If you or a loved one was diagnosed with gestational diabetes during pregnancy, don't assume that health problems ended after the baby was born. Women with gestational diabetes have a 35-60 percent chance of developing diabetes before their child is 20 years old. Their children are also at a greater risk of obesity and diabetes.
Because of this increased risk, the American Diabetes Association (ADA) has launched a new program to educate women about the risks of gestational diabetes both during and after pregnancy.
Gestational diabetes is marked by high blood sugar levels in pregnant woman. These women are likely to give birth to larger babies, which can lead to a complicated delivery and a higher risk of breathing problems for the baby. Most women who see an obstetrician will be tested for gestational diabetes around 20 weeks. The ADA estimates that one in five pregnant women will be diagnosed with gestational diabetes.
While doctors have long recognized the risks of gestational diabetes to mother and baby during pregnancy, "follow-up is frequently inadequate for gestational diabetes," said Dr. Robert Ratner, chief scientific and medical officer with the American Diabetes Association (ADA). "We now have a very substantial body of evidence to support that it's important to treat gestational diabetes in pregnancy, but even more important to follow these women long-term."
He noted that because a woman's diagnosis of gestational diabetes can increase her child's lifetime risk of developing diabetes, it's important for family doctors to understand these risks and the child's medical history.
"We can institute care for the entire family, to reduce the risk of diabetes," said Ratner. "If we can begin early, perhaps we can affect the next generation."
Diabetes is typically broken into three categories: Type 1, Type 2, and gestational diabetes. In Type 1 diabetes, the pancreas stops making insulin, a hormone that allows the body to create energy from food. Insulin shots are required to survive. In Type 2 diabetes, the body does not use insulin correctly. Type 2 diabetes can often be controlled by diet, exercise, or medication. Gestational diabetes is similar to Type 2 in that in can often be controlled by diet and exercise, but occurs only during pregnancy.
The health risks associated with all types of diabetes are high, making it important that women with gestational diabetes act to prevent a diagnosis of Type 2. Long-term high blood sugar can lead to heart disease, stroke, high blood pressure, or even blindness and severe vision loss. Diabetes is also the seventh leading cause of death in the United States.
Fortunately, women with a previous diagnosis of gestational diabetes can take action to prevent a future diagnosis of Type 2.
"Type 2 diabetes doesn't have to happen. Lifestyle intervention can reduce the incidence of Type 2 diabetes, sometimes by greater than half," said Susan Generose, a registered dietitian and certified diabetes educator with Blue Mountain Health Systems.
"Because the evidence suggests that women with gestational diabetes can develop Type 2 diabetes later on, we encourage them to continue on the changes that they made while pregnant."
Most pregnant women are able to control gestational diabetes through careful blood sugar management, which includes blood sugar testing, meal planning, and regular physical activity under a doctor's supervision. After giving birth, mothers who were diagnosed with gestational diabetes should continue to eat healthy and aim for 150 minutes per week of moderate physical activity. Their children should also be encouraged to maintain a healthier lifestyle.
"The lifestyle that was adopted during gestational diabetes should continue," said Generose. "You can ward off Type 2 diabetes indefinitely."
Women who are currently pregnant should focus on remaining as healthy as possible, gaining weight at a healthy rate and following their doctor's diet and activity recommendations.
"I think the days of eating for two are long gone," added Generose. "If you are in good health and in good nutrition before you get pregnant, there's no reason why you need to increase calories," she said, noting that the average woman needs just 300 extra calories to maintain a healthy pregnancy. "Beyond that, it's additional weight that mom will have to lose after the pregnancy."
While women with gestational diabetes are monitored frequently during their pregnancy, they should also have their blood sugar rechecked at regular intervals to ensure that they have not developed Type 2 diabetes.
"The woman needs to follow up 6 weeks after the baby is born, to make sure that their glucose levels have gone back to normal," she said. "It's suggested that they should also be screened for diabetes every 3 years. If they had abnormal glucose tolerance, they should be checked every year to make sure that their blood sugar is within normal limits."
Generose encouraged women with questions about gestational diabetes or the health of their current pregnancy to speak with their obstetrician and ask if they have been screened for gestational diabetes. She also noted that there are resources in our area, including certified diabetes educators, who can help women make the lifestyle changes necessary to reduce their risk of Type 2 diabetes.
"They need to reach out to the professionals who are out there. That's why we're here. We're here to help," she said.
For more information about gestational diabetes or about reducing your health risks after a pregnancy with gestational diabetes, go to www.yourdiabetesinfo.org/GDM.