Diabetes and Pregnancy

While no family wants to see their newborn baby spend time in a Neonatal Intensive Care Unit (NICU), a complicated pregnancy can sometimes lead to that outcome. One health issue that can cause an unstable pregnancy is gestational diabetes—diabetes that develops during pregnancy and can affect both mother and child. Fortunately, good nutrition and exercise can help reduce the risk of gestational diabetes in many cases.

“If women make the decision to be proactive about their health it will ultimately help them and their unborn child before, during, and after a pregnancy,” said Allison Durica, M.D., of Carilion Clinic’s maternal fetal medicine practice.

Gestational diabetes affects about 4 percent of all pregnant women.

A woman doesn’t need to have diabetes prior to a pregnancy to develop gestational diabetes. However some of the same risk factors lead to both.

“Women who are overweight, have a history of prior pregnancy complicated by gestational diabetes, or have a family history of diabetes are at risk,” Dr. Durica said.

But even if you don’t have any of these risk factors, Carilion Clinic follows the recommendations of the American College of Obstetricians and Gynecologists, which says all women should be screened for gestational diabetes between 24 and 28 weeks of pregnancy.

“Moms with multiple risk factors, however, should be screened for gestational diabetes as early as the first doctor’s visit or in the first trimester,” Dr. Durica said.

In the initial glucose test, women are given a sweet drink containing 50 grams of sugar. Their blood is then tested one hour later to determine the blood sugar level. If this test comes back abnormally high, slightly more involved testing will be done to determine a more definite diagnosis.

“There is also the possibility that routine 28-week screening comes back negative or with levels considered borderline,” Dr. Durica said. “If this is the case, we may re-screen in the third trimester, especially if the mom is overweight or the fluid around the baby seems larger than normal.”

Gestational diabetes can also increase the size of your unborn child in an unhealthy way.

“With babies who have grown too large, vaginal delivery can be unsafe,” Dr. Durica said. “In some cases, cesarean section may be recommended.”

For moms, it can be challenging to follow your doctor’s strict recommendations.

“Besides diet and exercise modifications, moms may also have to check blood sugar levels up to four times a day, possibly take an oral medication or insulin therapy, and visit their physician more often for monitoring and additional ultrasounds,” Dr. Durica said. “This means possibly more back and forth and more coordination, which can be harder for any mom, but especially for ones with other children.”

While a diagnosis can be a challenge, keeping steady blood sugar levels is necessary.

“We know having high blood sugar all the time is dangerous, but having highs and lows can often times be just as dangerous,” Dr. Durica said. “If a mom can’t control her blood sugar level, the baby may be exposed to high blood sugar, too. Often, this results in the baby receiving large amounts of blood sugar and making extra insulin to break it down. When they are born, and no longer get the high amounts of sugar from mom, it’s almost like going ‘cold turkey’ and they can become hypoglycemic (low blood sugar level) due to the excessive insulin they make.”

Babies in that condition can be treated in the NICU at Carilion Clinic Children’s Hospital until their bodies can adjust to normal insulin production. 

“We encourage patients to be strict with themselves and follow our recommendations for a healthy lifestyle and diet, and regular blood sugar monitoring,” Dr. Durica said. “We know what the negative impact of gestational diabetes can be, and moms must do their best to maintain steady blood sugar levels.”

If you have had gestational diabetes once, there is a greater risk for developing it again, and for developing diabetes later in life. But by maintaining a healthy and active lifestyle, you can stay on the best track for optimal health—for yourself and for your unborn child.