What is Gestational Diabetes?
Simply put, gestational diabetes is diabetes that develops during pregnancy. It is a result of high blood sugar, due to your body not producing enough insulin to counteract the glucose we get from our food.
Why does it happen?
If I ever write a book about pregnancy it will be called, “Who the hell knows why?”
What we do know, is that while you’re pregnant, your body sometimes works against itself in the pursuit of growing a baby.
Usually, your pancreas does an adequate job of balancing glucose by producing insulin. When you’re pregnant, your placenta is a cruel taskmaster, creating more and more hormones that cause your body to resist insulin. Undeterred, the pancreas works overtime to produce more insulin. When it can’t keep up, you end up with gestational diabetes.
Your pancreas tried, it really did. But pregnancy is a bitch sometimes.
Testing … 1 hour and 3
Because gestational diabetes has a prevalence of around 9%, all pregnant women are tested for it in routine prenatal care.
If you have significant risk factors, you may be tested at the beginning of your pregnancy to get a baseline reading.
For everyone else, the first test is called the glucose challenge test and takes place between 24-28 weeks. You will be given a syrupy drink glucose drink (frequently referred to by the name “Glucola”) that you have to choke down in a specific amount of time.
You know how some people love pregnancy and never have the slightest hint of nausea? And how before you got pregnant you fantasize that maybe you would be one of those women? I have heard of people who think this Halloween syrup doesn’t taste so bad. Go ahead and imagine yourself being one of them, but don’t be surprised when you realize it tastes like flat, concentrated orange soda mixed with melted candy corn.
I have heard of some providers letting women eat a certain number of gummy worms or jelly beans, etc, instead of the drink of misery. That’s up to your doctor or midwife.
After one long hour of orange-flavored burps, you will have your blood drawn to see how your body dealt with that influx of glucose.
In a day or two, you should find out if you passed or failed. Failure just means you have a higher than average risk of gestational diabetes. The one-hour test is not diagnostic. In fact, different clinics and offices have different cutoffs for what is considered “failing.”
True story: I actually avoided the three-hour test in my second pregnancy by risking out of my original provider and ending up at the high-risk clinic, where the threshold was different. I don’t really recommend this as a solid plan, though.
What does it mean to fail the one-hour glucose test?
It means more orange-flavored sadness syrup! It’s called the Glucose Tolerance Test, and this time, you get the pleasure of fasting beforehand and drinking twice as much. You have your blood drawn before you drink, and again every hour for three hours. You can’t have anything to eat or drink during that time. I wish I could say that it wasn’t so bad, and in the grand scheme of things it wasn’t exactly traumatic, but it definitely wasn’t fun. Hangry pregnant women are rarely fun.
Some people hate the idea of the three-hour test enough that they would prefer to move along as though they have gestational diabetes. This means routinely checking blood sugars and eating a healthy diet. That is another option you could discuss with your provider.
If you fail the three-hour test, you will be diagnosed with gestational diabetes.
Risk factors
Age: Women over 25 are more likely to develop gestational diabetes. That really narrows it down for a lot of us, I know.
Health history: If you have prediabetes, or have a close family member with type 2 diabetes, you are more likely to develop gestational diabetes. Your risk also increases if you have had gestational diabetes in a previous pregnancy, if you had a baby who weighed more than 9 pounds (4.1 kg) at birth, or if you have had an unexplained stillbirth.
Weight: Women with a BMI over 30 are at increased risk.
Race: Women who are black, Hispanic, American Indian, or Asian are also at increased risk.
Gestational Diabetes Symptoms
For many women, there are no noticeable symptoms, which is partially why we are all tested. The ones that do show up can sometimes be written off as a normal part of pregnancy.
- Unusual thirst
- Frequent urination
- Fatigue
- Nausea
- Frequent vaginal, bladder, and skin infections
- Blurred vision
- Sugar in urine (don’t drink your pee, your doctor would be the one to catch this symptom)
Risks to baby
- Macrosomia – aka “a really freaking big baby.” This can lead to shoulder dystocia, which is when the baby’s shoulders have trouble getting through the pelvis. You could also be at an increased risk of needing a c-section.
- Preterm birth
- Respiratory distress syndrome
- Low blood sugar, which comes with a risk of seizures
- Later risk of type 2 diabetes
Risks to mother
- High blood pressure
- Preeclampsia
- Future diabetes risk
Gestational diabetes treatment
- Frequent monitoring of blood sugar
- Diet and exercise. (This gives you an idea of what type of diet you’d follow)
- Between 10 and 20 percent of women with gestational diabetes will need supplemental insulin
- You will likely have your blood sugar tested after delivery and again at the six-week postpartum visit
Prevention
Diet and exercise is the answer to pretty much everything. Need to lose a few pounds? Diet and exercise. Need to lower your blood pressure? Diet and exercise. Depressed? Anxious? Got a wicked hangnail? Diet and exercise.
Takeaway
- Gestational diabetes is a common pregnancy condition that comes with a significant set of risks.
- It is diagnosed through the Glucose Tolerance Test.
- It can largely be controlled for most women through frequent blood sugar monitoring, diet, and exercise.
- Some women will need supplemental insulin.
- It generally resolves after pregnancy but does carry an increased risk of type 2 diabetes later in life for both mom and baby.
Further reading:
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