Pregnancy with Gestational Diabetes – Monitoring During Pregnancy and After

Pregnancy with gestational diabetes requires extra care.   Prenatal visits may be more frequent, and close blood sugar monitoring may be necessary.

Prenatal Visits

Most women who develop gestational diabetes have more frequent prenatal visits (once every week or two), especially if insulin is used. The purpose of these visits is to monitor your and your baby’s health, discuss your diet, and adjust your dose of insulin to keep your blood sugar levels near normal. It is common to change the dose of insulin as the pregnancy progresses, as insulin requirements usually increase as the pregnancy progresses.

 

Nonstress Testing

You may need tests to monitor the health of the baby during the last trimester of pregnancy, especially if your blood sugar levels have been high, you are using insulin, or if you have any pregnancy-related complications, such as high blood pressure. The most commonly used test is the nonstress test. This is done by monitoring the baby’s heart rate with a small device that is placed on the mother’s abdomen. The baby’s baseline heart rate should be between 110 and 160 beats per minute and should increase above its baseline by at least 15 beats per minute for 15 seconds when the baby moves.

The test is considered reassuring (called “reactive”) if two or more fetal heart rate increases are seen within a 20 minute period. Further testing may be needed if these increases are not seen after monitoring for 40 minutes.

 

Labor and Delivery

If your blood sugar levels are close to normal during pregnancy and you have no other complications, the ideal time to deliver is at term or between 39 and 40 weeks of pregnancy.

If you do not deliver by your due date, you may need additional testing to monitor your and your baby’s health. In most cases, if the baby is normal size, you can have a vaginal delivery. Blood sugar levels will be monitored during labor. High blood sugar levels during labor can cause problems in the baby, both before and after delivery. Insulin is not usually required unless your blood sugar level becomes elevated (above 90 mg/dL or 5 mmol/L).

 

After Delivery

As soon as the baby is delivered, most women with gestational diabetes go back to having normal blood sugar levels and do not require further treatment with insulin. If this is the case, you can return to your pre-pregnancy diet.  Breastfeeding is encouraged.

If your blood sugar level is normal after delivery, you should have testing for type 2 diabetes at six weeks postpartum. Testing usually includes a two-hour glucose tolerance test (GTT).

Overall, women with gestational diabetes have an increased risk of developing type 2 diabetes later in life, especially if the woman has other risk factors such as obesity, or family history of type 2 diabetes. The risk is greatest in the first five years after the pregnancy.  If you are overweight or obese, you can reduce your risk of type 2 diabetes by losing weight and exercising regularly. The American Diabetes Association recommends that all women with a history of gestational diabetes have testing for type 2 diabetes at least every three years after their pregnancies. Women who have gestational diabetes after age 45 should have testing once per year.

Read more about Gestational Diabetes:

 


 Reviewed by Dr. Mariela Glandt, Apr. 2013

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