You've Been Diagnosed With Gestational Diabetes. Now What?

Q&A with Dr. Shad Deering, maternal fetal medicine specialist

Every year, 2 to 10 percent of pregnancies in the United States are affected by gestational diabetes. What exactly is it, and how can it be managed effectively? We recently sat down with Dr. Shad Deering to talk about gestational diabetes and what women need to know.

Q: Can you explain what gestational diabetes is and how and when it’s diagnosed?

A: Gestational diabetes is a type of diabetes that occurs during pregnancy.It’s usually diagnosed when a woman is between 24 to 28 weeks pregnant with a one-hour glucose tolerance test.

Q: What are some common risk factors associated with gestational diabetes?

A: There are certain risk factors the predispose a woman to develop gestational diabetes. First, if you had it before with another pregnancy and specifically if your baby weighed more than nine pounds, the likelihood of you developing gestational diabetes is greater. Also, if you have polycystic ovarian syndrome (PCOS), you are also at risk. Other risk factors include being Hispanic or Black, having a family member with diabetes, having hypertension, or having a body mass index (BMI) of over 25.

Q: If you have the above risk factors, what are some things you can do to manage gestational diabetes better?

A: You can take some steps to lower your risk profile, including being mindful of what you eat and being active. Getting 30 minutes of exercise – at least three to five times a week – will help. Making changes to your diet and cutting out simple carbohydrates like white bread, for example, also will help. You should aim for 40% complex carbs (multigrain bread and cereals, beans, and vegetables), 20% protein, and 40% fats. In short, a balanced diet and exercise routine coming into pregnancy will significantly decrease your risk.

Q: If a pregnant woman is diagnosed with gestational diabetes, what should she eat? What should she not eat? How should she manage her pregnancy cravings?

A: When women receive a diagnosis of gestational diabetes, they immediately think, “what can I eat” instead of “what should I stop eating,” which is the more important question. Reducing soda intake as well as processed baked goods like crackers and chips can be effective in lowering blood sugar levels. Making dietary changes can be difficult, especially when a woman is experiencing cravings. However, just like lifestyle changes are a big deal in managing diabetes outside of pregnancy, they also play a role in managing gestational diabetes as well.

Q: When a woman is first diagnosed with gestational diabetes, what happens next? What is done to help them so they have a healthy outcome?

A: When it’s determined that a woman has gestational diabetes, they are often only given a handout providing some limited information on what they should or should not eat. But, if we are asking women to make significant changes in their eating habits for the health of their pregnancy, we think they deserve more.  When one of our patients receives this type of diagnosis, we take it a couple of steps further and immediately get them set up with one of our diabetic educators. The diabetic educator sits down with the patient, explains how to eat properly and what smart choices look like, and thoroughly answers a patient’s questions.

Q: Why is it important that a woman diagnosed with gestational diabetes take it seriously and follow the prescribed plan as set by either her physician or diabetic educator?

A: A diagnosis of gestational diabetes can cause multiple issues during pregnancy. One of them is having a large baby, which increases the likelihood of needing a C-section. Women with gestational diabetes are also prone to developing preeclampsia, a dangerous pregnancy complication which manifests with high blood pressure and can progress to eclampsia, or seizures. The risk of stillbirth also goes up substantially, especially if you’re not controlling your sugars. But, there is some good news. If you can control your blood sugars and get them within a specific range, then the risks of all of these things are much lower. It’s critical to keep in mind that what you’re dealing with is short-term and, in most cases, resolves after pregnancy.

Q: Besides diet and exercise, what are some other ways women can manage their gestational diabetes?

A: When it comes down to it, diet and exercise are key to managing gestational diabetes. Often, blood sugar levels will improve dramatically, and we won’t have to take any additional measures, like medication. However, if your blood sugars remain high, we’ll have to take further steps regardless of diet and exercise changes.

What is the typical medication for a pregnant woman with gestational diabetes? Is it different from what somebody would take if they have Type 2 diabetes and were pregnant?

A: The medication of choice for women with gestational diabetes is insulin. The recommendations have changed over the years. At first, it was insulin, and then we thought oral medications might be better, but we have come full circle and have settled on insulin as the optimal treatment, which is now recommended by The American College of Obstetricians and Gynecologists (ACOG). If, however, a woman is on Metformin already at the beginning of pregnancy, they might be asked to continue taking it. However, Metformin is used to treat pre-diabetes and not gestational diabetes, so it’s slightly different.

Q: How often does a woman with gestational diabetes need an insulin shot, and when?

A: It all depends on what time of day women are experiencing high blood sugars. Often women struggle first thing in the morning. In this case, they will take one dose of long-acting insulin before bed and hopefully, when they wake up, their levels will be in an acceptable range. On the other hand, if a woman experiences high blood sugar at dinner, one dose of short-acting insulin may be adequate. It is not only dependent on when a woman eats but what she eats as well. And all of this can change throughout pregnancy. You might start off not needing any insulin because the adjustments in your diet and exercise plan are working; however, you might need to start on a low dose the next trimester and even increase it later in pregnancy.

Q: Does a patient with gestational diabetes need to see her doctors more frequently?

A: If your diet is well controlled and you aren’t on medication, you will most likely be seeing your physician at almost the same intervals you would otherwise. Regardless, if you are on medication or not, you will need to track your blood sugar numbers and send them to your physician. This is especially important if you’re on medication because we’ll want to check those numbers weekly. After about 32 weeks, patients should plan on coming into the office so we can do fetal monitoring of the baby, which usually consists of an ultrasound where we are looking at fluid and movement and the size of the baby, or it can mean putting the patient on a monitor to watch the baby’s heart rate.

Q: So, throughout a woman’s pregnancy, can her gestational diabetes get worse? Why?

A: Yes, because the placenta makes hormones that predispose pregnant women to become diabetic. The human placental or lactogen HPL reduces the effectiveness of the insulin in your body when you are pregnant. As your pregnancy progresses, it’s not uncommon for women to require more insulin.

Q: What happens when a woman with gestational diabetes delivers? Does diabetes go away?

A: When you deliver, many things that would cause diabetes do go away. In other words, if you’re on insulin before having your baby, in many cases you won’t need it after you deliver. Your body will go back to a non-pregnant state. When this happens, you may not have gestational diabetes anymore, but you can still have diabetes. So, we highly recommend a two-hour 75-gram glucose test 4-12 weeks after you deliver to determine if you still have diabetes. If you have gestational diabetes, you have a 50 to 70 percent lifetime risk of developing Type 2 diabetes, which is why it’s so crucial for women to get checked and receive treatment if they need it.

Q: Is there a timeframe when a woman could develop Type 2 diabetes after having gestational diabetes? Is the risk higher right after she gives birth or later in life?

A: It depends a lot on the person because gestational diabetes has a lot to do with genetics and lifestyle. It’s a little hard to define an exact timeframe. The bottom line is if you have gestational diabetes, you should be checked for Type 2 diabetes regularly.

Q: Let’s say a woman leads a healthy lifestyle, exercises all the time, eats right, etc., and still develops gestational diabetes. What could be the reason?

A: It’s always a shock when women who don’t fit the profile are diagnosed with gestational diabetes. When someone comes in and their BMI is high, you’re going to expect some insulin resistance, but if they are the perfect picture of health, it’s a difficult pill to swallow. These women likely just have a genetic predisposition to developing gestational diabetes.

Q: Do you have any advice for women planning to get pregnant and how to avoid a diagnosis of gestational diabetes?

A: If you’re planning to get pregnant, there are some things you can start doing right away, like taking prenatal vitamins, folic acid, looking at your diet, and getting into an exercise routine. By the time you have that first appointment with your obstetrician, it’s too late. Your baby has already started forming, and you’re well into your pregnancy journey. So, making lifestyle adjustments before getting pregnant is my No. 1 piece of advice.

Dr. Shad Deering recommends a balanced diet, exercise routine and blood sugar monitoring to reduce the risks associated with gestational diabetes.