Pregnancy can be a very exciting time full of anticipation and excitement.
While many pregnancies go smoothly without any complications, certain conditions can arise during pregnancy that we need to address to keep mother and baby (or babies) healthy.
Gestational diabetes is one of the more common conditions that can impact women during pregnancy.
Gestational diabetes comes with risks for adverse pregnancy outcomes, such as the increased likelihood of Cesarean birth, high blood pressure during pregnancy, fetal macrosomia (large baby), premature birth, shoulder dystocia, or other birth trauma, and stillbirth.
If you’ve had gestational diabetes once, you might be wondering what your chances are of having it in subsequent pregnancies.
What is gestational diabetes?
Gestational diabetes mellitus (GDM) is the term for diabetes that develops during pregnancy. Gestational diabetes isn’t the same thing as a pregnant woman already having pre-existing diabetes.
Most women who get GDM have no history of diabetes, though they may have some of the many risk factors for gestational diabetes. The placenta (an organ that nourishes the growing baby) makes hormones that cause your blood glucose level to rise. If a woman’s body can’t produce enough insulin to help keep her blood sugar levels in a healthy range, gestational diabetes develops.
Insulin is the hormone responsible for lowering blood sugar. Pregnancy hormones can cause insulin resistance, a condition where the body doesn’t respond to insulin effectively.
Insulin resistance is the main cause of type 2 diabetes and can also cause gestational diabetes. Insulin sensitivity can drop as much as 50% by the third trimester, which is why gestational diabetes is a somewhat common occurrence impacting around 13% of pregnant women.
We can often manage gestational diabetes with diet and lifestyle changes alone. If that isn’t enough, your healthcare provider can provide medications and blood sugar monitoring. Having gestational diabetes is considered a high-risk pregnancy.
Diabetes during pregnancy usually resolves after delivery. However, having gestational diabetes leads to an increased risk of developing type 2 diabetes.
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What are the chances of having gestational diabetes more than once?
Once you’ve had gestational diabetes, there’s an increased risk that you’ll have it again. According to the American Diabetes Association, gestational diabetes recurs in 30-69% of subsequent pregnancies after being diagnosed in a previous pregnancy. One of the major risk factors for gestational diabetes is having it in an earlier pregnancy.
Risk factors for gestational diabetes
There are several risk factors for gestational diabetes besides having it in an earlier pregnancy. Some of the most common GDM risk factors are:
Being overweight or obese
Like the risk factors for type 2 diabetes, being overweight or obese before getting pregnant can increase the risk of developing gestational diabetes.
Being overweight can cause insulin resistance, which makes it harder for the body to keep your blood sugar level in a healthy range.
Excessive weight gain during pregnancy
Gaining weight within the recommended amount for your pre-pregnancy weight can help reduce your gestational diabetes risk.
The Institute of Medicine recommends the following weight gain amounts (for a singleton pregnancy) based on pre-pregnancy BMI weight status:
- Underweight (BMI less than 18.5): 28-40 pounds total
- Normal weight (BMI 18.5-24.9): 25-35 pounds total
- Overweight (BMI 25-29.9): 15-25 pounds total
- Obese (BMI 30+): 11-20 pounds total
Being inactive
A lack of physical activity can increase your risk of getting gestational diabetes. Being active helps reduce insulin resistance and can help lower blood sugar for up to 24 hours after exercise.
Most types of physical activity are safe during pregnancy. However, you may need to alter your intensity level or other aspects of your exercise routine depending on how far along you are in pregnancy and other factors.
Previous diagnosis of gestational diabetes or prediabetes
Prediabetes is a condition where blood glucose levels are higher than normal but not high enough to be diagnosed as diabetes. Having prediabetes is a significant risk factor for developing type 2 diabetes and can also increase gestational diabetes risk.
Having polycystic ovary syndrome (PCOS)
PCOS is a condition often associated with insulin resistance. Some common symptoms of polycystic ovary syndrome include high androgen (a type of hormone) levels, irregular menstrual cycles, infertility, facial hair growth, acne, and hair thinning.
Diabetes in a close family member
Many of the risk factors for gestational diabetes are similar to those for type 2 diabetes. If you have a close relative with diabetes, especially immediate family members, you’re more likely to have blood sugar imbalances as well.
Having had a baby weighing nine pounds or more
Having higher blood sugar levels during pregnancy can result in having a large baby. Gestational diabetes and having large babies are often connected, so high birth weight is a risk factor for gestational diabetes.
Your race
Women of Black, Hispanic, Native American and Asian American races are more likely to develop gestational diabetes than other races.
Your age
While a maternal age of 25 years isn’t “old” for pregnancy, it does correlate with increased gestational diabetes risk.
According to a paper published in Diabetes Care, being 25 years and older is a risk factor for developing gestational diabetes. The risk is even higher for those of “advanced maternal age,” or being 35 years and older while pregnant.
Where you carry your weight
Having more fat around the abdominal region links with insulin resistance and increased gestational diabetes risk.
Your height
Being of short stature, or 4’9” or shorter, is a risk factor for gestational diabetes.
How to decrease your risk
Some risk factors for gestational diabetes can’t be changed, like your age, family history, and race. There are some things you can take into your own hands to help decrease your risk, though.
Be physically active
Women who are active before pregnancy may have a 70% or more reduction in their risk for gestational diabetes. Being active helps improve insulin sensitivity and can promote a healthy weight.
Strength or resistance training can also be beneficial since muscle takes up extra blood glucose.
The general recommendation is to get at least 150 minutes per week of moderate to vigorous physical activity.
Eat a healthy diet
Diet plays a large role in blood sugar levels. Focus on whole foods that contain fiber, a nutrient that helps boost satiety without raising blood sugar levels.
According to a study, gestational diabetes risk falls by 26% for every 10-gram increase of fiber per day. Fiber is in fruits, vegetables, legumes, whole grains, nuts, and seeds.
Aim for a healthy weight before getting pregnant
Being overweight or obese for your height and weight is a risk factor for gestational diabetes. Losing 5% of your body weight (nine pounds for a 180-pound person) can help reduce your risk of type 2 diabetes by almost 60%, so losing weight before pregnancy can also reduce your risk for gestational diabetes.
Get screened early
We test for gestational diabetes between 24-28 weeks of pregnancy by measuring glucose levels after drinking a sugary drink. If you have a history of gestational diabetes or have other risk factors, you may opt to get a screening for blood sugar issues sooner.
Women with a history of gestational diabetes will likely have a blood glucose screening at their first OB visit. Women with gestational diabetes during pregnancy should have a blood glucose screening 6-12 weeks after delivery to check for prolonged blood sugar metabolism. High blood sugar levels usually go away after delivery but can persist in some women.
Conclusion
Gestational diabetes mellitus, commonly referred to as just gestational diabetes or GDM, is a condition where diabetes develops during pregnancy.
GDM typically impacts women without any history of diabetes mellitus and usually goes away after delivery. However, having gestational diabetes increases the chance of developing type 2 diabetes later in life. GDM prevalence is around 13% of pregnancies.
Moreover, having a history of gestational diabetes increases the likelihood of having it in subsequent pregnancies. In fact, the recurrence rate is estimated to be as high as nearly 70%.
There are several things you can do to reduce your risk of developing gestational diabetes. This includes eating a healthy diet, being physically active, losing weight before pregnancy if you’re overweight, and getting screenings for blood sugar problems early in pregnancy if you have several risk factors.
If preventative measures aren’t enough, it’s important to know that gestational diabetes can be effectively managed to achieve the best outcomes for mother and baby.
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