You can still have a healthy pregnancy with gestational diabetes

Gestational diabetes is a common condition that some people develop during pregnancy in which the hormonal influences of pregnancy prevent their bodies from effectively using insulin they’re producing. In most cases, women develop insulin resistance, which their own pancreas production of insulin can’t compensate for.

In one of the first analyses of data of gestational diabetes cases from birth certificates, the U.S. Centers for Disease Control and Prevention released data showing that, between 2016 to 2020, there was a 30% spike in gestational diabetes, with cases affecting about 8% of pregnancies nationwide. That accounts for about 100,000 women each year.

But with proper management, you can still have a healthy pregnancy with gestational diabetes. Here’s what you should know.

What happens if you’re diagnosed with gestational diabetes?

Gestational diabetes is a state of carbohydrate intolerance at 20 weeks or later during pregnancy. The condition generally improves following delivery of a baby. Pregnant people with gestational diabetes are at an increased risk for a developing type 2 diabetes during their lifetime. Once detected, the goal is to control the mother's blood sugars, so that the developing fetus does not experience excess glucose or sugar transported across the placenta.

Are there risk factors for developing gestational diabetes?

There are certain risk factors that increase the likelihood of certain people developing gestational diabetes.

Gestational diabetes is, again a forerunner of type 2 diabetes. The following are risk factors:

• Previously had gestational diabetes during previous pregnancies
• Have a strong family history of type 2 diabetes
• A diagnosis of maternal obesity
• Some ethnic and racial groups are at higher risk, including those with Black, Hispanic, American Indian and Pacific Islander backgrounds
• A diagnosis of polycystic ovarian syndrome
• A diagnosis of pre-diabetes
• If you’re considered to be of advanced maternal age (35 or older during pregnancy)

Importantly, up to half of all women who develop gestational diabetes lack any risk factors at all.

Possible treatments for gestational diabetes, and how to know which treatment is best for you

Fortunately, most cases of gestational diabetes can be treated with diet changes alone in approximately 25-50% of cases. If diet modification fails to control blood sugars sufficiently, then medication is required. Insulin remains the first choice for therapy, but an oral medication called metformin can be safe for use short-term throughout the duration of pregnancy.

Metformin doesn’t cause birth defects in the developing fetus. But at the Ohio State Wexner Medical Center, we’re researching whether offspring exposed to metformin are at increased risk for either obesity or diabetes later in life. We need to do detailed follow-up studies on these babies when they’re teenagers to determine whether there are long-term effects associated with metformin exposure during pregnancy.

If left untreated, how does gestational diabetes affect baby and birthing parent?

If left untreated, pregnant people with gestational diabetes are at a greater risk of having a larger baby, which might require a cesarean section delivery and/or make delivery complicated. Babies who are born pre-term are at higher risk of developing other health issues, having low blood sugar or developing type 2 diabetes later in life.

Birthing parents who develop gestational diabetes are about 50% more likely to develop type 2 diabetes later on in life.

Expert Guide to a Healthy Pregnancy: Answers to more of your questions

How far along in your pregnancy can you get a gestational diabetes test?

Across the United States, universal screening is provided for gestational diabetes during pregnancy. The screening typically involves a two-step approach in which a 50-gram flavored glucose drink is administered between 24 to 28 weeks gestation. If the blood glucose level after one hour is elevated sufficiently, then a diagnostic three-hour oral glucose tolerance test is ordered. Blood glucose levels are checked every hour to determine if there is gestational diabetes.

Can gestational diabetes be prevented once pregnant?

There's no prevention once you become pregnant. What happens during pregnancy is that hormones secreted by the placenta increase insulin resistance and interfere with the action of insulin. During pregnancy, you’re normally in an insulin-resistant state. Some people can’t overcome this insulin resistance when pregnant and develop gestational diabetes. The good news is that, once identified, it can be treated satisfactorily in almost all cases.