Diabetes During Pregnancy
What is diabetes?
Diabetes is a condition in which the body can't make enough insulin, or can't use
insulin normally. Insulin is a hormone. It helps sugar (glucose) in the blood get
into cells of the body to be used as fuel. When glucose can’t enter the cells, it
builds up in the blood. This is called high blood sugar (hyperglycemia).
High blood sugar can cause problems all over the body. It can damage blood vessels
and nerves. It can harm the eyes, kidneys, and heart. In early pregnancy, high blood
sugar can lead to birth defects in a growing baby.
There are 3 types of diabetes:
- Type 1 diabetes. Type 1 diabetes is an autoimmune disorder. The body's immune system damages the cells
in the pancreas that make insulin.
- Type 2 diabetes. This is when the body can’t make enough insulin or use it normally. It’s not an autoimmune
- Gestational diabetes. This is a condition in which the blood glucose level goes up and other diabetic symptoms
appear during pregnancy in a woman who has not been diagnosed with diabetes before.
It happens in about 3 in 100 to 9 in 100 pregnant women.
What causes diabetes during pregnancy?
Some women have diabetes before they get pregnant. This is called pregestational diabetes.
Other women may get a type of diabetes that only happens in pregnancy. This is called
gestational diabetes. Pregnancy can change how a woman's body uses glucose. This can
make diabetes worse, or lead to gestational diabetes.
During pregnancy, an organ called the placenta gives a growing baby with nutrients
and oxygen. The placenta also makes hormones. In late pregnancy, the hormones estrogen,
cortisol, and human placental lactogen can block insulin. When insulin is blocked,
it’s called insulin resistance. Glucose can't go into the body’s cells. The glucose
stays in the blood and makes the blood sugar levels go up.
Who is at risk for diabetes during pregnancy?
The risk factors for diabetes in pregnancy depend on the type of diabetes:
- Type 1 diabetes often occurs in children or young adults, but it can start at any
- Overweight women are more likely to have type 2 diabetes.
- Overweight women are more likely to have gestational diabetes. It’s also more common
in women who have had gestational diabetes before. And it’s more common in women who
have a family member with type 2 diabetes. Women with twins or other multiples are
also more likely to have it.
What are the symptoms of diabetes during pregnancy?
There are no common symptoms of diabetes. Most women don't know they have it until
they get tested.
How is diabetes during pregnancy diagnosed?
Nearly all nondiabetic pregnant women are screened for gestational diabetes between
24 and 28 weeks of pregnancy. A glucose screening test is given during this time.
For the test, you drink a glucose drink and have your blood glucose levels tested
after 2 hours.
If this test shows a high blood glucose level, a 3-hour glucose tolerance test will
be done. If results of the second test are not normal, gestational diabetes is diagnosed.
How is diabetes during pregnancy treated?
Treatment will depend on your symptoms, your age, and your general health. It will
also depend on how severe the condition is.
Treatment focuses on keeping blood glucose levels in the normal range, and may include:
- A careful diet with low amounts of carbohydrate foods and drinks
- Blood glucose monitoring
- Insulin injections
- Oral medicines for hypoglycemia
What are possible complications of diabetes during pregnancy?
Most complications happen in women who already have diabetes before they get pregnant.
Possible complications include:
- Need for insulin injections more often
- Very low blood glucose levels, which can be life-threatening if untreated
- Ketoacidosis from high levels of blood glucose, which may also be life-threatening
Women with gestational diabetes are more likely to develop type 2 diabetes in later
life. They are also more likely to have gestational diabetes with another pregnancy.
If you have gestational diabetes you should get tested a few months after your baby
is born and every 3 years after that.
Possible complications for the baby include:
- Stillbirth (fetal death). Stillbirth is more likely in pregnant women with diabetes. The baby may grow slowly
in the uterus due to poor circulation or other conditions, such as high blood pressure
or damaged small blood vessels. The exact reason stillbirths happen with diabetes
is not known. The risk of stillbirth goes up in women with poor blood glucose control
and with blood vessel changes.
- Birth defects. Birth defects are more likely in babies of diabetic mothers. Some birth defects are
serious enough to cause stillbirth. Birth defects usually occur in the first trimester
of pregnancy. Babies of diabetic mothers may have major birth defects in the heart
and blood vessels, brain and spine, urinary system and kidneys, and digestive system.
- Macrosomia. This is the term for a baby that is much larger than normal. All of the nutrients
the baby receives come directly from the mother's blood. If the mother's blood has
too much sugar, the pancreas of the baby makes more insulin to use this glucose. This
causes fat to form and the baby grows very large.
- Birth injury. Birth injury may occur due to the baby's large size and difficulty being born.
- Hypoglycemia. The baby may have low levels of blood glucose right after delivery. This problem
occurs if the mother's blood glucose levels have been high for a long time. This leads
to a lot of insulin the baby’s blood. After delivery, the baby continues to have a
high insulin level, but no longer has the glucose from the mother. This causes the
newborn's blood glucose level to get very low. The baby's blood glucose level is checked
after birth. If the level is too low, the baby may need glucose in an IV.
- Trouble breathing (respiratory distress). Too much insulin or too much glucose in a baby's system may keep the lungs from growing
fully. This can cause breathing problems in babies. This is more likely in babies
born before 37 weeks of pregnancy.
Can diabetes during pregnancy be prevented?
Not all types of diabetes can be prevented. Type 1 diabetes usually starts when a
person is young. Type 2 diabetes may be avoided by losing weight. Healthy food choices
and exercise can also help prevent type 2 diabetes.
How is diabetes during pregnancy managed?
Special testing and monitoring of the baby may be needed for pregnant diabetics, especially
those who are taking insulin. This is because of the increased risk for stillbirth.
These tests may include:
- Fetal movement counting. This means counting the number of movements or kicks in a certain period of time,
and watching for a change in activity.
- Ultrasound. This is an imaging test that uses sound waves and a computer to create images of
blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as
they function, and to look at blood flow through blood vessels.
- Nonstress testing. This is a test that measured the baby’s heart rate in response to movements.
- Biophysical profile. This is a measure that combines test the nonstress test and ultrasound to check fetal
movements, heart rate, and amniotic fluid.
- Doppler flow studies. This is a type of ultrasound that uses sound waves to measure blood flow.
A baby of a diabetic mother may be delivered vaginally or by cesarean section. It
will depend on your health, and how much your pregnancy care provider thinks the baby
weighs. Your pregnancy care provider may advise an amniocentesis in the last weeks
of pregnancy. This test takes out some of the fluid from the bag of waters. Testing
the fluid can tell if the baby's lungs are mature. The lungs mature more slowly in
babies whose mothers have diabetes. If the lungs are mature, the healthcare provider
may advise induced labor or a cesarean delivery.
Key points about diabetes during pregnancy
- Diabetes is a condition in which the body can't produce enough insulin, or it can't
use it normally.
- There are 3 types of diabetes: type 1, type 2, and gestational diabetes.
- Nearly all pregnant women without diabetes are screened for gestational diabetes between
24 and 28 weeks of pregnancy.
- Treatment for diabetes focuses on keeping blood sugar levels in the normal range.
- Women with gestational diabetes are more likely to develop type 2 diabetes in later
life. Follow-up testing is important.
Tips to help you get the most from a visit to your healthcare provider:
- Know the reason for your visit and what you want to happen.
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments,
or tests. Also write down any new instructions your provider gives you.
- Know why a new medicine or treatment is prescribed, and how it will help you. Also
know what the side effects are.
- Ask if your condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if you do not take the medicine or have the test or procedure.
- If you have a follow-up appointment, write down the date, time, and purpose for that
- Know how you can contact your provider if you have questions.