2009_0804gdm_cons_singlpgs.pdf

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Gestational DiabetesA Guide for Pregnant Women

August 2009


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fast factsn Gestational diabetes is a kind o diabetes that can happen

during pregnancy. It usually goes away ater delivery.

n Gestational diabetes is treated by controlling blood sugar.Some women can do this with a special diet or diabetes

and staying active. Other women will need insulin shots

or diabetes pills.

n Insulin and two kinds o diabetes pills can lower blood

sugar or women with gestational diabetes.

n Many women who have gestational diabetes get type 2

diabetes later in lie. Controlling your weight gain during

pregnancy may prevent type 2 diabetes later on.

n It is important to keep being tested or type 2 diabetes

regularly ater pregnancy.

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Gestational Diabetes A Guide for Pregnant Women1

Gestational (jes-TAY-shun-ul)

diabetes is a type o diabetesthat can happen during

pregnancy. It means you have

never had diabetes beore.

Having gestational diabetes

means you have a problem with

high blood sugar while you are

pregnant. The treatment is tocontrol blood sugar. This can help

prevent a difcult birth. It also

helps keep your baby healthy.

What Does This Guide Cover?Tis guide can help you talk with your doctor or midwieabout gestational diabetes. It helps answer these questions.

n What is gestational diabetes?

n How is it treated?

n How do I ollow up aer pregnancy?

Tis guide is based on a government-unded review o researchabout gestational diabetes.

What Is Not Coveredin This Guide?

Tis guide does not cover treatment o type 1 or type 2 diabetes

during pregnancy. ype 1 and type 2 diabetes are dierent romgestational diabetes.


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Learning About

Gestational Diabetes

What is diabetes?Diabetes means the body has a problem with insulin. Insulinis a hormone. It helps the body use sugar rom the blood orenergy.

When you have diabetes, your body either does not makeenough insulin or does not use insulin as well as it should.Glucose (sugar) builds up in the blood because the body cannotuse sugar without the help o insulin. Tis causes blood sugarto stay high.

Tere are dierent types o diabetes.

n ype 1 diabetesMost people are diagnosed when they are

children or in their teens. reatment is always insulin shots.n ype 2 diabetesMost people are diagnosed when they are

adults. Sometimes it can be treated just with diet. Diabetespills or insulin may also be needed.

n Gestational diabetesTis diabetes happens duringpregnancy. It usually goes away aer pregnancy.

What is gestational diabetes?Gestational diabetes means that the body has a problem withinsulin during pregnancy. When women are pregnant, thebody needs more insulin to keep blood sugar at the right level.Womens bodies make more insulin during pregnancy. Whenthe extra insulin is not enough to keep blood sugar normal,women get high blood sugar. Tis is called gestational diabetes.Blood sugar usually returns to normal aer delivery.


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Who gets gestational diabetes?About 7 out o 100 pregnant women get gestational diabetes.

Gestational diabetes is more likely or:

n Women who are overweight.

n Women with amily members who have had gestationaldiabetes.

n Women with amily members who have type 2 diabetes.

n Arican American, American Indian, and Hispanic/LatinaAmerican women.

How do I know if I have gestational diabetes?

Gestational diabetes starts during the second trimester. Mosto the time, doctors and midwives test or it in the 5th or 6thmonth o pregnancy. Women are tested by drinking a specialsugary drink and having their blood sugar checked soon aer.


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Why Treat

Gestational Diabetes?High blood sugar can cause the baby to get too big 9 poundsor more. Tis is the most common problem with gestationaldiabetes. It is called macrosomia (mak-ruh-SO-me-uh).A baby that is too big can cause problems during delivery.At birth, the baby can also have breathing problems or bloodsugar that is too low.

Women with gestational diabetes can

give birth to healthy babies.

Keeping blood sugar under control

may help prevent problems.

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Delivery OptionsI you have gestational diabetes, your doctor or midwie maydiscuss dierent delivery options. Te goal is to have a saedelivery and a healthy baby.

Many times doctors or midwives induce (or start) a womanslabor beore her due date i she has gestational diabetes.Sometimes this is done so the baby does not get so big. Research

cant tell us i inducing labor early is better or the mom andbaby than waiting or labor to start on its own.

Sometimes doctors or midwives suggest cesarean section, orc-section. It is another option to prevent problems with deliveryrom a big baby. A c-section is an operation done to deliverthe baby rom the moms belly. Research also cant tell us i ac-section is better or the mom and baby than inducing labor or

waiting or labor to start on its own.


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How Can I TreatGestational Diabetes?

Eating healthy and staying activeEating healthy and staying active are two o the most importantways to control blood sugar and treat gestational diabetes.Activities like walking and swimming are helpul. Te activitydoes not have to be hard. Te goal is to get up and move. alk

with your doctor or midwie about creating an exercise plan thatworks or you.

All women with gestationaldiabetes need to ollow a specialdiabetes meal plan. Your doctoror midwie may ask you to meetwith a diabetes educator or

dietitian. Diabetes educators ordietitians can help create a planjust or you.

Te diabetes meal plan ollowssimple guidelines like:

n Watching portion size.

n Eating a variety o oods,including resh ruits, vegetables, and whole grains.

n Limiting at calories to 30 percent or less each day.

Being careul about weight gain during pregnancy is also veryimportant to control gestational diabetes. Ask your doctor ormidwie how much weight gain is right or you.

ATo learn more about the diabetes meal plan, visit the National

Diabetes Inormation Clearinghouse Web site:

www.diabetes.niddk.nih.gov/dm/pubs/eating_ez


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MedicineMost women can control their gestational diabetes by ollowinga diabetes meal plan and being more active. Some will alsoneed insulin or diabetes pills to control their blood sugar.Insulin and two kinds o diabetes pills are used to treat

gestational diabetes. Tey all work to lower blood sugar. So ar,research shows that they all seem sae to use while pregnant.

InsulinInsulin needs to be injected (given by a shot). Te insulin youinject is like the insulin your body makes, but it is made in a lab.Tere are many kinds o insulin.

Diabetes pillswo kinds o diabetes pills have been used to treat gestationaldiabetes. Glyburide (Diabeta, Glynase Presab, Micronase)is a pill that helps raise the amount o insulin in the body.Metormin (Glucophage) blocks the liver rom makingglucose (sugar).

The two pills used to treat gestational diabetes are also

used or type 2 diabetes. I your doctor prescribes pills

or your gestational diabetes, you may want to look at

another guide. It is called Pills for Type 2 Diabetes:

A Guide for Adults (2007) and is available at the Web site:

www.effectivehealthcare.ahrq.gov .

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Learning About Blood Sugar

How is blood sugar tested?Blood sugar is tested by a nger stick done at home. Tis testuses a glucose meter that shows your blood sugar level. Yourdoctor or midwie can show you how to use the meter. Tey willprobably want you to check your blood sugar at dierent timeso the day.

Te chart below shows what blood sugar usually should beduring dierent times o the day. Ask your doctor or midwiewhat targets are right or you.

Time of blood sugar test Target blood sugar level

Beore eating Less than 95

One hour aer eating Less than 130

wo hours aer eating Less than 120

It is important to keep track o your blood sugar test results.Your doctor or midwie will use the results at your checkup todecide i you need to start medicine or blood sugar control. Iyou are already taking insulin or pills, it helps them decide i

your medicine needs to be adjusted.


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Watch for blood sugar that drops too lowBlood sugar that is too low is called hypoglycemia (high-po-gly-SEE-mee-ah). It can make you eel dizzy, sweaty,conused, shaky, hungry, and weak.

Both insulin and pills or gestational diabetes can cause bloodsugar to drop too low. More women using insulin develop very

low blood sugar than women taking metormin (Glucophage).

WarningI you think you may have

low blood sugar, eat or drink

something with sugar in itright away. Your doctor

or midwie may suggest

something

like hard candy, juice,

or glucose tablets.

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Watching for Type 2Diabetes After Delivery

Aer you give birth, gestational diabetes usually goes away.Blood sugar returns to normal aer delivery. You probably wontneed to keep checking your blood sugar at home with the ngersticks. But there are important things to keep in mind.

Women who have had gestational diabetes are more likely toget type 2 diabetes later in lie. Tey have a higher chance thanwomen who have not had gestational diabetes. Women whogain more weight than normal during pregnancy also have ahigher chance o getting type 2 diabetes later.

Tere are ways to help lower your risk o getting diabeteslater on. Staying at a healthy weight, ollowing a healthy diet,and being active can help. Tese small steps are importantduringand aferyour pregnancy.

Be sure to tell all your doctors and nurses that you hadgestational diabetes while you were pregnant. It is veryimportant to have your blood sugar checked at your doctorsofce rom time to time. Te test will make sure that you havenot developed type 2 diabetes. Your doctor or nurse can tell youhow oen you should have your blood sugar tested.


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About 60 out o 100 women who have

gestational diabetes will have

type 2 diabetes by 10 years ater their pregnancy.

The good news isyou can reduce your risk.

Stay at a healthy weight, eat a healthy diet,get active, and be tested regularly.


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Questions You Might HaveCan I control my gestational diabetes by eatinga healthy diet and staying active?Yes, most women with gestational diabetes can control theirblood sugar with the diabetes meal plan and exercise. It isalso important to be careul about your weight gain duringpregnancy. Work with your doctor or midwie to come up witha plan that works or you.

If I need medicine, can I take a pill or do I need a shot?For many women, a pill might be all that is needed to controlblood sugar. Some women will need to start insulin. alk toyour doctor or midwie about a treatment plan or you.

How often do I need to check my blood sugar?Some women will need to check their blood sugar several times

a day. Tis is usually done in the morning beore breakast andaer each meal. alk to your doctor or midwie about when youneed to check yours.

How soon do I need to be tested for type 2 diabetes after mydelivery? How often do I need to be tested?Research cant tell us exactly when and how oen you need tobe tested. Te important thing is that you test regularly. Having

gestational diabetes means that you are at high risk o gettingtype 2 diabetes later on.


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What Is theSource of This Guide?

Te inormation in this guide comes rom a detailed reviewo 45 research reports. Te review is called Terapeutic

Management, Delivery, and Postpartum Risk Assessment andScreening in Gestational Diabetes (2008) and was written by theJohns Hopkins University Evidence-based Practice Center.

Te review was updated in the journal Obstetrics&

Gynecologyin 2009.

Te Agency or Healthcare Research and Quality (AHRQ)created the Eisenberg Center at Oregon Health & ScienceUniversity to make research helpul or consumers. Tis guidewas written by Erin Davis, B.A., Martha Schechtel, R.N., BruinRugge, M.D., Valerie King, M.D., and David Hickam, M.D., o

the Eisenberg Center. Women with gestational diabetes helpedthe Eisenberg Center develop this guide.

Where Can I GetMore Information?

For an electronic copy o this guide and materials aboutchoosing treatments and medications or other conditions,visit this Web site: www.efectivehealthcare.ahrq.gov

For a free print copy, call:Te AHRQ Publications Clearinghouse(800) 358-9295

Ask or AHRQ Publication Number 09-EHC014-A

For more inormation about gestational diabetes,visit the MedlinePlus Web site:www.nlm.nih.gov/medlineplus/diabetesandpregnancy.html
http://www.effectivehealthcare.ahrq.gov/http://www.nlm.nih.gov/medlineplus/diabetesandpregnancy.htmlhttp://www.nlm.nih.gov/medlineplus/diabetesandpregnancy.htmlhttp://www.effectivehealthcare.ahrq.gov/


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AHRQ Pub. No. 09-EHC014-AAugust 2009

2009_0804gdm_cons_singlpgs.pdf

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