Pregnancy is a time of promise and expectation, but it can also raise the possibility for some women that they will develop gestational diabetes mellitus (GDM).
Finding out you have GDM can be very frightening. Not only do you have to deal with all the emotions (the ups and the downs) and the questions that come with being pregnant, but also the uncertainty of this new-found condition. Fortunately, as with all types of diabetes, there are many well-informed health professionals to help answer your questions and to guide you through this very important time in your life. The more you know, the easier it is to accept and make the necessary changes for a successful and happy pregnancy.
GDM is defined as high blood sugar (hyperglycemia) with onset or first recognition during pregnancy. In Canada, GDM is higher than previously thought, varying from 3.7% in non-Aboriginal women to 8–18% in Aboriginal women.
Risk factors for developing GDM:
- a previous diagnosis of GDM or delivery of a macrosomic (excessive birth weight) infant
- being a member of a high-risk population, including women of Aboriginal, Hispanic, South Asian, Asian and African descent
- being 35 years of age or older
- being obese (BMI of 30 kg/m2 or higher)
- a history of polycystic ovary syndrome (PCOS)
- acanthosis nigricans (a skin disorder characterized by the appearance of darkened patches of skin)
- use of corticosteroids
Although some women are at greater risk than others, the Canadian Diabetes Association 2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada recommend that all women be screened for GDM between 24 and 28 weeks' gestation using a gestational diabetes screening test†. For women with multiple risk factors, this screening test should be done during the first trimester, then again during the second and third trimesters, even if the first test is negative.
Prompt diagnosis of GDM is important, as it carries several risks to both mother and infant. For example, children born to mothers with GDM may be “macrosomic”, a medical term meaning “excessive birth weight”, associated with higher rates of cesarian deliveries. This poses a risk of trauma to both mother and baby during the delivery. These babies also have a higher risk of dangerously low blood sugar levels after birth (hypoglycemia) and excess levels of insulin in the blood (hyperinsulinemia). They are also at higher risk for potential long-term obesity and glucose intolerance.
Although the diagnosis should be taken seriously, GDM can be managed by some of the same measures with which type 2 diabetes is managed.
Lifestyle
During pregnancy, women with GDM should be evaluated and followed by a registered dietitian to ensure that nutrition therapy promotes normal levels of blood glucose, appropriate weight gain and adequate nutritional intake. Physical activity is encouraged with the frequency and intensity of activity decided with your doctor based on your pregnancy and risk factors.
If women with GDM do not reach the recommended blood glucose target levels within two weeks of nutrition therapy alone, insulin therapy may be initiated. Certain types of insulin can be safely used during pregnancy.
Recommended blood glucose targets during pregnancy*
| A1C** | Fasting blood glucose / blood glucose before meals (mmol/L) | Blood glucose one hour after eating (mmol/L) | Blood glucose two hours after eating (mmol/L) | |
| Target for most pregnant women | ≤6.0% (normal) | 3.8 to 5.2 | 5.5 to 7.7 | 5.0 to 6.6 |
* This information is based on the Canadian Diabetes Association 2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada and is a guide only. In some women, particularly those with type 1 diabetes, higher targets may be necessary to avoid excessive low blood sugar (hypoglycemia). Talk to your doctor about YOUR blood glucose target ranges.
** A1C is a blood test that indicates an average of your overall blood glucose levels over the past 120 days.
After the baby is delivered
Women who have had GDM are at increased risk of developing subsequent type 2 diabetes later in life. A blood glucose test should be performed between six weeks and six months after the baby is born.
To reduce the risk of developing type 2 diabetes in the future, women with previous GDM should:
- Be encouraged to breastfeed
- Follow a healthy lifestyle
- Be screened regularly for the development of type 2 diabetes or impaired glucose tolerance
- Consult their physician and be screened for type 2 diabetes when planning another pregnancy
With prompt diagnosis and good management, women with GDM can expect to have a healthy pregnancy and a happy, healthy baby.
The suggested test for GDM is the Gestational Diabetes Screen (GDS). This test usually takes place in a medical diagnostic laboratory. An initial sample of blood is drawn (to be used as a baseline blood glucose reference level). The person then drinks a liquid that contains 50 grams of glucose (sugar). After one hour, a second blood sample is drawn. The purpose of this test is to see how well the body deals with the glucose in the blood over time. In a person without diabetes, glucose levels rise and then fall quickly. In someone with GDM or diabetes, glucose levels rise higher than normal and fail to come back down as quickly. The 2008 Canadian Diabetes Association Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada recommend diagnosing GDM if glucose levels 1 hour after the GDS is 10.3 mmol/L or greater.
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