If youโ€™re pregnant, youโ€™ve likely heard of gestational diabetes, which is when a pregnant woman develops high blood sugar due to hormonal changes.

The condition affectsย three to seven percent ofย non-Aboriginal pregnant women and up to eight toย 18 percent of Aboriginalย women in Canada.ย Many factors affect theย risk of developing gestationalย diabetes, including:

  • a previous diagnosis ofย gestational diabetes orย delivery of a macrosomicย (excessive birth weight)ย infantย 
  • being a member ofย a high-risk population,ย including women of Aboriginal,ย Hispanic, Southย Asian, Asian and Africanย descentย 
  • being 35+ years of age
  • being obese (BMI of 30ย or higher)ย 
  • a history of polycysticย ovary syndrome

We spoke to Lauren Davidson, a clinical dietitian and diabetes educator, for information including how to know if youโ€™re at risk, how to manage the condition, and how it could affect your baby.

Q:ย How do you knowย if you have gestationalย diabetes?

A: Although some women are atย greater risk than others, theย Canadian Diabetes Associationย 2008 Clinical Practiceย Guidelines for the Preventionย and Management of Diabetesย in Canada recommends thatย all women be screened forย gestational diabetes betweenย 24 and 28 weeks gestation.ย The reason for this timing ofย testing is that at 24โ€“28 weeks,ย the placenta starts releasingย hormones that increase insulinย resistance. Some women areย unable to tolerate it, and bloodย glucose rises.ย For women with multipleย risk factors, this screeningย test should be done duringย the first trimester, thenย again during the secondย and third trimesters, evenย if the first test is negative.ย As well, someone who hasย previously had gestationalย diabetes should test beforeย trying to conceive.

Q: What does theย screening test involve?

A:ย An oral glucose toleranceย test involves fasting forย eight hours, after whichย blood glucose will beย tested. A woman will thenย drink a glucose-rich drinkย (kind of like a really sweetย orange pop) and her bloodย glucose will be monitored one,ย two and three hours after. Gestationalย diabetes is diagnosed ifย two of the readings are aboveย normal.

Q:ย Is gestational diabetesย risky for the mom or theย baby?

A: There are risks for Mom and Baby. Because there is extra glucose in the bloodstream which crosses the placenta, babies born to women with gestational diabetes are at increased risk for high birth weight, may require a cesarian birth and are at higher risk of birth injuries. If the baby grows too large and requires early delivery, they may be at increased risk of respiratory distress syndrome because their lungs have not had time to fully develop in utero. After birth, babies are at risk of hypoglycemia because in utero they were required to release so much insulin due to the large amounts of glucose present that they will continue to release this amount even after delivery. In this case, babiesโ€™ blood glucose is checked at delivery. If blood glucose is low, they will be given glucose (sugar water) at birth to stabilize. Babies born early are also at increased risk of jaundice due to their immature liver being unable to properly break down bilirubin. Gestational diabetes also places the mother at increased risk for pre-eclampsia and high blood pressure during pregnancy, as well as future gestational diabetes and/or development of type 2 diabetes.

Q:ย How is diabetesย managed duringย pregnancy?

  • Choose a healthy diet:ย Nutrition requirements duringย pregnancy are generally similarย for women with or withoutย diabetes.ย A healthy diet is good forย you and your growing familyย now and in the future. Enjoyingย foods from all four of theย food groups and eating atย regular times will play an importantย role in managing bloodย glucose levels and achievingย the best nutrition for you and
    your growing baby. Moderateย carbohydrate adjustments mayย be required based on bloodย glucose monitoring.ย Women with gestationalย diabetes should speak with aย registered dietitian/diabetesย educator to ensure all nutrientย needs of pregnancy are beingย met while adequately managingย healthy blood glucose.ย 
  • Achieve a normal pregnancyย weight gain. The amount ofย weight you gain will vary dependingย on your weight beforeย your pregnancy.ย Weight loss is not recommended.ย Again, speak withย your dietitian/physician orย educator.
  • Be physically active, if possible.ย Regular physical activityย can help control your bloodย glucose levels. It can also helpย you to manage stress andย prepare your body for labour,ย delivery and recovery.ย 
  • Test your blood glucose. Self-monitoring of blood glucose is essential during pregnancy. Both before- and after-meal testing are recommended to guide therapy in order to achieve glycemic targets. You may be given a blood glucose metre to test your blood at home. Testing your blood glucose will help you and your healthcare team know that your gestational diabetes is being well managed for a healthy pregnancy.ย 
  • Take insulin, if needed.ย Sometimes healthy eatingย and physical activity are notย enough to manage bloodย glucose levels and you mayย need to take insulin. Insulinย will help keep your bloodย glucose normal and will helpย to keep you and your baby inย good health. Having to takeย insulin does not mean thatย your health has declined. Itย only means that you requireย an additional “tool” to helpย manage the blood sugars for aย healthy pregnancy โ€“ for bothย mom and baby.

Q: What are the futureย implications or risksย for moms who developย gestational diabetes?

A: Having gestational diabetesย puts you at increased risk ofย developing type 2 diabetes.ย It is important to be testedย for type 2 diabetes on aย regular and timely basis.ย Early diagnosis and properย management will help youย have healthy futureย pregnancies.ย Undiagnosed diabetes in aย pregnant woman increases theย risk of miscarrying or havingย a baby born with a malformation.ย Stay healthy and avoidย diabetes complications such asย heart attack, stroke and damageย to your eyes, kidneys andย nerves. Remember, you needย to be tested for type 2 diabetesย within six weeks to six monthsย of giving birth, when planningย another pregnancy, and everyย three years (or more often dependingย on your risk factors).

Q:ย What else shouldย women with gestationalย diabetes keep in mind?

A:ย The biggest thing I see withย women who have gestationalย diabetes is the tendency toย restrict intake โ€“ specificallyย from carbohydrate sourcesย (whole grains, breads, cereals,ย crackers, rice, pasta, potatoesย and sometimes even fruitย and starchy vegetables) forย fear that these foods willย cause blood glucose levelsย to rise. While it is ok underย dietitian advice to moderateย carbohydrate intake, often byย restricting, women end up alsoย not meeting their nutritionalย requirements which sacrificesย both their health and theย babyโ€™s health.ย Choosing healthy carbohydratesย such as whole grains,ย brown rice, ancient grainsย like quinoa or bulgur, fruits,ย vegetables and legumes, andย moderating portions (ratherย than restricting altogether) isย recommended. Eating smallerย portions more consistentlyย throughout the day is the bestย way to manage and maintainย nutrition quality.

Originally published in December 2013.