Women with diabetes can have a healthy pregnancy if blood glucose levels are controlled. It is important to get good control of your blood glucose levels at least 3 months prior to pregnancy. Well controlled blood glucose levels during pregnancy can help to reduce complications in the mother and baby.
Gestational diabetes (GDM) is a condition of hyperglycemia (high blood glucose) first identified in pregnancy. During pregnancy, the hormones produced by the placenta cause insulin resistance, so the body cannot use insulin properly. This leads to elevated blood glucose levels and requires the pancreas to produce extra insulin. In gestational diabetes, the pancreas cannot produce extra insulin and the blood glucose levels remain elevated.
- Obesity (BMI 35 or higher)
- High risk populations (Asian, South Asian, Aboriginal, Hispanic, African)
- Age 35 years or older
- Previous delivery of a baby greater than 9lb or previous GDM or polycystic ovarian syndrome (PCOS)
The risk for GDM ranges from 3.7% (in the Non-Aboriginal population) to 8-18% (in the Aboriginal population).
Symptoms are non-specific and may include fatigue and frequent urination.
Women who are pregnant should be screened for GDM between 24-28 weeks’ gestation. For individuals with several of the above risk factors, screening should be done in the first trimester and in subsequent trimesters if negative. The Gestational Diabetes Screen (GDS) is used to diagnose GDM. Women are given a 50g glucose drink, followed by a plasma glucose test taken 1 hour after. An oral glucose tolerance test (OGTT) may be required if the GDS is not diagnostic.
If not treated, GDM increases the risk for a large for gestational age baby, hypoglycemia at birth and higher rates of caesarian section. The baby will not be born with diabetes, however may be at risk for future diabetes if there are poor lifestyle choices such as obesity or inactivity.
Treatment usually includes following a carbohydrate controlled diet with 3 meals and at least 3 snacks and daily blood glucose monitoring. Regular activity (ie. walking for 30 minutes/day) is recommended to assist with good blood glucose control, as long as there are no contraindications (ie. vaginal bleeding, severe high blood pressure).
Women with gestational diabetes are at risk for future diabetes. It is recommended to follow up with an OGTT within 6 months to check whether diabetes is still present.