Gestational Diabetes Treatment

Overview

Treatment of gestational diabetes involves eating a balanced diet and getting regular exercise to keep your blood sugar (glucose) levels within an acceptable range.

The goal is to reduce the risk of complications for you and your baby during pregnancy and after birth. If your blood sugar level and the fetus's weight remain normal, the risk of complications is no greater than if you did not have gestational diabetes.

During pregnancy

Treatment for gestational diabetes during pregnancy includes:

Eating a balanced diet. Controlling the amount of carbohydrates in your diet allows your body's naturally produced insulin to keep blood glucose levels within the acceptable range. Nutritional counseling by a registered dietitian is an important part of treatment for gestational diabetes.

Getting regular exercise. Following a balanced diet and getting regular exercise may prevent the need for insulin injections.

Monitoring blood glucose levels. Take a home blood sugar test 1 hour after the first bite of each meal. Some experts recommend that women who take insulin should also test their blood sugar before meals. Keeping blood sugar levels within the acceptable range reduces the risk that the fetus will gain excessive weight, leading to possible complications.

Monitoring fetal growth and well-being. You may be asked to monitor fetal movements and report any significant decrease. Fetal ultrasound is used to evaluate fetal growth during pregnancy. If the fetus is growing larger than expected, you may need to take insulin injections. If you take insulin, a nonstress test may be done to evaluate the fetus's heart rate. A nonstress test may also be done near the expected delivery date for all women with gestational diabetes.

Having regular medical checkups. Women with gestational diabetes are twice as likely to develop high blood pressure as other pregnant women. Therefore, you need regular medical visits to monitor your blood pressure and to check your urine for protein. Your health professional may ask you to keep daily food records. They may be reviewed along with your weight to make sure you are getting adequate nutrition.

Taking insulin injections. If blood sugar levels are not remaining within an acceptable range after at least 2 weeks of eating a balanced diet and exercising regularly, insulin injections will be needed. Insulin may be started after 1 week of diet and exercise if your blood sugar level is not within an acceptable range. Usually, when the baby is delivered, a woman's blood sugar level returns to normal and she no longer needs to take insulin.

Most obstetricians generally advise pregnant women not to diet, and a total weight gain during pregnancy of about 25 lb (11.3 kg) to 35 lb (15.9 kg) is expected. However, if you were very overweight before becoming pregnant, a weight gain of less than 15 lb (6.8 kg) is acceptable. If you are obese, your doctor will probably ask you to restrict your caloric intake, even during your pregnancy.

During labor and delivery

Once your pregnancy has reached its 38th week, your doctor may want to deliver your baby to reduce the chance that the baby will be abnormally large (macrosomia). At this point, your obstetrician may try to induce labor or perform a cesarean section (C-section) to deliver the baby. Unless your fetus is not as developed as it should be, this delivery should not harm it. If allowed to become too large, it may be too difficult to deliver your fetus safely. Periodic ultrasound measurements help determine the size of the fetus and the need for early delivery. However, since treatment of gestational diabetes is very successful in preventing large babies, many obstetricians will increase fetal monitoring rather than deliver early.

During labor and delivery, you and the baby are monitored closely. Monitoring includes:

--Your blood glucose levels, which will be tested at least every 1?2 hours. If your level rises too high, you may be given small amounts of insulin through a vein (intravenous, or IV). If your level drops too low, you may be given IV fluid that contains glucose.

--The fetal heart rate, which provides an indication of how well the baby is tolerating the birth. Internal or external fetal heart monitoring may be used. If the baby is large or does not seem to be tolerating labor, surgery (cesarean section, or C-section) may be needed to deliver the baby. However, most women with gestational diabetes are able to deliver their babies naturally.

After delivery

After delivery, you and the baby need to be monitored closely.

--Your blood glucose levels may be tested as often as hourly for the first few hours. In most cases, women do not need to have insulin injections after delivery.

--The baby's blood glucose levels will be monitored. If your blood glucose levels were above the acceptable range during pregnancy, the baby's body will continue to produce extra insulin for several hours after birth. The extra insulin may cause the baby's blood glucose to drop too low (hypoglycemia). For babies who are able to take feedings by mouth, breast-feeding seems to help protect against low blood sugar.12 If the baby's blood glucose level drops below the acceptable range, he or she may need extra sugar, such as a sugar water drink or glucose given intravenously.

--The baby's blood may be checked for low calcium, high bilirubin, and extra red blood cells.

What to Think About

The blood glucose levels of most women with gestational diabetes return to normal within a few hours after delivery. However, women who have had gestational diabetes in a previous pregnancy are at risk for developing type 2 diabetes later in life. In addition, between 30% and 69% of women who have gestational diabetes develop the condition again in future pregnancies.