What is gestational diabetes?
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By T1D Sugar Mommas and Reviewed and Contributed by Dr. Marina Basina, MD, Endocrinology Stanford University School of Medicine and T1DSM Medical Advisory Board
Gestational diabetes mellitus, or gestational diabetes (GDM), is not preexisting but instead diagnosed after 20 weeks of pregnancy. Hormones produced by the placenta during pregnancy place increased demand on the insulin-producing cells of your pancreas. Gestational diabetes is diagnosed if your body cannot keep up with this demand or stops using the insulin effectively. In this case, blood glucose levels remain elevated leading to potential risks and complications for both you and the baby. Do note that while it does affect how your cells use glucose, gestational diabetes is not type 1 (T1D) or type 2 diabetes (T2D).
How is gestational diabetes diagnosed?
All pregnant women (without pre-existing diabetes) are administered the Oral Glucose Tolerance Test (OGTT) between 24 and 28 weeks of gestation. The test takes around 2 hours to complete.
The day of the test begins with a fasting blood sample. Ideally, the results should reflect a blood glucose value of 95 mg/dl or lower. Following the results of the blood sample, the pregnant woman drinks 75g of glucose (sugar) syrup.
After 2 hours, another blood sample is taken, the blood glucose target value is under 160 mg/dl.
Waiting is the hardest part.
The test is determining how your insulin production is responding to the increased demand brought on by the massive single serving of sugar just ingested. Does your pancreas perform to spec, does it do a less than adequate job, or has it decided it’s on vacation?
Am I Diagnosed After the First Test?
The simple answer is no. Having a blood glucose value higher than the values noted above, at either blood draw, will cause the test to be repeated in order to verify the accuracy of the results. If the subsequent OGTT again shows elevated blood glucose levels, gestational diabetes will then be diagnosed.
How is gestational diabetes controlled?
Gestational diabetes can be classified as A1 or A2. Gestational diabetes A1 can be controlled by adhering to a particular diet and exercise plan as outlined by your doctor. If however, blood sugar levels continue to remain outside of target levels, doctors prescribe insulin injections or other medications for control (A2). Your practitioner will let you know which insulins and/or oral medications are safe for use in pregnancy. Ask questions and be sure you feel equipped. This can be overwhelming but there are many resources to support you in successfully controlling gestational diabetes. Some clinics may also encourage your participation in classes or community groups geared specifically to pregnant women with gestational diabetes.
Will my gestational diabetes go away?
Following the delivery and subsequent removal of the placenta, gestational diabetes will entirely resolve for many women. It is important to point out that having had gestational diabetes does correlate with a higher risk of developing type 2 diabetes in the future. Research suggests that about half (50%) of women that had gestational diabetes will develop type 2 diabetes within 3-5 years of giving birth; less than 5% of these women will develop type 1 diabetes. Care standards suggest that women with gestational diabetes during pregnancy are tested for continuing diabetes 6 weeks following delivery. Be sure to schedule this follow-up early on—the blur of new parenthood is real—it’s essential to make it to this appointment.
