Diabetes during pregnancy (Gestational Diabetes)

Dear Alice,

I have just been diagnosed with gestational diabetes; however, it was detected late in my pregnancy — I am at thirty-two weeks. Normally, diagnosis comes at twenty-eight weeks or prior. I am worried that I may have been diabetic for a long period of time, and am worried about how my baby may have been affected so far. All I have learned so far is that it can cause big babies, and potential respiratory problems. I am going to see a health care person at the gestational diabetes clinic tomorrow to be put on a special diet. I would appreciate any information you can provide me with on this topic. Thank you.

Dear Reader,

It's understandable that you're concerned about your and your baby's health; bringing a new life into the world can be both emotionally and physically draining! It's better that you were diagnosed a little later than not at all, however, and the good news is that you now know of your condition and can manage its effects and development to keep you and your baby in the best health possible.

Gestational diabetes (GD) occurs when an expectant woman's placental hormones cause her body's cells to be more resistant to insulin and, therefore, glucose absorption. As the baby continues to grow and more hormones are produced, the pancreas cannot produce enough insulin to account for the cells' resistance. About 3 to 5 percent of pregnant women in the United States develop GD, usually after their 20th week of pregnancy. Some risks associated with gestational diabetes include being older than 25 years, overweight, or having a personal or family history of diabetes. Unlike types 1 and 2 diabetes, GD does not usually present itself with typical symptoms such as extreme thirst and increased urination; your health care provider, however, will be on the lookout for GD at your regular prenatal visits. Screening usually takes place during week 24 to week 28 of your pregnancy and involves a blood test to determine your blood glucose level an hour after drinking a syrupy glucose "cocktail."  

Unlike the diabetes that a woman may have before conception, gestational diabetes does not usually cause birth defects, in part because it sets in after all the baby's major organs have already been formed. One major complication associated with GD is, as you noted, big babies. Macrosomia, the medical term for this condition, occurs when the unborn baby stores extra glucose as fat and sometimes becomes too large to deliver through the vaginal canal. But GD does not necessarily mean you must give up natural childbirth: many women with GD are able to give birth vaginally.

Babies born to mothers with gestational diabetes may also exhibit hypoglycemia (low blood sugar), low levels of serum calcium and/or magnesium, or jaundice right after birth, all of which can be easily and quickly treated by health care providers. Also, some babies who are born early may be at risk for respiratory distress syndrome, making unassisted breathing difficult until their lungs become stronger.

A child born to a mother with gestational diabetes does have increased risk for developing type 2 diabetes (the most common form of adult diabetes) later in life. A mother with GD usually does not develop diabetes after the birth, but she is also at higher risk of developing type 2 diabetes later in life and should therefore have regular check-ups to test blood sugar levels, maintain a healthy body weight and exercise regularly. To read more information about types 1 and 2 diabetes, check out the question Diabetes mellitus in the archived Q&As.

GD can usually be managed by frequent blood sugar monitoring, a nutritional diet, and regular physical activity. Sometimes oral or injected medications are also recommended to help keep your insulin and glucose in balance. You can also expect to have more prenatal visits and more rigorous monitoring of your baby's growth. Hopefully you'll find your visit with the health care provider at the gestational diabetes clinic to be useful and reassuring. Diabetes educators, registered dietitians, and personal trainers are other resources you may find valuable as you manage these last weeks of pregnancy. 

For a comprehensive overview of gestational diabetes, take a look at the American Diabetes Association's web page on the GD.

Best to you and your baby-on-the-way!

Last updated Jun 26, 2015
Originally published Jun 23, 2000

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