If you are pregnant and have been diagnosed with gestational diabetes, you probably have a lot of questions, fears, and anxieties.
While it can be overwhelming to process, the good news is that the condition can be managed without diabetic medication in most cases, and making healthy lifestyle changes can reduce your long-term risk of developing diabetes after pregnancy.
What is Gestational Diabetes?
Diabetes is a disease that affects the body’s ability to break down blood sugar, or glucose. This happens when the body is unable to produce enough insulin- the hormone that breaks down blood glucose - or when the body stops using insulin properly.
This type of diabetes develops during pregnancy and affects approximately 2-10% of all pregnancies in the U.S. every year (CDC, 2019). It occurs as a result of hormonal changes and weight gain in pregnancy, which affect the body’s ability to use insulin effectively.
While blood sugar levels usually return to normal after pregnancy, there is an increased risk of recurrence in future pregnancies and of developing Type II diabetes in the future.
Gestational diabetes typically develops around 24 weeks of pregnancy and does not usually present with any symptoms. It is diagnosed through routine blood glucose testing, usually done between 24 and 28 weeks of pregnancy.
Regular prenatal care is essential in diagnosing gestational diabetes so that it can be treated as soon as possible, reducing the risk of harm to you and your baby.
Babies born to women are at risk of being very large (over 9 pounds), increasing the risk of a cesarean delivery. They are also at risk for premature delivery, having low blood sugar at birth, and developing diabetes later in life.
How is Gestational Diabetes Treated?
Treatment for gestational diabetes, for many women, does not need to involve medication. The first treatment approach is lifestyle modification, including diet changes and physical activity, which should be guided by the physician and a nutritionist.
By eating specific food at certain intervals, women can often maintain healthy blood glucose levels. Moderate physical activity helps lower blood glucose and is recommended throughout pregnancy, as long as there are no medical reasons preventing exercise.
The minimum recommended exercise is 150 minutes of moderate exercise every week. In some cases, women may need to test their blood sugar regularly to ensure that healthy blood glucose levels are being maintained.
Most clinical guidelines for gestational diabetes recommend a trial of 1-2 weeks of diet and exercise therapy alone for controlling blood glucose. If adequate control of blood glucose is not reached at that time, guidelines then recommend a diabetes medication, such as insulin or an oral medication such as glyburide or metformin (Zhang et al., 2019).
These medications are sometimes necessary, but are also associated with risks and high costs.
Other Treatment Options for Gestational Diabetes: Emerging Options
Research is currently exploring the use of myo-inositol as a treatment strategy for gestational diabetes. Myo-inositol is a naturally occurring sugar found in cereal, legumes, corn, and meat and has been found to lower insulin resistance, which means that it helps the body use insulin more effectively.
A small pilot study found that the use of a myo-inositol supplement may reduce the need for insulin in women with gestational diabetes (Lubin et al., 2016). A recent review showed promise for the use of myo-inositol in pregnancy to prevent gestational diabetes, though the evidence is still too low to recommend it for routine use (Crawford et al, 2015).
However, a clinical trial is currently examining its effectiveness in women with gestational diabetes on a variety of outcomes, which could provide more evidence for this new treatment option.
Additional research suggests that Vitamin D supplementation may play a role in preventing gestational diabetes as well as improving maternal and neonatal outcomes.
Postpartum Considerations for Gestational Diabetes
Blood glucose usually returns to normal after your baby is born, but breastfeeding your baby is recommended if possible, because it can help lower your blood sugar after delivery and reduce your risk of developing Type II diabetes (NIH, 2015).
Breastfeeding can also help you return to a healthy weight after pregnancy, which is an important part of reducing your risk for developing diabetes in the future. Breastfeeding and skin-to-skin time can also help prevent low blood sugar in newborns.
Maintaining a healthy diet, achieving a healthy weight, and engaging in regular physical activity can help you reduce your risk of developing gestational diabetes or Type II diabetes. Reach out to your doctor and health care team for help in reducing your risk of diabetes.
Additional Reading
References
Center for Diseases Control and Prevention. (2019). Gestational Diabetes. https://www.cdc.gov/diabetes/basics/gestational.html
Crawford, T. J., Crowther, C. A., Alsweiler, J., & Brown, J. (2015). Antenatal dietary supplementation with myo-inositol in women during pregnancy for preventing gestational diabetes. The Cochrane database of systematic reviews, 2015(12), CD011507. https://doi.org/10.1002/14651858.CD011507.pub2
Lubin, V., Shojai, R., Darmon, P., & Cosson, E. (2016). A pilot study of gestational diabetes mellitus not controlled by diet alone: First-line medical treatment with myoinositol may limit the need for insulin. Diabetes & metabolism, 42(3), 192–195. https://doi.org/10.1016/j.diabet.2016.01.005
National Institute of Health. (2015). Breastfeeding may help prevent type 2 diabetes after gestational diabetes. https://www.nih.gov/news-events/nih-research-matters/breastfeeding-may-help-prevent-type-2-diabetes-after-gestational-diabetes
Zhang, M., Zhou, Y., Zhong, J., Wang, K., Ding, Y., & Li, L. (2019). Current guidelines on the management of gestational diabetes mellitus: a content analysis and appraisal. BMC pregnancy and childbirth, 19(1), 200. https://doi.org/10.1186/s12884-019-2343-2