Controlling Gestational Diabetes Is Key for Mom and Baby

August 13, 2023

According to the Centers for Disease Control and Prevention (CDC), between two and 10 percent of pregnant women are diagnosed with gestational diabetes annually, and that number continues to rise.

Gestational diabetes occurs when the body can’t produce enough insulin during pregnancy. This causes elevations in blood sugar, which can harm both the mother and fetus, says Jillian Fetzner, CNP, program director for Diabetes Clinical Care Improvement within the University Hospitals Diabetes and Metabolic Care Center.

“While gestational diabetes can’t be prevented, it can be controlled,” says University Hospitals OB/GYN and high-risk pregnancy specialist Christopher Nau, MD. “The most important thing for improving pregnancy complications with diabetes is very strict and tight blood sugar control.”

Risks for Mother and Baby

Screening for gestational diabetes typically occurs between the 24th and 28th week of pregnancy, though it may be recommended earlier for patients with certain risk factors. These can include previously delivering a large baby (over 9 pounds), family history, polycystic ovarian syndrome (PCOS), elevated body mass index or BMI, markers of cardiovascular disease, or advanced maternal age.

When blood sugar is not well-controlled during pregnancy, both mother and baby are at risk for health complications. Risks to the mother include:

Complications during delivery due to baby’s large size
Preeclampsia (dangerously high blood pressure during or after pregnancy)
Hypoglycemia (low blood sugar)
Cesarean delivery
Increased chance of miscarriage, preterm birth or stillbirth

Risks to the baby include:

Preterm delivery
Low or high birth weight
Respiratory distress syndrome
Abnormal glucose tolerance and metabolism in childhood
Birth trauma
Jaundice

Controlling Blood Sugar

Expectant mothers with gestational diabetes require close blood sugar monitoring and need to limit their carbohydrate intake. A program of regular exercise is also important to lower blood sugar naturally. While the majority of women are able to control gestational diabetes through diet and exercise alone, some may require insulin or other medication if they are unable to keep their blood sugar levels in a safe range – which is of vital importance for the health and safety of mother and baby.

“There is definitely a stressful component to learning that your pregnancy or baby is at risk. It can be difficult, especially if patients are experiencing morning sickness or food aversions, because carbs are often associated with comfort,” says Fetzner. “But most mothers do the hard work to safeguard the health of themselves and their baby.”

Postpartum Follow-Up

In women with gestational diabetes, blood sugar levels typically return to normal after the baby is born. However, approximately 50 percent of women diagnosed with gestational diabetes will develop type 2 diabetes within five to 10 years, says Dr. Nau. It’s important for these women to understand this risk and regularly visit their primary care provider so they can catch signs of poor blood sugar control early.

“This is an opportunity to intervene early, connect people with good follow-up care, and make sure we're passing the baton to their primary care providers,” says Dr. Nau.

The American Diabetes Association recommends blood sugar testing through a two-hour oral glucose tolerance test at 6 – 12 weeks postpartum. Another type of test, called hemoglobin A1C, measures blood sugar averages over two to three months. This test can be done between 3 and 6 months postpartum, and then yearly going forward.

Returning to a healthy body weight after delivery can help lower the risk of developing type 2 diabetes as well as the risk of developing gestational diabetes in future pregnancies. Women can work with their primary care provider, a dietitian or another healthcare provider to develop a diet and exercise regimen that can help them reach their goals and maintain a healthy lifestyle. Dr. Nau notes that breastfeeding, apart from its beneficial effects on weight loss, also protects against developing type 2 diabetes by as much as 50 percent.

“When patients go back to their previous eating and exercise patterns, that is when problems can occur,” says Fetzner. “We want to provide the support women need to stay healthy before, during and after pregnancy.”