What I need to know about Gestational
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What is gestational diabetes?
Gestational (jes-TAY-shun-ul) diabetes is diabetes that is found
for the first time when a woman is pregnant. Out of every 100
pregnant women in the United States, three to eight get gestational
diabetes. Diabetes means that your blood glucose (also called
blood sugar) is too high. Your body uses glucose for energy. But
too much glucose in your blood can be harmful. When you are pregnant,
too much glucose is not good for your baby.
This booklet is for women with gestational diabetes. If you have
type 1 or type 2 diabetes and are considering pregnancy, call
the National Diabetes Information Clearinghouse at 1-800-860-8747
for more information and consult your health care team before
you get pregnant.
What causes gestational diabetes?
Changing hormones and weight gain are part of a healthy pregnancy.
But both changes make it hard for your body to keep up with its
need for a hormone called insulin. When that happens, your body
doesn't get the energy it needs from the food you eat.
What is my risk of gestational diabetes?
To learn your risk for gestational diabetes, check each item
that applies to you. Talk with your doctor about your risk at
your first prenatal visit.
||I have a parent, brother, or sister with diabetes.
||I am African American, American Indian, Asian American,
Hispanic American, or Pacific Islander.
||I am 25 years old or older.
||I am overweight.
||I have had gestational diabetes before, or I have given
birth to at least one baby weighing more than 9 pounds.
||I have been told that I have "pre-diabetes," a condition
in which blood glucose levels are higher than normal, but
not yet high enough for a diagnosis of diabetes. Other names
for it are "impaired glucose tolerance" and "impaired fasting
If you checked any of these items, ask your health care team
about testing for gestational diabetes.
- You are at high risk if you are very overweight,
have had gestational diabetes before, have a strong family
history of diabetes, or have glucose in your urine.
- You are at average risk if you checked one or
more of the risk factors.
- You are at low risk if you did not check any
of the risk factors.
When will I be checked for gestational diabetes?
Your doctor will decide when you need to be checked for diabetes
depending on your risk factors.
- If you are at high risk, your blood glucose level may
be checked at your first prenatal visit. If your test results
are normal, you will be checked again sometime between weeks
24 and 28 of your pregnancy.
- If you have an average risk for gestational diabetes,
you will be tested sometime between weeks 24 and 28 of pregnancy.
- If you are at low risk, your doctor may decide that
you do not need to be checked.
How is gestational diabetes diagnosed?
Your health care team will check your blood glucose level. Depending
on your risk and your test results, you may have one or more of
the following tests.
Fasting Blood Glucose or Random Blood Glucose Test
Your doctor may check your blood glucose level using a test called
a fasting blood glucose test. Before this test, your doctor will
ask you to fast, which means having nothing to eat or drink except
water for at least 8 hours. Or your doctor may check your blood
glucose at any time during the day. This is called a random blood
These tests can find some people with gestational diabetes, but
other tests are needed to be sure diabetes is not missed.
Screening Glucose Challenge Test
For this test, you will drink a sugary beverage and then have
your blood glucose level checked an hour later. This test can
be done at any time of the day. If the results are above normal,
you may need further tests.
Oral Glucose Tolerance Test
If you have this test, your health care provider will give you
special instructions to follow. For at least 3 days before the
test, you should eat normally. Then you will fast for at least
8 hours before the test.
The health care team will check your blood glucose level before
the test. Then you will drink a sugary beverage. The staff will
check your blood glucose levels 1 hour, 2 hours, and 3 hours later.
If your levels are above normal at least twice during the test,
you have gestational diabetes.
|Above-Normal Results for the
Oral Glucose Tolerance Test*
||95 or higher
|At 1 hour
||180 or higher
|At 2 hours
||155 or higher
|At 3 hours
||140 or higher
|Note: Some labs use other numbers
for this test.
*These numbers are for a test using a drink with 100 grams
How will gestational diabetes affect my baby?
Untreated or uncontrolled gestational diabetes can mean problems
for your baby, such as
- being born very large and with extra fat; this can make delivery
difficult and more dangerous for your baby
- low blood glucose right after birth
- breathing problems
If you have gestational diabetes, your health care team may recommend
some extra tests to check on your baby, such as
- an ultrasound exam, to see how your baby is growing
- "kick counts" to check your baby's activity (the time between
the baby's movements) or special "stress" tests
Working closely with your health care team will help you give
birth to a healthy baby.
How will gestational diabetes affect me?
Often, women with gestational diabetes have no symptoms. Gestational
- increase your risk of high blood pressure during pregnancy
- increase your risk of a large baby and the need for cesarean
section at delivery
The good news is your gestational diabetes will probably go away
after your baby is born. However, you will be more likely to get
type 2 diabetes later in your life. (See the information on how
to lower your chances of getting type 2 diabetes.) You may
also get gestational diabetes again if you get pregnant again.
Some women wonder whether breastfeeding is OK after they have
had gestational diabetes. Breastfeeding is recommended for most
babies, including those whose mothers had gestational diabetes.
Gestational diabetes is serious, even if you have no symptoms.
Taking care of yourself helps keep your baby healthy.
How is gestational diabetes treated?
Treating gestational diabetes means taking steps to keep your
blood glucose levels in a target range. You will learn how to
control your blood glucose using
- a meal plan
- physical activity
- insulin (if needed)
You will talk with a dietitian or a diabetes educator who will
design a meal plan to help you choose foods that are healthy for
you and your baby. Using a meal plan will help keep your blood
glucose in your target range. The plan will provide guidelines
on which foods to eat, how much to eat, and when to eat. Choices,
amounts, and timing are all important in keeping your blood glucose
levels in your target range.
You may be advised to
- limit sweets
- eat three small meals and one to three snacks every day
- be careful about when and how much carbohydrate-rich food
you eat; your meal plan will tell you when to eat carbohydrates
and how much to eat at each meal and snack
- include fiber in the form of fruits, vegetables, and whole-grain
crackers, cereals, and bread in your meals
For more about meal planning, call the National Diabetes Information
Clearinghouse for a copy of What I Need to Know About Eating
and Diabetes or you can read
Physical activity, such as walking and swimming, can help you
reach your blood glucose targets. Talk with your health care team
about the type of activity that is best for you. If you are already
active, tell your health care team what you do.
Some women with gestational diabetes need insulin, in addition
to a meal plan and physical activity, to reach their blood glucose
targets. If necessary, your health care team will show you how
to give yourself insulin shots. Insulin is not harmful for your
baby. It cannot move from your bloodstream to the baby's.
How will I know whether my blood glucose levels are on target?
Your health care team may ask you to use a small device called
a blood glucose meter to check your levels on your own. You will
- how to use the meter
- how to prick your finger to obtain a drop of blood
- what your target range is
- when to check your blood glucose
You may be asked to check your blood glucose
- when you wake up
- just before meals
- 1 or 2 hours after breakfast
- 1 or 2 hours after lunch
- 1 or 2 hours after dinner
The following chart shows blood glucose targets for most women
with gestational diabetes. Talk with your health care team about
whether these targets are right for you.
|Blood Glucose Targets for Most Women With Gestational
||less than 105
|1 hour after a meal
||less than 155
|2 hours after a meal
||less than 130
Each time you check your blood glucose, write down the results
in a record book. Take the book with you when you visit your health
care team. If your results are often out of range, your health
care team will suggest ways you can reach your targets.
Will I need to do other tests on my own?
Your health care team may teach you how to test for ketones (KEE-tones)
in your morning urine or in your blood. High levels of ketones
are a sign that your body is using your body fat for energy instead
of the food you eat. Using fat for energy is not recommended during
pregnancy. Ketones may be harmful for your baby.
If your ketone levels are high, your health care providers may
suggest that you change the type or amount of food you eat. Or
you may need to change your meal times or snack times.
After I have my baby, how can I find out whether my diabetes
You will probably have a blood glucose test 6 to 12 weeks after
your baby is born to see whether you still have diabetes. For
most women, gestational diabetes goes away after pregnancy. You
are, however, at risk of having gestational diabetes during future
pregnancies or getting type 2 diabetes later.
How can I prevent or delay getting type 2 diabetes later in
You can do a lot to prevent or delay type 2 diabetes.
- Reach and maintain a reasonable weight. Even if you stay above
your ideal weight, losing 5 to 7 percent of your body weight
is enough to make a big difference. For example, if you weigh
200 pounds, losing 10 to 14 pounds can greatly reduce your chance
of getting diabetes.
- Be physically active for 30 minutes most days. Walk, swim,
exercise, or go dancing.
- Follow a healthy eating plan. Eat more grains, fruits, and
vegetables. Cut down on fat and calories. A dietitian can help
you design a meal plan.
Remind your health care team to check your blood glucose levels
regularly. Women who have had gestational diabetes should continue
to be tested for diabetes or pre-diabetes every 3 years. Diagnosing
diabetes or pre-diabetes early can help prevent complications
such as heart disease later.
Where can I get more information?
Diabetes Teachers (nurses, dietitians, and other health
To find a diabetes teacher near you, call the American Association
of Diabetes Educators toll-free at 1-800-TEAMUP4 (1-800-832-6874).
Or go to www.diabeteseducator.org
and click on "Find a Diabetes Educator."
To find a dietitian near you, call the American Dietetic Association's
National Center for Nutrition and Dietetics at 1-800-366-1655.
Or go to www.eatright.org
and click on "Find a Nutrition Professional."
To learn more about pregnancy, contact the National Institute
of Child Health and Human Development (NICHD), part of the National
Institutes of Health. Call NICHD toll-free at 1-800-370-2943.
Or go to www.nichd.nih.gov.
For more information about diabetes, contact the National
Diabetes Information Clearinghouse (NDIC) for free copies
of these publications or read them online:
What I Need to Know About Eating and Diabetes
Medicines for People With Diabetes
Your Guide to Diabetes: Type 1 and Type 2
Preventing Type 2 Diabetes
Am I at Risk for Type 2 Diabetes?
Small Steps. Big Rewards. Your GAME PLAN for Preventing Type 2
The NDIC would like to thank the following individuals who provided
editorial guidance or facilitated field-testing of this publication.
Boyd E. Metzger, M.D.
Susan A. Biastre, R.D., L.D.N., C.D.E.
Women & Infants' Hospital
Beverly Gardner, R.D., L.D.N., C.D.E.
Outpatient Nutrition & Diabetes Education Center
Durham Regional Hospital
1 Information Way
Bethesda, MD 20892-3560
The National Diabetes Information Clearinghouse (NDIC) is a service
of the National Institute of Diabetes and Digestive and Kidney
Diseases (NIDDK). The NIDDK is part of the National Institutes
of Health under the U.S. Department of Health and Human Services.
Established in 1978, the clearinghouse provides information about
diabetes to people with diabetes and to their families, health
care professionals, and the public. NDIC answers inquiries, develops
and distributes publications, and works closely with professional
and patient organizations and Government agencies to coordinate
resources about diabetes.
Publications produced by the clearinghouse are carefully reviewed
by both NIDDK scientists and outside experts.
This e-text is not copyrighted. The clearinghouse encourages
users of this e-pub to duplicate and distribute as many copies
NIH Publication No. 04-5129