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Avoid developing gestational diabetes to ensure a healthy pregnancy

Erika F. Werner M.D., M.S. Women & Infants Hospital of Rhode Island, The Warren Alpert Medical School of Brown University
Avoid developing gestational diabetes to ensure a healthy pregnancy

Gestational diabetes mellitus (GDM) affects between four and eighteen percent of the United States pregnant population depending on the population examined and how GDM is diagnosed. Women who are overweight or obese, older women and some ethnic groups (particularly Asian women) are at particularly high risk.

In pregnancy, our cells become relatively resistant to insulin. Insulin helps us to reduce the sugar levels in our blood. Normally in pregnancy, our bodies compensate by making more insulin to keep our sugar levels normal. In GDM, our bodies do not adequately compensate and women either develop high levels of sugar in blood when they are fasting or after meals or most often in both situations.

It is important to know your risk for gestational diabetes not just because it affects a pregnant woman’s health, but also because it can affect the fetus’s health and the pregnancy outcome. There are some things you can do to reduce your risk of developing GDM.


Do

Do your best to achieve a healthy weight prior to conceiving

Your healthiest or ideal weight is determined by comparing your weight to your height in a ratio called your body mass index (BMI). This can be calculated using an online calculator, such as this one provided by the National Institute of Health. If your BMI is greater than 25 kg/m2, you are considered overweight, and if your BMI is greater than 30 kg/m2, you are considered obese. Women who are overweight or obese more than double their risk of developing gestational diabetes mellitus (GDM) compared to their normal weight counterparts. This risk increases the heavier you are. Even if you can’t achieve your ideal body weight before getting pregnant, any weight reduction decreases your risk of GDM.

Do maintain a healthy diet when you are trying to get pregnant and when you are pregnant

Unless you are underweight, a healthy diet involves eating no more than 35 kcal/kg/day. If you are overweight or obese, your intake should be reduced to 25-30 kcal/kg/day. A healthy diet also involves at least 9 servings of fruits and vegetables per day and ideally an additional 30-40 percent of your calories will come from protein. By eating carefully before you get pregnant and continuing these habits once you conceive, you are less likely to gain too much weight in pregnancy. Excessive weight gain in pregnancy increases your risk of developing GDM.

Do take prenatal vitamins for at least 3 months before you get pregnant

There is mounting evidence that your risk of developing GDM may be reduced by maintaining a diet rich in vitamins such as biotin, inositol and folic acid. While you can get these nutrients from vegetables, fruits, grains and nuts, it is a good idea to also take a prenatal vitamin daily for at least 3 months prior to getting pregnant. This way you increase the likelihood that you get all the necessary vitamins for a healthy pregnancy, and you minimize your risk of birth defects.

Do ask your doctor if you should be screened for GDM early

If you are at high risk for GDM because you are obese, had GDM in a prior pregnancy, have multiple family members with diabetes mellitus or had a baby who weighed more than 9lb 9oz in a prior pregnancy, your doctor may recommend screening for GDM before 20 weeks. Ask if you have any of these risk factors.

Do ask how to minimize your pregnancy risks with treatment

Talk to your doctor about the pregnancy risks associated with GDM including having a big baby, needing a cesarean delivery, developing preeclampsia, and even having a stillbirth. Many of these risks can be minimized by controlling your blood sugars. Find out how to test your blood sugars, when to test and what the goals are. If you can’t meet those goals with diet and exercise, you may need medication including insulin.


Don't

Do not think pregnancy is a time when you can eat whatever you want

No woman makes it through pregnancy without splurging (i.e. eating birthday cake, fried food or a donut) a few times. However, pregnancy should not be used as an excuse to splurge every day. The Institute of Medicine recommends that if you are heavier (BMI greater than 30 kg/m2), you need to limit your pregnancy weight gain to 20lb. Even if you are a healthy weight (BMI 20-25 kg/m2), your weight gain should be no more than 30lb. Women who gain more than the recommended amount are at higher risk for GDM.

Do not forget that clinicians can help

If you are considering getting pregnant, meet with your primary care doctor. Ask if you are overweight and if you are, ask for a referral to a nutritionist and exercise physiologist. Often times, your insurance will cover at least one visit.

Do not miss getting screened for GDM

All women are screened for GDM between 24 and 28 weeks of pregnancy. The screening test involves drinking a sugary drink and then having blood drawn. Even if you had an early screening test for GDM and it was normal, you should be screened again at 24-28 weeks gestation.

Do not forget that GDM affects not only you but your baby too

Baby’s born to women with GDM need to have their blood sugars watched closely in the first day of life. They also may need to go to a special nursery to be observed more closely. Working with your doctor to maximize your glucose control may help your baby to have an easier transition to the outside world.

Do not miss getting screened for diabetes mellitus after you deliver

Approximately half of the women who are diagnosed with GDM, develop diabetes mellitus (DM) during their lifetime. All women who develop GDM must be screened for DM after they deliver. This is vital because you may get pregnant again, and if you have DM, you want to know so that you can manage it and avoid future pregnancy and health problems.


Summary
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Your risk of developing gestational diabetes mellitus can be reduced by the choices you make before and during pregnancy. And if you develop GDM, you can have a successful pregnancy if you work with your clinicians to manage your disease.


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Erika F. WernerM.D., M.S.

Erika Werner, MD, MS, is a maternal-fetal medicine specialist in the Integrated Program for High-Risk Pregnancy and the Division of Maternal-Fetal Medicine at Women & Infants Hospital of Rhode Island. A graduate of the University of Virginia wit...

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