Insulin is a hormone made by the pancreas. It helps your body use sugar (glucose) as a source of energy. It also keeps your body’ s blood sugar levels in the normal range.
During pregnancy, your body needs more insulin; up to three times more! This forces your pancreas to work harder.
Some people cannot make enough insulin to meet this new need and their blood sugar goes up. When this happens, it is called gestational diabetes.
Gestational diabetes can happen to any pregnant person. Here are some of the factors that can increase your risk:
There are usually no symptoms for gestational diabetes. This is why pregnant people must be screened with a blood test. All pregnant people in Canada are tested for gestational diabetes between 24 and 28 weeks of pregnancy.
To test for gestational diabetes we use a one-hour plasma glucose test (1hPG). During this test, you will drink a sugary drink and then we’ll test your blood one hour later. If your blood sugar level is at or above a certain number, you have gestational diabetes.
Sometimes the test will show that your blood sugar level is high, but not quite high enough to be certain that you have gestational diabetes. If this happens we complete another test. The second test is an oral glucose tolerance test (OGTT) that is two hours long. It is a fasting blood sugar test which means that you can’t eat or drink anything on in the morning before your test.
During pregnancy, everything the baby needs to grow and be healthy (vitamins, minerals and sugar) comes from the pregnant person. If everything works as it should, the pregnant person and baby will both have the energy they need.
With gestational diabetes, the pregnant person’s high blood sugar is passed on to the baby. If your baby’s sugar levels are too high, they will have to produce more insulin to lower them.
Insulin is also a powerful growth hormone. If your baby produces too much of it, they may grow quickly and become larger than usual. This can increase the risk of injury for both pregnant person and baby during the delivery. Sometimes a Cesarean section is necessary.
During labour, your healthcare team will watch your blood sugar levels closely. We will let you know what is happening and give you medicine to help with your blood sugar during labour if you need it.
None of this means that your baby will be born with diabetes. Their pancreas will produce less insulin after birth as their blood sugar levels return to normal.
Sometimes, this extra insulin may cause your baby’s blood sugar to drop too low in the first day after birth. This can happen especially if the pregnant person’s blood sugars were high in the few days before delivery.
We will check your baby’s blood sugar level often for several hours after birth and give care as needed.
Some babies are born with jaundice (slightly yellow skin colour). This is due to a build-up of a body chemical called bilirubin.
It happens more often in babies born to people with diabetes, but it is usually not serious. It often goes away by itself. Sometimes we use a special light treatment to help the baby’s body break down the extra bilirubin. All newborns will have a blood test to screen for jaundice.
People with gestational diabetes sometimes have a greater risk of infection. Vaginal and bladder infections are the most common. If this happens, you may have to take medicine. Your doctor may also do monthly urine tests to look for infections.
Some pregnant people develop a serious complication called pre-eclampsia. Symptoms of pre-eclampsia include:
Pre-eclampsia can be unhealthy for both the pregnant person and baby. It needs quick treatment. You may need to go to the hospital, stay in bed for a while, or take medicine. Pre-eclampsia generally goes away after delivery.
Three to six months after birthing a baby, about 16 to 20 per cent of people may have higher blood sugar levels that are not high enough to be called diabetes. This is called impaired fasting glucose and impaired glucose tolerance.
Many people who had gestational diabetes will have a higher risk of developing diabetes later in life. Obese people have the greatest risk of developing lifelong diabetes. Your doctor should do a follow-up blood glucose test between six weeks and six months after the baby is delivered.
The treatment for gestational diabetes is to keep your blood sugar levels as close to target as possible. There are several ways you can help yourself.
Now that you have been diagnosed with gestational diabetes, you may need more care from healthcare professionals with who know how diabetes can affect a pregnancy. This may include:
Your healthcare team will help you manage your blood sugar level, diet, and exercise.
Your health care team can show you how to test your blood sugar levels. Here’s what you’ll need:
You will place a small drop of your blood on the strip and the meter will show your results in seconds. Check with your insurance provider to see if you have coverage for the meter and the test strips. Blood sugars are usually lower before meals and highest one hour after meals.
When you have gestational diabetes, it is very important that you check your blood sugar level often:
Doing this work during your pregnancy will reduce the risks for you and your baby. Your healthcare team will explain what your blood sugar level should be and how this is affected by food and exercise. Write your target in your diabetes diary or log book.
Note: (mmol) stands for millimole. It is a unit of measurement used to measure blood glucose levels in terms of molar concentration.
Your body’s cells normally burn sugar to get energy. But, if you do not have enough insulin in your body to help your cells use sugar or do not eat enough carbohydrate, your body will use fat as another fuel source. During fat breakdown, waste products called ketones are formed.
A dietitian or diabetes nurse can help you create a healthy, well-balanced meal plan. It should include all the basic food types, including starches, because a starch-free diet could be harmful to your baby.
Healthy meal plan goals:
We will talk to you about physical activity during pregnancy. Before you start any type of activity, talk to your doctor to find out which activities are safe for you. There may be times when your doctor recommends rest for your or your baby’s health.
If it is safe for you to be active:
Regular physical activity is good for your body and mind and can help keep your weight at a healthy level.
It is important that you keep records of:
We’ll check your records each visit to see if we need to change your care plan.
Caffeine and some artificial sweeteners should be limited during pregnancy. Artificial sweeteners with saccharin and cyclamates in them should be avoided.
You may also want to cut out or reduce your intake of concentrated sweets and/or high-carbohydrate foods to control blood sugar levels after meals.
It is important that you start taking folic acid. It is recommended to take a daily multivitamin containing 5 mg folic acid at least three months before trying to become pregnant, and for three months after becoming pregnant. From three months up to the first six weeks after delivery and during breastfeeding or chestfeeding, you should take a multivitamin containing 0.4 to 1.0 mg of folic acid.
If you follow the advice of your healthcare team but your blood sugar levels are still too high, you may need to start insulin. Many people with gestational diabetes take insulin. It will not harm your baby because it does not cross your placenta into your baby’s bloodstream. Your healthcare team will explain how to take the insulin and its effects.
Your diabetes educator will teach you:
Needing more insulin is just a normal result of your baby growing.
Your doctor, nurse, or midwife will teach you to count the kicks you feel from your baby to get a general idea of their health. You may be asked to count the number of times your baby moves during a period of time each day. Call your doctor/midwife if you notice any decrease in the number or kicks or any change in the pattern of the baby’s movements.
This is a painless test that uses a microphone to record your baby’s heartbeat. This test is usually done once or twice a week near the end of pregnancy. We record your baby’s heartbeat and look at its relationship to the baby’s movement. We generally do this test after 28 weeks of pregnancy.
This is an ultrasound with a non-stress test. It is generally done after 32 weeks of pregnancy.
This is a painless test that uses sound waves to make a picture of the baby. Ultrasounds allow your healthcare provider to look at the baby’s well-being and diagnose potential problems. Many doctors order an ultrasound to check the baby’s size before choosing the safest way to deliver the baby.
Your baby will have a heel prick test to check blood sugar levels. All blood work is done using skin to skin contact and at the breast to help control pain in your baby. After, your baby may be taken to the neonatal intensive care unit so we can monitor their blood sugar levels closely for the next 24 hours. We’re not checking for diabetes, but to see if extra feedings are needed to bring the baby’s blood sugar levels to normal.
Gestational diabetes does not affect your ability to breastfeed or chestfeed your baby. Your milk is a good source of infant nutrition and helps the baby fight infections. Breastfeeding or chestfeeding can also help you lose weight.
As a person who has had gestational diabetes, you have an increased risk of type 2 diabetes. Your condition should be checked within six months of delivery. Even if you have normal blood sugars after giving birth, you need to take extra care.
Have a fasting blood test done:
These are the recommendations for those with no risk factors. It will help you make sure that your blood sugar levels stay normal.
If you have been taking insulin, you should be able to stop after your baby is born. Your healthcare team will work with you to make these decisions.
People who have had gestational diabetes have an increased risk of developing type 2 diabetes. Staying active and at a healthy weight may prevent future diabetes.
Type 2 diabetes could happen years after your baby is born. This is why you should be tested for diabetes regularly. Start with a blood sugar test at your first doctor’s visit after you have your baby.
Learn the symptoms of type 2 diabetes. There are often no symptoms in the early stages. When symptoms happen, they may be gradual and very mild. They can include:
Most importantly, you should have your blood sugar tested before becoming pregnant again.
Gestational diabetes is something you and your baby can live with. Most people with gestational diabetes have healthy babies. Just remember to:
If you take care of yourself properly, you should be able to manage your blood sugar and have as few problems as possible.
The information provided in this document is presented in summary form, is general in nature, and is provided for informational purposes only.
The information is intended only for the purpose of helping patients and family members better understand certain health conditions and treatment options. The content is not intended in any way to be a substitute for professional medical advice and should not be interpreted as treatment recommendations.
Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition. Neither the content nor any other service offered by or through this brochure is intended to be relied on for medical diagnosis or treatment, without a physician’s interaction and involvement.