Gestational Diabetes: Possible Complications

Gestational diabetes occurs when a pregnant woman’s body doesn’t use insulin as effectively as it should.

The condition can cause complications for you and your baby, including high birth weight (macrosomia), increased chances of cesarean section delivery, hypoglycemia, and preeclampsia.

Gestational diabetes should be closely monitored, but many people have perfectly normal pregnancies and healthy babies. You will need to work closely with your medical team to keep your blood sugar levels under control. This could involve making lifestyle changes and taking medication.

Here’s what you need to know about the condition and its possible complications.

What is gestational diabetes?

Gestational diabetes is a condition that may occur in women during pregnancy.

You don’t need to have pre-existing diabetes to develop gestational diabetes, but you may have a higher risk if type 2 diabetes runs in your family.

Symptoms of gestational diabetes

The condition does not usually cause any noticeable signs or symptoms, but you may experience increased thirst or pass urine more often.

What causes gestational diabetes?

What exactly causes gestational diabetes is unknown. It is thought that pregnancy placenta hormones could be the cause.¹

Insulin is a hormone that is made by the pancreas. It helps your body use glucose for energy and control blood glucose levels. Your placenta supplies nutrients to your unborn baby and could produce hormones that have a blocking effect on insulin. This prevents your body from processing insulin as effectively as it should, causing insulin resistance.

All women develop some level of insulin resistance during pregnancy, but not all can overcome it on their own. If you cannot overcome insulin resistance without treatment, you may develop gestational diabetes.

Who is at risk of developing gestational diabetes?

Gestational diabetes can affect any woman, but certain factors could increase your risk.

You may have a higher chance of developing gestational diabetes if:

• You are overweight

• You are aged 25 or over

• You have a family history of type 2 diabetes

• You already had a baby who weighed more than nine pounds at birth

• You have been diagnosed with polycystic ovarian syndrome (PCOS)

• You previously had gestational diabetes

• You are Asian American, African American, Pacific Islander, Hispanic, American Indian, Native Hawaiian, or Alaska Native

How is gestational diabetes diagnosed?

Being tested for gestational diabetes is a routine part of prenatal care. Your doctor will likely test you for gestational diabetes between 24 and 28 weeks of pregnancy.

If you’re at risk of gestational diabetes, you may be tested during your first pregnancy appointment.

Gestational diabetes is diagnosed through a series of blood tests. Your doctor may give you the glucose challenge test and oral glucose tolerance test. These tests both work to demonstrate how well your body uses glucose.

Glucose challenge test

The glucose challenge test is also known as the glucose screening test.

You will be asked to drink a sweet liquid that contains glucose and your doctor will draw a sample of your blood after one hour. You don’t need to fast (not eat or drink anything besides water) before this test.

If the results show that your blood glucose is too high, you may need to take a different test to confirm gestational diabetes.

Oral glucose tolerance test

A doctor or nurse will draw your blood before giving you a sweet liquid drink containing glucose. Your blood will then be drawn every hour for the next two to three hours. If your blood sugar is too high at any two blood draws, you may have gestational diabetes.

You will need to fast for at least eight hours before this test, only drinking water.

Possible complications from gestational diabetes

Most women who are diagnosed with gestational diabetes go on to have healthy pregnancies and deliveries, but complications are possible.

Possible gestational diabetes complications include:

Macrosomia

Gestational diabetes can make fetal macrosomia up to 20% more likely.² Fetal macrosomia occurs when a baby has abnormal growth, weighing more than 4kg or 4.5kg.

Macrosomia may increase the likelihood of cesarean delivery or instrumental vaginal delivery. Vaginal delivery may be more challenging with macrosomia, and fetal birth trauma may occur.

Fetal macrosomia may cause shoulder dystocia, a rare but serious injury. Fracture of the clavicle and damage to the nerves of the brachial plexus are the most common injuries caused by macrosomia.

Neonatal hypoglycemia

With poorly managed gestational diabetes, your baby may receive more sugar than they need during pregnancy, which increases their insulin levels. This raises the risk of your baby developing neonatal hypoglycemia (low blood sugar levels) after delivery.

Fetal macrosomia also increases the risk of neonatal hypoglycemia.

Polycythemia

Polycythemia is a blood disorder that can affect babies whose mothers have gestational diabetes. The condition occurs when the concentration of red blood cells is too high, slowing blood flow.

The condition is thought to occur because of the baby’s high insulin levels.

Jaundice

Gestational diabetes could increase the risk of your baby developing jaundice at birth. Jaundice can occur in babies born to mothers without gestational diabetes, and it can be monitored at home. However, some babies may require more extensive treatment in hospital.

Polyhydramnios

Gestational diabetes may cause polyhydramnios, a condition where there is too much amniotic fluid in the womb. This could make it challenging for your baby to move into the proper birth position.

Polyhydramnios may also cause other complications, including early labor and postpartum hemorrhage.

Preeclampsia

Gestational diabetes increases your risk of developing preeclampsia, a condition categorized by high blood pressure. If not properly managed, preeclampsia can lead to dangerous complications for you and your baby.

In preeclampsia, high blood pressure typically occurs after 20 weeks of pregnancy. It may be accompanied by other characteristics, including proteinuria (excess protein in the urine), thrombocytopenia (low blood platelet count), poor kidney or liver function, pulmonary edema, or cerebral or vision symptoms.

Premature birth

Gestational diabetes could cause you to go into labor early. This may be due to polyhydramnios, where the excess amniotic fluid causes the womb to stretch. It could also be caused by macrosomia, where your baby’s growth rate is higher than normal.

Your medical team may recommend scheduling an induction or cesarean section early to lower the risk of stillbirth or fetal birth trauma.

Stillbirth

In rare cases, stillbirth can result from gestational diabetes.

Future diabetes

You and your child may have a higher risk of developing diabetes in the future.

Gestational diabetes raises the chance of your child being overweight, obese, or developing type 2 diabetes in the future, while an estimated 50%³ of women with the condition go on to develop type 2 diabetes.

How is gestational diabetes treated?

Gestational diabetes can lead to serious complications for both you and your baby, so you should get treatment as soon as possible.

Treatment for gestational diabetes is aimed at maintaining normal blood sugar levels. You should work closely with your doctor and follow your personalized treatment plan as directed to help prevent problems during pregnancy, birth, or after delivery.

Your doctor will recommend a treatment plan based on your condition, medical history, and current lifestyle.

Gestational diabetes can be managed in several ways, including:

Making healthy dietary choices

Eating plenty of fruits, vegetables, lean proteins, and limiting your fat and sugar consumption can help keep your blood sugar under control. Working with a dietitian may help if you need guidance on which foods to eat, limit, or avoid.

Exercising regularly

Incorporating exercise into your daily routine — like brisk walks, swimming, or yoga — can help you maintain a healthy weight and keep your blood sugar levels under control. Regular exercise encourages your body to use glucose without needing extra insulin.

Be sure to consult your doctor before starting a new exercise routine.

Maintaining a healthy weight

If you’re overweight, losing weight can help prevent complications for you and your baby in the future, including type 2 diabetes.

Ask your doctor about safe and sustainable ways to maintain a healthy weight.

Regularly testing your blood glucose

Try to be aware of your blood glucose levels throughout the day.

Glycemic goals for women with gestational diabetes are:

• Before a meal (preprandial): 95 mg/dl or less

• One hour after a meal (postprandial): 140 mg/dl or less

• Two hours after a meal (postprandial): 120 mg/dl or less

Taking your medication as directed

Follow your doctor’s advice carefully and take the correct dose of insulin or any other medication.

Finding support with gestational diabetes

Being diagnosed with gestational diabetes can be overwhelming. Not only will you have concerns about your own health, but you will also be worried about your baby.

You don’t have to take on the challenge of managing your gestational diabetes on your own. It’s important to find individuals who can provide you with the support you need to live a healthier lifestyle and lower your chances of developing complications.

Here are some tips to help you find the support you need:

Be honest

It may be tempting to pretend like everything is normal and not make any changes to your lifestyle, but this approach can have serious consequences for you and your baby.

Acknowledge your diagnosis and work with your doctor to create a treatment plan that helps you stay healthy and avoid complications throughout your pregnancy.

Include your loved ones

You may be more likely to stick to a healthy routine and diet when those around you are participating and supporting you. Try encouraging family and friends to join you by making changes to adopt a healthier lifestyle.

Work with a dietitian

Altering the way you eat can feel like an impossible task, but it doesn’t have to.

With the help of a professional dietitian, you can create healthy meal plans that are nutritious, delicious, and, most importantly, fit seamlessly into your daily routine.

Try to follow professional medical advice when making changes to your diet to ensure your food choices are suitable for you and your baby.

Find a support group

Remember you’re not alone if you’re diagnosed with gestational diabetes. It’s estimated that between 2% and 10%³ of pregnant women in the US will develop gestational diabetes.

With this in mind, finding a support group of other women with gestational diabetes in your area or online could be incredibly beneficial.

When to see a doctor

Taking good care of yourself is always important, particularly during pregnancy. While you may not notice any unusual signs or symptoms of gestational diabetes, you should visit your doctor regularly to receive proper prenatal care.

If you think you may have risk factors for developing the condition, be sure to tell your doctor. They will carry out a routine test to determine if you have gestational diabetes and monitor you closely throughout your pregnancy.

If you are diagnosed with gestational diabetes, be sure to follow the individualized treatment plan prescribed by your doctor to manage your blood sugar levels and protect the wellbeing of you and your baby.

The lowdown

Gestational diabetes is a condition that affects up to 10% of pregnant women. It means their bodies can’t process insulin effectively.

While gestational diabetes does not always present any noticeable symptoms, your doctor will perform a routine blood test between 24 and 28 weeks of pregnancy to determine if your blood sugar levels are within the normal range. You could be diagnosed with gestational diabetes if they are too high.

Possible complications from gestational diabetes include having a large baby (macrosomia), premature birth, hypoglycemia, and preeclampsia. Gestational diabetes also increases you and your baby’s risk of developing type 2 diabetes later in life.

Working closely with your medical team and undergoing the correct treatment (whether that’s taking medication and/or making lifestyle changes) is key to having a normal pregnancy and delivering a healthy baby.