“Rochelle” came to me after a new diagnosis: gestational diabetes (also known as GD or GDM). She was anxious about what GD meant for her pregnancy and wondered what had caused it.
Diabetes is a condition in which too much glucose (sugar) stays in the blood instead of being used for energy. GD is a form of diabetes that develops during pregnancy. It is one of the most common pregnancy complications, affecting at least 1 in 20 pregnancies.
As an ob-gyn who treats high-risk pregnancies, I see women with GD every day. I want to reassure patients like Rochelle that while GD is serious, it’s also manageable.
Here are six questions my patients often ask about GD, and how I answer them.
1. Did my diet cause my GD?
No, nothing you ate gave you GD.
To understand GD, it helps to understand insulin. This is a hormone that helps cells absorb blood sugar. During pregnancy, the placenta produces hormones that can interfere with insulin.
Usually, the body can make more insulin during pregnancy to keep blood sugar in the normal range. But sometimes the body cannot make enough insulin due to the increased levels of pregnancy hormones. Then the body stops responding to insulin as it should, which we call insulin resistance. This causes blood sugar levels to go up and leads to GD. Health problems can occur when blood sugar is too high.
Many patients like Rochelle express guilt and shame about having GD. But there shouldn’t be any finger-pointing with GD. If you want to blame something for your GD, blame the placenta for producing all those pregnancy hormones!
2. How will GD affect my baby?
GD may cause your baby to be born larger than normal, or less often, smaller than normal. Babies born to mothers with GD also tend to store more fat in their shoulders and abdomen, so there is a greater chance of getting stuck in the birth canal during a vaginal birth (called shoulder dystocia). GD can also lead to cesarean birth and stillbirth. Your ob-gyn may recommend you deliver slightly before your due date to decrease these risks.
After birth, your baby may have health problems, including low blood sugar, jaundice, or trouble breathing. Your baby’s doctor should watch your baby very closely for these complications.
Long term, your child may have a higher risk of becoming overweight or developing type 2 diabetes. Be sure to tell your baby’s doctor that you had GD so your baby can be monitored accordingly.
3. What can I do about GD?
Your goal is to keep your blood sugar levels within a target range for the rest of your pregnancy. You’ll learn to check your levels multiple times a day using a blood glucose meter.
Healthy eating plays an important role in treatment. Most people with GD can manage their blood sugar through diet and exercise.
You will also need more frequent prenatal care visits to monitor your health and your fetus’s health. You may meet with a nutritionist. They can help you choose what to eat, track your meals and blood sugar readings, and make changes as needed to stay in range.
4. Will I need to take insulin?
For some people, lifestyle changes are not enough to control their blood sugar during pregnancy. In these cases, we turn to medication.
The best medication for treating GD is insulin. Insulin has been used for over 100 years, and it is excellent at controlling blood sugar. When you give yourself insulin, you add back some of the natural hormone your body has become resistant to. You can inject just the right doses of insulin throughout the day depending on what you eat and other factors.
Insulin is very safe to use during pregnancy. It doesn’t cross the placenta, so it doesn’t affect the fetus. Insulin also comes with very few side effects.
If injecting insulin isn’t a good option for you, your ob-gyn can prescribe another medicine to take by mouth. Some people need to take both during pregnancy.
5. Will I become dependent on insulin?
No, you will not become dependent on insulin during pregnancy. That’s because, with GD, your body still makes its own insulin. (This is unlike type 1 diabetes, where your body stops making insulin entirely.)
Injecting insulin takes some getting used to. But the good news is that you shouldn’t need it forever.
After you give birth, your body stops making the pregnancy hormones that cause insulin resistance. In most cases, blood sugar returns to normal after birth.
6. Will GD go away after I give birth?
Yes, GD usually goes away after childbirth.
However, I think of pregnancy as a “stress test” for your body. What happens when you’re pregnant can predict your future health. Women who have had GD are at much higher risk of developing type 2 diabetes later in life.
If you had GD, it’s important to get a blood test 4 to 12 weeks after you give birth. Some hospitals may even test you 1 to 2 days after the baby is born. If everything is normal, you should be tested for diabetes every 1 to 3 years thereafter. Tell your primary care doctor about your history of GD, so they know when to screen you for type 2.
You can lower your risk of developing type 2 diabetes with a healthy lifestyle, like how you managed GD during pregnancy. This includes eating nutritious foods, exercising regularly, and maintaining a healthy weight.
Also, breastfeeding has been shown to help lower both your risk and your baby’s risk of developing type 2 in the future.
You are not alone.
As with any health condition, it helps to learn why GD happens and what you can do about it—which is a lot.
That said, GD can be difficult and time-consuming to manage, especially on top of work, life, and caring for older children. As you navigate your pregnancy with GD, you should have the support of your health care team and loved ones. Turn to your ob-gyn, high-risk ob-gyn, diabetes educator, nutritionist, or nurses for truth and guidance (and please, turn off TikTok).
As for Rochelle, I treated her until the end of her pregnancy. The more she learned about GD and practiced managing her blood sugar, the more confident she became. She took charge, did her best, and had a healthy birth. Rochelle and her baby are doing great, and I was honored to support her on her journey with GD.