Gestational Diabetes - Diagnosis, Treatment and Prevention

By: Divya Yogi-Morren, MD • Posted on April 01, 2024

As a physician, I never expected to receive a concerning call from my gynecologist while six months pregnant. However, the office informed me that I had failed my glucose screening test, indicating potential gestational diabetes. I scheduled a follow-up glucose tolerance test at my own office the next week to confirm the diagnosis. Despite my athletic background and healthy lifestyle, the test came back positive. I did have gestational diabetes!

This news blindsided me. I reviewed the risk factors, knowing this diagnosis put me at an increased lifetime risk of developing diabetes. As an Endocrinologist, I had counseled many patients about gestational diabetes. Now I became the patient, pricking my finger to check blood sugar five times per day. This intimate experience gave me new empathy for my patients' challenges.

I worked hard to control my gestational diabetes through diet and exercise alone and was fortunate enough to avoid medication during the pregnancy. Counting carbohydrates proved difficult, as even natural foods such as an apple varied in carb content based on the size and degree of ripeness of the fruit. Processed foods spiked my blood sugar regardless of the stated carb count. With diligence and excellent care, I delivered a healthy baby at 37 weeks.

Given my family history of diabetes, developing gestational diabetes served as a warning. I research preventative measures and make daily efforts to reduce my diabetes risk. As an Endocrinologist, I now share my personal experience with patients, providing the tips and empathy I gained as a patient myself. This motivates me to take preventative action and help others do the same. 

What is Gestational Diabetes?

If you have ever been pregnant, you've probably heard of gestational diabetes. But what exactly is it, and should you be concerned? 

Gestational diabetes mellitus (GDM) is a form of glucose intolerance that is first recognized during pregnancy. It occurs when the body is unable to produce adequate insulin to compensate for the increased insulin resistance that naturally occurs during pregnancy. GDM generally resolves after delivery but confers a high risk of developing type 2 diabetes later in life. 

What are the risk factors for Gestational Diabetes?

You may be more likely to get gestational diabetes if:

• You had it in a previous pregnancy (40% chance it will recur)
• You had prediabetes or high blood sugar before this pregnancy
• You have a first-degree relative with diabetes
• Your pre-pregnancy BMI was 30+
• You've gained significant weight in early adulthood or between pregnancies
• You have polycystic ovary syndrome (PCOS)
• You're age 35+
• You're Hispanic, Native American, Alaska Native, Native Hawaiian, South Asian, or Pacific Islander
• You previously delivered a baby weighing 9+ pounds

How many women are affected by Gestational Diabetes?

About 16.5% of pregnancies are affected by gestational diabetes, and rates are rising with obesity. If you have risk factors, make sure your prenatal care includes screening. Monitoring blood sugar, diet, exercise, and medication if needed can help manage gestational diabetes for a safer pregnancy. Staying at a healthy weight after birth also lowers your chance of developing chronic diabetes later.

How is Gestational Diabetes diagnosed?

If you're pregnant, your doctor will likely recommend getting tested for gestational diabetes sometime between 24-28 weeks. This crucial screening helps identify high blood sugar levels that can develop during pregnancy.

There are two main approaches used to diagnose gestational diabetes:

1. One-Step Method: This involves a 2-hour oral glucose tolerance test (OGTT) using a sweet drink containing glucose. Your blood sugar levels will be checked before, 1 hour after, and 2 hours after you drink the solution. If your glucose results meet or exceed certain thresholds, gestational diabetes is diagnosed.

2. Two-Step Method: You'll first complete a 1-hour screening test by drinking a sugary solution and getting your blood drawn an hour later. If that test shows elevated glucose, you'll come back for the 3-hour diagnostic OGTT to confirm gestational diabetes.

   While the exact testing approach may vary based on your physician's practice, the goal is the same - to catch high blood sugar in pregnancy when it can be properly managed. Controlling gestational diabetes reduces risks to you and your baby like excessive growth, preeclampsia, early delivery and newborn complications.

Lowering Your Risk of Gestational Diabetes

If you're at higher risk for developing gestational diabetes during pregnancy, making certain lifestyle changes may help reduce your chances.

• The main goal is losing weight if you're overweight or obese when you become pregnant. Extra weight contributes to insulin resistance, making it harder for your body to regulate blood sugar levels. Shedding just a few pounds before conception and maintaining a healthy gestational weight gain can really help.
• Regular exercise is also key - aim for at least 30 minutes of moderate activity most days of the week. Taking up walking, swimming, or prenatal yoga classes can get your body moving. Staying active helps improve insulin sensitivity and blood sugar control.
• Watching your diet can also lower gestational diabetes risk. Focus on whole, unprocessed foods like fruits, veggies, lean protein, whole grains and healthy fats from foods like olive oil, nuts and fish. Limit sugary and high-fat foods which cause bigger blood sugar spikes. An overall balanced, low-glycemic diet supports better blood sugar regulation for mom and baby.
• If you smoke, try to quit before getting pregnant. While the link between smoking and gestational diabetes isn't totally clear, quitting provides major health benefits for you and your little one.
• The key is starting healthy habits before pregnancy and keeping them up after conceiving. Staying active and eating well will help you feel your best during pregnancy and minimize complications like gestational diabetes down the line. Your physician can offer more tips on improving your pre-pregnancy health.

How is Gestational Diabetes Treated?

If you're diagnosed with gestational diabetes during pregnancy, working with your doctor to manage blood sugar is crucial for your health and your baby's. The four main components of treatment include:

1. Diet - Eating regular, balanced meals with a focus on complex carbs, fiber, and protein. This helps keep blood sugar steady without restricting calories needed for you and baby.
2. Blood Sugar Monitoring - Checking glucose levels routinely lets you see spikes and determine if medication is needed.
3. Exercise - Moderate activity like walking most days helps improve blood sugar control.
4. Medication - If diet and exercise aren't enough, insulin injections or oral medication like metformin may be used to lower glucose levels.

Together, you and your healthcare team will find the right combination to maintain normal blood sugar. This lowers risks like accelerated fetal growth, early delivery and C-section birth. With regular monitoring and adjustments, gestational diabetes can be well-managed for the healthiest pregnancy possible.

Does Gestational Diabetes Lead to Type 2 Diabetes?

In many cases, gestational diabetes serves as an early indicator that a woman is prone to blood sugar control problems. The demands of pregnancy simply unmask the issue earlier than it otherwise would have emerged. 

For women who have had gestational diabetes, these findings underline the importance of paying close attention to blood sugar levels and pursuing preventative lifestyle measures after giving birth. Steps like achieving a healthy weight, exercising regularly and eating a diabetes-friendly diet can help reduce the likelihood of developing chronic type 2 diabetes down the road. Staying on top of postpartum check-ups and screening is also essential.

Ways to help prevent a future type 2 diabetes diagnosis

• Intermittent Fasting is a diet regimen, which cycles between periods of feasting and fasting. Some studies indicate that intermittent fasting can facilitate weight loss, enhance insulin sensitivity, and improve glycemic control. These factors may reduce the risk of developing diabetes and aid in its management.
• Low-Carbohydrate Diets have long been a strategic approach to blood sugar regulation. Diets low in carbohydrates have demonstrated the ability to induce weight loss and improve insulin resistance, as well as other metabolic parameters pivotal to diabetes care. 
• Vitamin D Supplementation may exert a synergistic effect on blood sugar homeostasis. Ensuring adequate vitamin D intake, whether through sunlight exposure, dietary sources, or supplementation, could potentially fortify one's defenses against hyperglycemia and type 2 diabetes mellitus.
• Be aware of Obstructive Sleep Apnea. Recently, there has been growing awareness of obstructive sleep apnea's potential risks during pregnancy such as links to gestational diabetes. The current screening tools like questionnaires and physical exams demonstrate modest accuracy in detecting OSA among expectant mothers, particularly in the third trimester when risks may peak. Experts advocate developing specialized, comprehensive screening protocols tailored precisely for pregnancy. Expectant mothers should remain vigilant for potential symptoms such as snoring, poor sleep quality, fatigue during the day and daytime somnolence and advocate for appropriate screening with their healthcare providers.
• Berberine and alpha-lipoic acid (ALA) show promise as natural compounds that may aid in managing diabetes. Berberine, derived from plants like goldenseal, activates an enzyme that improves glucose tolerance and reduces weight in diabetic and insulin-resistant individuals. Clinical trials revealed berberine significantly lowered blood glucose, A1C, triglycerides, and cholesterol in type 2 diabetics. Simultaneously, the antioxidant ALA may enhance glycemic control and insulin sensitivity while mitigating diabetes-related nerve damage by neutralizing oxidative stress. As research progresses, these natural products show potential as complementary diabetes therapies by favorably affecting key metabolic pathways, underscoring their role in holistically addressing this prevalent condition.

My happy ending

Despite being diagnosed with gestational diabetes during pregnancy, I was able to effectively manage the condition through diligent lifestyle modifications. By adhering to a carefully planned diet rich in nutrients and fiber while limiting simple carbohydrates, coupled with a consistent exercise regimen, most of the time, I was able to control blood sugar levels throughout the remainder of my term. And I delivered a healthy baby boy.

While lifestyle adjustments such as dietary changes and physical activity are the cornerstones of gestational diabetes management, medical options like insulin and metformin are available when needed to ensure optimal outcomes. This commitment to a disciplined yet balanced lifestyle allowed me to avoid medical interventions and culminated in the delivery of a healthy, full-term infant. The challenges of gestational diabetes were navigated successfully through proactive self-care and compliance with my physician's guidance, resulting in a positive outcome for both myself and my newborn.

With awareness and proactive self-care, the transition from gestational to lifelong diabetes doesn't have to happen. For women with a history of gestational diabetes, knowledge and prevention are key!

Be Strong, Be Healthy, Be in Charge!
Divya Yogi-Morren, MD, F.A.C.E.

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