Diabetes and Pregnancy: Gestational Diabetes, Risks and Management

With diabetes, your blood glucose (blood sugar) is too high. Glucose comes from food, and the hormone insulin helps it get into your cells for energy. In type 1 diabetes the body makes no insulin; in type 2 it doesn't make or use insulin well. Without enough insulin, glucose stays in the blood.

Gestational diabetes

Some people have diabetes before pregnancy. Others develop it during pregnancy — gestational diabetes, which usually appears around the 24th week. It happens when the body can't make the extra insulin pregnancy requires. Researchers think it's caused by pregnancy's hormonal changes, together with genetic and lifestyle factors.

Anyone who is pregnant can develop it, but it's more likely if you:

• are overweight or have obesity;
• have a family history of diabetes;
• had gestational diabetes in an earlier pregnancy;
• have given birth to a baby weighing 9 pounds or more;
• have polycystic ovary syndrome (PCOS);
• are African American, Hispanic/Latino, American Indian, Alaska Native, Native Hawaiian or Pacific Islander.

Testing

It often causes no symptoms; any symptoms tend to be mild, such as being thirstier than usual or urinating more often. Most people are screened between weeks 24 and 28; those at higher risk may be tested at their first prenatal visit.

You may have one or both.

How diabetes can affect pregnancy

For you

• Higher risk of preeclampsia, a serious condition with a sudden rise in blood pressure.
• Higher chance of a cesarean delivery, because the baby is more likely to be larger than average.
• Pregnancy's hormonal and physical changes affect blood glucose, so if you had diabetes before, you may need to adjust your meal plan, activity or medicines — and existing diabetes problems may worsen.
• Gestational diabetes usually goes away after birth, but raises your risk of type 2 diabetes later.

For your baby

• High blood glucose early in pregnancy raises the risk of birth defects.
• Higher risk of obesity and type 2 diabetes later in life.
• More likely to be born early.
• May have breathing problems or low blood glucose right after birth.
• Higher risk of miscarriage and stillbirth.

Managing diabetes

Before pregnancy (if you already have diabetes)

The best time to get blood glucose under control is before you conceive — high levels can harm a baby in the first weeks, even before you know you're pregnant. See your provider to plan: how to lower risks, diet, activity and which diabetes medicines are safe in pregnancy.

During pregnancy

• Work with your provider to manage blood glucose — often with healthy eating and regular activity, adding diabetes medicines if that isn't enough.
• Get regular prenatal checkups.
• Take your prenatal vitamins.
• Avoid alcohol, tobacco and illegal drugs.

After pregnancy

• If you had gestational diabetes, you'll be tested for type 2 diabetes 4 to 12 weeks after giving birth — and, even if your levels are back to normal, every 1 to 3 years after that.
• If you had diabetes before pregnancy, you and your provider will watch your glucose and adjust your plan as needed.

Sources

Based on "Diabetes and Pregnancy," MedlinePlus, U.S. National Library of Medicine; summary text from the NIH's National Institute of Diabetes and Digestive and Kidney Diseases. A work of the United States government in the public domain.