Q&A with gestational diabetes specialists: Getting the care you need during and after pregnancy

Gestational diabetes is a type of diabetes brought on by pregnancy. If you’re at risk — and especially if you’ve been diagnosed — it’s important to understand how gestational diabetes can affect you and your baby.

Roughly 6% to 9% of people who are pregnant will develop gestational diabetes. With this condition, the pancreas does not produce enough insulin to control sugar levels in the blood.

As co-directors of the Diabetes in Pregnancy Program our goal is to help our patients deliver healthy babies, avoiding serious birth complications and long-term health challenges that can occur without proper care. Here, we answer some of the most common questions about gestational diabetes and how we can help you manage the health risks involved during and after pregnancy.

What are the warning signs of gestational diabetes?

You probably won’t know you have gestational diabetes because there usually aren’t noticeable symptoms. That’s why screening for gestational diabetes between your second to third trimester is so important. In some rare cases, patients with extremely high blood sugar may feel tired, thirsty and need to urinate more than usual.

What causes gestational diabetes?

Gestational diabetes is high blood sugar that first develops during pregnancy. When you're pregnant, hormonal changes make your body less effective at using insulin, which is the hormone produced by your pancreas that manages blood sugar levels. If your pancreas is unable to adjust and produce more insulin to control your blood sugar, you have gestational diabetes. Obesity, high blood pressure, prediabetes and a family history of diabetes increase your chance of developing gestational diabetes; so does being African American, Latinx, Native American, Asian American and Pacific Islander.

How can diabetes affect my baby’s health?

The health risks depend on the type of diabetes, how well blood sugars are controlled and the stage of your pregnancy. During your first trimester, poorly controlled type 1 or type 2 diabetes puts your baby at increased risk for birth defects, including heart, brain and spine malformations.

Later in pregnancy, diabetes can lead to your baby being too large for a safe vaginal delivery, being born prematurely and having severe problems from being born early. It can also cause your baby to be born with low blood sugar and be at increased risk for obesity and Type 2 diabetes later in life.

Still, it’s important to remember that patients with gestational diabetes can have healthy babies – and the better diabetes is controlled throughout your pregnancy, the greater the likelihood you’ll have a healthy baby.

Can eating too much sugar cause gestational diabetes?

This is a common misunderstanding about gestational diabetes. Eating sugary foods, like candies or soda drinks, doesn’t increase your risk for developing gestational diabetes. However, eating too much sugar does cause weight gain, and obesity increases your chance of developing gestational diabetes.

Can gestational diabetes be prevented?

You can reduce your chance of developing gestational diabetes by:

• Maintaining a healthy weight before you get pregnant - If you have obesity (BMI 30 and above) and you’re planning ahead for pregnancy, talk with your doctor about a plan to manage your weight before you conceive.
• Eating a balanced diet, including vegetables, fruits, whole grains, seafood and lean meats.
• Following a regular exercise schedule - Talk to your doctor if you’re not sure about which exercise regimen would be best for you.

How can I get rid of gestational diabetes?

You can’t get rid of gestational diabetes during pregnancy, so the best way to lessen its effects is to work closely with your doctor and stick to your treatment plan. Controlling gestational diabetes depends on:

• Making diet modifications
• Ensuring regular exercise
• Carefully monitoring your blood sugar levels throughout your pregnancy

Follow the recommended weight gain set out by your doctor. This varies, but generally, the higher your weight is before pregnancy, the less weight you should gain during pregnancy.

Gestational diabetes that can’t be managed through diet and exercise alone requires medications, such as insulin. The good news is that gestational diabetes often goes away after giving birth.

Does weight loss help gestational diabetes?

Losing weight during pregnancy is not recommended to help manage gestational diabetes and could be harmful, especially after the first trimester. Nausea and food aversions can sometimes lead to first trimester weight loss, which is common and usually not concerning. But losing weight in the second or third trimester could mean that you are not taking in or passing along enough nutrients for your baby to grow at a healthy rate.

What can help is working closely with your doctor to monitor weight gain as part of your treatment plan. Your doctor can help you understand what would be a healthy rate of weight gain for you based on your body mass index (BMI) before pregnancy. This is an important part of your treatment plan, because excessive weight gain can increase your risk for complications and make conditions like diabetes more difficult to treat during and after pregnancy.

If I have gestational diabetes, will I have to deliver early?

It’s possible. In some cases, delivering early may be the safest option to manage your or your baby’s risk. But the more your gestational diabetes is controlled, the less your chances are of delivering early.

Does having gestational diabetes mean I'll have to give birth by C-section?

Poorly controlled gestational diabetes can cause babies to grow too big and have trouble passing through the birth canal safely. If this happens, your doctor may recommend medical interventions, like delivering via C-section, to avoid injuries during birth.

What kind of diabetes care do I need after I’ve had my baby?

Again, for many patients, gestational diabetes resolves shortly after childbirth. But if it doesn’t, it’s considered to be pre-diabetes or Type 2 diabetes.

To determine the status of diabetes and whether you need medication to control it, your doctor will check your blood sugar after you give birth and again six to eight weeks later. Don’t postpone this follow-up care for your own health, even if you’re busy taking care of a new baby. Managing your diabetes well today can prevent long-term health problems in the future, including cardiovascular, nerve and eye damage.

Does having gestational diabetes mean I’ll have diabetes later in life?

Roughly half of patients who have gestational diabetes go on to develop Type 2 diabetes within 20 years. But you can reduce your risk of developing Type 2 by maintaining a healthy diet and weight. If you’re able to breastfeed, that can really help with after-pregnancy weight loss and may decrease your chance of type 2 diabetes later on.

Your body also needs at least 150 minutes of moderate-intensity exercise every week. Granted, it’s not always easy finding time to exercise, but this could be as simple as a quick 20-minute brisk walk every day. You should also have your blood sugar level tested annually.