Each November, National Diabetes Month aims to raise awareness about the diabetes epidemic. Gestational diabetes is a type of diabetes that can develop during pregnancy in women who don’t already have diabetes because of the body’s inability to make enough insulin. According to the Centers for Disease Control and Prevention, 2% to 10% of pregnancies in the United States are affected by gestational diabetes every year.
Sara Mohr, APRN, CDCES, advanced practice registered nurse and certified diabetes care and education specialist at Regional Obstetric Consultants, part of Pediatrix® Medical Group, in Jacksonville, Florida, has led diabetes education for the practice since 2007.
“We see a lot of diabetic patients,” said Sara.
Annually, 12% to 15% of the practice’s patients has some form of diabetes. Sara sees patients in-person and remotely via telehealth visits, which they find works very well not only because of the convenience but also the undistracted one-on-one time it allows.
“They can be on their lunch break or at home, and I can easily show visual aids and share copies of those via email, so patients have easy access to them,” Sara said.
The group also counsels patients with existing Type 1 or Type 2 diabetes and polycystic ovarian syndrome (PCOS), which puts women at an increased risk of developing gestational diabetes, who are trying to conceive or expecting.
Risk Factors
Prevention is key to reducing risk. Before becoming pregnant, having a general healthy lifestyle — eating a balanced diet, being active, taking prenatal vitamins and staying well-hydrated — can help set the stage for a healthy pregnancy.
You’re more likely to have gestational diabetes if you:
- Are older than age 25
- Are Asian, black, American Indian or Hispanic
- Have a body mass index (BMI) over 30
- Have a family history of gestational or Type 2 diabetes
- Have hypertension, PCOS or pre-diabetes
- Had a previous baby that weighed more than 9 pounds
- Had gestational diabetes during an earlier pregnancy
High-risk patients are generally screened early in their pregnancy and then again during the normal timeframe of 26 to 28 weeks.
“Patients who we know have a strong family history or a condition that is indicative of an increased risk, we recommend they be screened in the first trimester,” said Sara. “Usually, it’s a one-hour glucose tolerance test. If they pass that, they’re in the clear for now and they’ll get another screen in the second trimester when most women are more insulin resistant. We get more insulin resistant as pregnancy progresses because of the increase in pregnancy hormones.”
Management
Following diagnosis, the first line of defense is to begin monitoring blood sugars and implementing lifestyle changes. The patient is then re-screened in two weeks to determine if additional treatment is needed.
A nutritionally sound diet and low-to-moderate-intensity exercise are key to keeping gestational diabetes under control.
“I try really hard to make the meal plans specific for the patient, taking into account both their cultural and dietary preferences, as well as their schedules,” said Sara.
During the sessions, she reviews how to read food labels, proper portion sizes, the importance of limiting processed and fast foods and the role of carbohydrates, protein and fat and how much is needed of each depending on the patient’s individual nutrition needs (e.g., moms carrying multiples will require additional calories). Another important component of counseling is recommended timing of meals to achieve optimal blood sugar levels.
While patients can sometimes manage the condition with lifestyle changes alone, some may require insulin and/or oral medication to achieve optimal glucose levels. Those who are diagnosed late in pregnancy typically respond well to lifestyle changes whereas those diagnosed early on are more likely to require insulin as hormones naturally increase throughout the pregnancy.
“Insulin is the gold standard for diabetes management in pregnancy,” said Sara.
Insulin does not cross placenta and is safe for babies.
Outcomes
Gestational diabetes can have negative effects on both mom and baby. Possible outcomes include:
- Higher chance of preterm labor due to excess amniotic fluid around the baby
- Higher chance of a cesarean delivery (C-section)
- Increased risk of preeclampsia, a serious blood pressure condition
- Likelihood of delivering a larger-than-average baby (macrosomia); resulting in injury to mom during delivery
- Slightly higher risk of fetal and neonatal death
Mom’s insulin levels typically return to normal following delivery. To be sure, she will be screened in the hospital and again at her 6- to 8-week follow-up appointment. For any future pregnancies, mom should be screened early for gestational diabetes, and primary care should check levels every one to three years. Later in life, she is at an increased risk of developing type 2 diabetes (50% risk rate within 10 years), cardiovascular disease and high blood pressure. Baby is also at risk of developing future obesity, type 2 diabetes and metabolic syndrome.
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