Gestational Diabetes: Managing Risk During and After Pregnancy

October 6, 2015 Brigham and Women's Hospital

The initial approach to treating gestational diabetes mellitus is to control a mother’s blood glucose levels with healthy eating and physical activity.

Gestational diabetes mellitus (GDM) is a type of diabetes that occurs only in pregnancy. It comes on in the second half of pregnancy, and it goes away after delivery. Obesity is one of the main risk factors for GDM. In the United States, most health centers screen all women for gestational diabetes, because obesity is becoming so common in the overall population. It’s estimated that five percent of all pregnancies are complicated by GDM. The rates of GDM are even higher in Hispanic and non-white populations, ranging from 10 to 20 percent of pregnancies.

Women with GDM may require high-risk pregnancy care due to complications that may arise during pregnancy and childbirth. Women with GDM have an increased risk of preeclampsia, which is a type of high blood pressure that develops during pregnancy. Preeclampsia is a serious condition that can lead to early delivery. Women who have gestational diabetes also may have larger babies, increasing their risk of cesarean section.

While GDM goes away after pregnancy, the health risks to a mother and her child persist. Research has found that 50 to 70 percent of women who have gestational diabetes develop type 2 diabetes later in life. Research also has found that babies born to mothers with GDM have a higher birth weight and may become obese during adolescence, increasing their risk of developing diabetes and other conditions, such as high blood pressure.

The initial approach to treating GDM is to control a mother’s blood glucose levels with healthy eating and physical activity. Lifestyle changes, such as healthy eating and physical activity, are effective in controlling blood glucose levels in about 60-75 percent of women with GDM. If the lifestyle changes don’t work, insulin therapy is started to control a mother’s blood sugar for the rest of her pregnancy.

In the video below, Ellen Seely, MD, Director of Clinical Research in the Division of Endocrinology, Diabetes and Hypertension at Brigham and Women’s Hospital, discusses the health risks associated with GDM during and after pregnancy. Dr. Seely also describes Balance after Baby, a web-based pilot program designed to educate women on eating healthfully and increasing their physical activity, with the goal of helping them lose their pregnancy weight within a year of giving birth.

Dr. Seely emphasizes that although women who have had gestational diabetes face an increased future risk for type 2 diabetes, they can take steps to decrease that risk.

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– Jamie R. 

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