Diabetes & Gestational Diabetes

If you had type 1 or type 2 diabetes before pregnancy, careful blood sugar management is particularly important throughout pregnancy. Pregnancy changes how your body responds to insulin, so your medication needs may change as pregnancy progresses.

Your pregnancy care will typically include additional monitoring, which may include:

• Maternal-Fetal Medicine (MFM) consultation to help manage diabetes and pregnancy-specific risks.

• A detailed Level II anatomy ultrasound to evaluate your baby's development.

• A fetal echocardiogram, which is a specialized ultrasound that looks closely at your baby's heart.

• Additional ultrasounds later in pregnancy to monitor your baby's growth.

• Antenatal testing later in pregnancy to monitor your baby's well-being. This typically includes nonstress tests (NSTs), which monitor your baby's heart rate, and ultrasounds to evaluate amniotic fluid and/or other measures of your baby's well-being.

If blood sugar is well controlled and you and your baby are doing well, delivery is often planned around 39 weeks. Earlier delivery may be recommended depending on blood sugar control, your baby's growth, or other pregnancy complications.

• Pregnancy with Type 1 or Type 2 Diabetes (ACOG)

• Diabetes & Women (ACOG)

Gestational diabetes (GDM) occurs when blood sugar levels become elevated during pregnancy. Pregnancy hormones naturally make the body more resistant to insulin, and some patients are unable to produce enough additional insulin to keep blood sugar within the recommended range.

Most people with gestational diabetes have healthy pregnancies. Keeping blood sugar well controlled helps reduce the risk of complications, including excessive fetal growth, birth complications, newborn low blood sugar, and certain pregnancy complications.

If you are diagnosed with gestational diabetes, we will typically refer you Novant Health's Gestational Diabetes Team. They will help teach you how to check your blood sugar, review recommended glucose targets, and discuss nutrition and lifestyle changes.

We usually begin with dietary changes, regular physical activity, and home blood sugar monitoring. If these changes are not enough to keep your glucose within the recommended range, medication, most commonly insulin, may be recommended.

Your prenatal care will depend partly on how your blood sugar is controlled and whether medication is needed. Some patients will need additional ultrasounds to monitor their baby's growth and antenatal testing later in pregnancy. Delivery timing is individualized based on glucose control, medication use, your baby's growth, and other pregnancy factors. For many patients requiring medication with good glucose control, delivery is planned around 39 weeks.

• Gestational Diabetes (ACOG)

• How Gestational Diabetes Can Impact Your Baby (ADA)

• You Can Have a Healthy Pregnancy with Gestational Diabetes (ACOG)

• Managing a Pregnancy with Gestational Diabetes (ACOG)

• Gestational Diabetes FAQ (Mama Doctor Jones, video)

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After you are diagnosed with gestational diabetes, you will typically be asked to check your blood sugar four times each day. Your gestational diabetes team will teach you how to use your glucose meter and how to record and share your results.

Unless you are given different instructions, check your blood sugar:

• Fasting: First thing in the morning, before eating or drinking

• 1 hour after breakfast

• 1 hour after lunch

• 1 hour after dinner

Our usual blood sugar goals during pregnancy are:

Fasting: less than 95 mg/dL
1 hour after meals: less than 140 mg/dL

Continue keeping a record of your readings so your diabetes team can review your glucose trends and determine whether any changes to your nutrition, activity, or treatment plan are needed.

• How to Check Your Blood Sugar (ParkView Health, video)

You do not need to eliminate carbohydrates when you have gestational diabetes. The goal is to choose nutritious carbohydrate sources, balance them with protein and healthy fats, and spread carbohydrate intake throughout the day rather than eating large amounts at one time.

Regular physical activity can also help improve blood sugar levels. For many patients, even a short walk after meals can be helpful. Follow any pregnancy-specific activity restrictions your care team has given you.

• Dietary Recommendations for Gestational Diabetes (UCSF Health)

• Diabetes During Pregnancy: Diet Tips (UCSF Health)

• Optimizing Diet for Diabetes During Pregnancy (Ohio State Medical Center, video)

• Optimizing Diet for Diabetes During Pregnancy, Part 2 (Ohio State Medical Center, video)

• Meal Planning for Diabetes (ADA)

• Reading Food Labels (ADA)

For most patients, gestational diabetes improves quickly after delivery. We will usually check your blood sugar at least once while you are in the hospital after your baby is born. If your blood sugar has returned to a normal range, additional blood sugar checks, strict dietary modifications, and diabetes medications can usually be discontinued. If your blood sugar remains elevated, we may recommend continued monitoring or additional follow-up.

We will also recommend repeat diabetes testing around the time of your 6-week postpartum visit to make sure your blood sugar has returned to normal. Traditionally, this is done with a fasting 2-hour glucose tolerance test, although other options may sometimes be appropriate, such as checking a hemoglobin A1c or monitoring your blood sugar at home for several additional days. We can discuss which approach makes the most sense for you.

Even when your postpartum testing is normal, having gestational diabetes is important for your future health. It increases your risk of developing gestational diabetes again in a future pregnancy as well as your lifelong risk of developing type 2 diabetes. Because of this, continued diabetes screening with your primary care provider is important over time.