment and management team may include other members, too. This
booklet uses the term health care provider to describe your doctor and the other members of your
health care team.
4 Will gestational diabetes  hurt my baby?
Most women who have gestational diabetes give birth to healthy babies,
especially when they keep their blood sugar under control, eat a healthy diet,
get regular, moderate physical activity, and maintain a healthy weight. In some
cases, though, the condition can affect the pregnancy.
Keeping glucose levels under control may prevent certain problems related to
gestational diabetes.
Below are some conditions that can result from your having gestational
diabetes. Keep in mind that just because you have gestational diabetes does
not mean that these problems will occur.
Macrosomia (pronounced  mak­row­SOHM­ee­uh)—Baby’s body is larger
than normal.   Large­bodied  babies sometimes get injured  by natural delivery
through the vagina;  the baby may need  to be delivered  through cesarean
section.   The most common complication for these babies is shoulder dystocia
(pronounced  dis­TOE­shee­uh).   
Hypoglycemia (pronounced  high­po­gl­eye­SEEM­ee­uh)—Baby’s blood
sugar  is too low.   You may need  to start breastfeeding right away to get more
glucose into the baby’s system.   If  it’s not possible for  you  to start feedings,
the baby may need  to get glucose through a thin,  plastic tube in his or  her
arm  that puts glucose directly into the blood.
Jaundice (pronounced  JAWN­diss)—Baby’s skin turns yellowish;  white parts
of  the eyes may also change color slightly.   If  treated,  jaundice is not a serious
problem  for  the baby. 
Respiratory  Distress  Syndrome  (RDS)—Baby has trouble breathing.
The baby might need  oxygen or  other  help breathing if  he or  she has RDS.
         
        
      
   
  
   
    
  
         
Low  Calcium  and  Magnesium  Levels  in  the  Baby’s  Blood—Baby
could  develop a condition that causes spasms in the hands and  feet,  or
twitching or  cramping muscles.   This condition can be treated  with calcium
and  magnesium  supplements.   
will gestational diabetes hurt my baby? 5 6 will           gestational diabetes hurt my baby?
         
    
   
        
                      
                   
                     
              
        

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