Gestational diabetes

Gestational diabetes can severely impact pregnancy and delivery for both mother and child. Gestational diabetes usually passes after giving birth, but it increases the risk of type 2 diabetes.

Fortunately, you can affect the situation through active gestational diabetes prevention and treatment. By taking care of yourself during the pregnancy you help both yourself and your child to avoid glucose metabolism disturbances and obesity later on in life.

Risk factors for gestational diabetes:

• obesity
• hereditary factors
• age over 40
• previous child over 4,5 kg
• previous gestational diabetes
• glucose in morning urine
• Polycystic Ovary Syndrome (PCOS).

Diagnosing gestational diabetes

Gestational diabetes is diagnosed through a glucose tolerance test that is usually performed on the 24th – 28th week of pregnancy. If the risks are high, the test is performed as early as on the 12th – 16th week.

Are you about to take a glucose tolerance test? Here is how it’s done:

• The test starts in the morning at 8 – 10 o’clock. Make sure you have plenty of time because the test lasts for at least 2 hours.
• Fast for 12 hours, but in the morning before the test you are allowed to have a glass of water.
• First you will be given a blood test, after which you will receive 3 dl of water with glucose content to be consumed within 5 minutes.
• You will then be moved to the waiting area. During the test you must refrain from movement.
• You will be given additional blood tests after 1 and 2 hours.

Gestational diabetes is confirmed if one or more of these factors are evident:

• Your fasting blood sugar level is 5,3 mmol/l or higher
• Your blood sugar is 10,0 mmol/l or higher an hour after starting the test
• Your blood sugar is 8,6 mmol/l or higher two hours after starting the test

If you are found to have gestational diabetes, you will receive care guidance at the maternity clinic as well as at the hospital maternity ward. The maternity clinic informs you how to monitor your blood sugar at home. The time and amount of self-monitoring is agreed upon individually. The equipment needed for self-monitoring can be obtained at the maternity clinic or the medical supplies distributor.

Your target blood sugar levels during gestational diabetes are:

• 5,5 mmol/l in the morning before eating
• less than 7,8 mmol/l an hour after eating

Treating gestational diabetes

Diet plays a significant part in treating gestational diabetes. The goal of the treatment is the well being of both you and your child. The treatment involves:

• blood sugar self-monitoring
• a healthy diet: wholegrain, vegetables, fruit, low-fat products and unsaturated fats
• exercise to help manage blood sugar levels
• medical treatment if needed.

Dietary treatment is not always enough to reach an adequate blood sugar balance in which case it is necessary to begin medication. Roughly 15 – 20 per cent of women with gestational diabetes need medication during their pregnancy.

If your blood sugar is unmanageable with diet and exercise you will be put on medication at the hospital maternity clinic.

Your prescribed medication might consist of metformin tablets, insulin shots or both. The doctor assesses the requirements individually. Keep in mind that you also need dietary treatment and exercise in addition to possible medication.

Postpartum follow-up

Gestational diabetes usually ends after having given birth, but it increases the risk for type 2 diabetes. That is why your blood sugar levels need to be regularly monitored as part of your basic health care, even if the gestational diabetes has passed.

Postpartum glucose tolerance tests:

• If your gestational diabetes has required medication the glucose tolerance test must be renewed 6 – 12 weeks after giving birth.
• If your gestational diabetes has been managed with dietary treatment the glucose tolerance test needs to be performed a year after giving birth.
• If the glucose tolerance test is normal the monitoring interval will in the future be 3 years, but if it is increased the monitoring will happen once a year.

When a year has passed since your gestational diabetes

Exercise, a healthy diet, an adequate amount of sleep and normal weight help you prevent diabetes and the reoccurrence of gestational diabetes.

Your blood sugar should be monitored regularly through laboratory tests every 3 years or more, depending on individual need.

Your blood sugar levels are now equal to those of a healthy person, i.e. less than 6 mmol/l after fasting and less than 7,8 mmol/l in the two-hour glucose tolerance test.

In addition to blood sugar levels, your blood pressure and cholesterol levels should be monitored as well. Also attend to weight control and waist girth.

Roughly one in five pregnant women gets gestational diabetes. Gestational diabetes reoccurs in 40 – 60 per cent of mothers in Finland.