Gestational Diabetes: Symptoms, Who Is at Risk, Diet and After the Birth

What is gestational diabetes?

Gestational diabetes is diabetes that appears for the first time during pregnancy, when the body cannot make enough extra insulin to keep blood sugar in the normal range. ACOG explains that pregnancy hormones can interfere with insulin. The CDC says gestational diabetes affects 5% to 9% of US pregnancies every year.

The NHS says it can start at any stage of pregnancy but is more common in the second or third trimester, and usually goes away after the birth. Most women with gestational diabetes have otherwise normal pregnancies and healthy babies, according to the NHS.

What are the symptoms of gestational diabetes?

Gestational diabetes usually has no symptoms, and the NHS says most cases are only found when blood sugar is tested during screening. NIDDK and the CDC both say that when symptoms do appear they may be mild, such as being thirstier than normal or needing to urinate more often.

The NHS lists the signs of blood sugar that has gone too high: increased thirst, needing to pee more often than usual, a dry mouth, tiredness, blurred eyesight, and genital itching or thrush. Several of these are common in pregnancy anyway, so the NHS says to speak to your midwife or doctor if any of them worry you. The glucose test is how it is diagnosed.

Who is at risk of gestational diabetes?

Anyone can get gestational diabetes, and ACOG says it can develop in women with no risk factors at all. The risk factors ACOG lists are:

• being overweight or having obesity
• being physically inactive
• gestational diabetes in a previous pregnancy
• a previous baby weighing 9 pounds (4.1 kg) or more
• high blood pressure
• a history of heart disease
• polycystic ovary syndrome (PCOS)

ACOG also says women of African, Asian, Hispanic, Native American and Pacific Island descent are affected more than others. The NHS list overlaps but adds age and uses different thresholds: being over 40, a BMI above 30, a previous baby of 10 lb (4.5 kg) or more, a parent or sibling with diabetes, south Asian, Black, African-Caribbean or Middle Eastern origin, and past weight-loss surgery.

How is gestational diabetes treated?

Gestational diabetes is treated by keeping blood sugar in range, first with changes to food and activity and then with medicine if those are not enough. ACOG says a healthy diet and regular exercise control blood sugar for many women. You check your levels with a glucose meter and keep a log; the NHS says testing is usually advised before breakfast and 1 hour after each meal.

For food, ACOG advises regular meals through the day, often three meals and two to three snacks, with small snacks especially at night to avoid dips and spikes. The NHS suggests starchy, low glycemic index foods that release sugar slowly, such as brown rice, wholewheat pasta, beans and lentils, plenty of fruit and vegetables, and avoiding sugary snacks and drinks. It notes that fruit juice can be high in sugar and that you do not need a completely sugar-free diet. The usual foods to avoid in pregnancy still apply.

For activity, ACOG generally recommends 30 minutes of moderate aerobic exercise on at least 5 days a week, or a minimum of 150 minutes a week. It also suggests a 10 to 15 minute walk after each meal for better blood sugar control.

ACOG says insulin is the recommended medicine in pregnancy and does not cross the placenta, although an ob-gyn may sometimes prescribe a medicine taken by mouth instead. The NHS says you may be given medicine if your blood sugar is still not stable 1 to 2 weeks after changing your diet and exercise, and that it may be tablets, usually metformin, or insulin injections. It says insulin may be recommended if you cannot take metformin, metformin does not lower your blood sugar enough, your blood sugar is very high, or your baby is very large or there is too much fluid in your womb.

How does gestational diabetes affect the baby?

Gestational diabetes can make the baby grow larger than usual: ACOG explains that the body passes more sugar to the fetus than it needs. According to ACOG, a baby of 9 pounds (4.1 kg) or more raises the chance of a difficult labor, a cesarean birth, heavy bleeding after delivery and severe tears, and of a shoulder injury to the baby during a vaginal birth.

After birth, babies may have breathing problems, jaundice or low blood sugar, according to ACOG. The NHS advises feeding your baby within 30 minutes of the birth and then every 2 to 3 hours until their blood sugar is stable. Both bodies also list a higher risk of preeclampsia and of stillbirth, which the NHS describes as rare. Most women whose gestational diabetes is controlled can complete a full-term pregnancy, ACOG says.

Children whose mothers had gestational diabetes may be more likely to become overweight in childhood and to develop diabetes, ACOG says, so tell your baby's doctor that you had it.

Does gestational diabetes go away after birth?

Gestational diabetes usually goes away after the birth, but it leaves a higher risk of diabetes later. The CDC says about half of women with gestational diabetes go on to develop type 2 diabetes. ACOG gives a range of 15 to 70 percent later in life and says one third have diabetes or a milder form of raised blood sugar soon after giving birth.

ACOG recommends a blood test 4 to 12 weeks after the birth and, if it is normal, a diabetes test every 1 to 3 years. The NHS recommends a test at 6 to 13 weeks and then once a year if that is normal, and says to have the tests even if you feel well, because many people with diabetes have no symptoms. Gestational diabetes is also more likely in a future pregnancy, and the NHS says you will then be offered screening earlier.

When should you call your doctor or midwife?

Call your doctor or midwife right away if:

• Your baby is moving less, or their movements have slowed, stopped or changed. ACOG says to contact your ob-gyn about any change in activity, and the CDC lists slowing or stopping movement as an urgent warning sign. See tracking your baby's movements.
• You have a headache that will not go away, see spots or other changes in your eyesight, or have swelling of your face or hands, pain in your upper belly or shoulder, nausea and vomiting in the second half of pregnancy, sudden weight gain or difficulty breathing. These are ACOG's symptoms of preeclampsia, which is more common with gestational diabetes.

If you take insulin, the NHS says low blood sugar can make you feel shaky, sweaty or hungry, look paler than usual or find it hard to concentrate. Test your blood sugar and treat a low straight away, using the information your care team gave you.

After the birth, the NHS says to see your doctor if you get increased thirst, need to pee more often or have a dry mouth, without waiting for your next test.