(Diabetes, Gestational; GDM; Gestational Onset Diabetes Mellitus [GODM]; Glucose Intolerance During Pregnancy)
Glucose comes from the breakdown of food. It is the body's energy source. It can pass from the blood to cells with a hormone called insulin. Without insulin, glucose will build up in the blood. This is called hyperglycemia. At the same time, your body's cells are starved for glucose (energy).
When this happens during pregnancy it is called gestational diabetes. The extra glucose in the blood can cross to the baby. This condition can cause problems for the mother and baby.
Large Baby Due to Gestational Diabetes
The exact cause is unknown. But these factors may contribute to the condition:
- Hormones needed for the baby's growth interfere with insulin
- Excess weight increases insulin resistance
- Insulin resistance prevents the body from effectively using insulin
These factors increase your chance of developing this condition:
- Obesity]]> or being overweight
- Family members with ]]>diabetes]]>
- Age: 25 or older
- Race: Hispanic, African-American, Native-American, Asian-American, Indigenous Australian, or a Pacific Islanders
- Gestational diabetes in a previous pregnancy
- Previous delivery of a large baby
- Previous stillbirth or too much fluid surrounding a baby during pregnancy
- Glucose in urine
This condition may not cause any symptoms. If symptoms occur, they may include:
- Increased urination
- Recurring vaginal or urinary tract infections
If you are at high risk, you may need glucose testing as soon as possible. If your initial test is negative, you should be retested between 24-28 weeks of gestation.
If you are at average risk, you may be given the 50-gram glucose test (see below). This is given between 24-28 weeks of gestation.
If you are at low risk, you do not need glucose testing. To be low risk, you must meet all of the following criteria:
- Less than 25 years of age
- Normal weight before and during pregnancy
- Member of an ethnic group with a low risk of gestational diabetes
- No known diabetes in any siblings or parents
- No history of abnormal glucose tolerance
- No history of poor pregnancy outcomes
- Drinking a liquid high in sugar
- Taking a blood sample one hour later to measure the glucose level
In some cases, a urine glucose test may be done. These are not as reliable as the blood test.
- A three-hour glucose-tolerance test if the initial screening test shows an above normal sugar level
- Glucose monitoring in the morning and after meals
The aim of treatment is to return glucose levels to normal. Treatment includes:
- Eat a balanced diet]]> .
- Eat plenty of ]]>vegetables]]> , and ]]>fiber]]> .
- Limit the amount of fat you eat. Avoid food high in sugar.
- Eat ]]>moderate portions]]> of food at each meal.
- Eat a bedtime snack with protein and a starchy food.
- Do not gain more than the recommended amount of weight during pregnancy. Gaining too much weight can increase the risk of having:
- Keep a record of your food intake. Share this with your doctor.
]]>Physical activity]]> helps the body use glucose. The insulin you produce will be more effective. Ask your doctor about an exercise routine.
Blood Sugar Testing
Use a monitor to check your glucose levels. Show your doctor the results at prenatal visits.
If you've made lifestyle changes and your glucose levels stay above normal, you may need to inject insulin each day.
After delivery, glucose levels usually return to normal. You will need a glucose tolerance test 6-8 weeks after delivery. Exercising, breastfeeding, and losing weight will help to reduce your chance of developing ]]>type 2 diabetes]]> .
American College of Obstetricians and Gynecologists
American Diabetes Association
Canadian Diabetes Association
Women's Health Matters
American Diabetes Association. Position statement: gestational diabetes mellitus. Diabetes Care . 2003;26(suppl 1):S103-105.
American Dietetic Association. Nutrition practice guidelines for gestational diabetes mellitus.American Dietetic Association . 2001.
Buchanan TA, Xiang AH. Gestational diabetes mellitus. J Clin Invest . 2005;115:485-491.
Taylor JS, Kaemar JE, Nothnagh M, Lawrence RA. A systematic review of the literature associating breastfeeding with type 2 diabetes and gestational diabetes. J Am Coll Nutr . 2005;24:320-326.
Urine glucose. EBSCO Health Library website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=81 . Updated May 2008. Accessed June 25, 2008.
Urine ketone testing. National Center for Chronic Disease Prevention and Health Promotion website. Available at: http://www.cdc.gov/nccdphp/ . Updated December 2005. Accessed June 25, 2008.
What is gestational diabetes? National Institute of Child Health and Human Development website. Available at: http://www.nichd.nih.gov/publications/pubs/gdm/sub1.htm . Accessed October 7, 2005.
*¹2/5/2009 DynaMed's Systematic Literature Surveillance
: Cheng YW, Chung JH, Kurbisch-Block I, Inturrisi M, Shafer S, Caughey AB. Gestational weight gain and gestational diabetes mellitus: perinatal outcomes.
Hillier TA, Pedula KL, Vesco KK, et al. Excess gestational weight gain: modifying fetal macrosomia risk associated with maternal glucose. Obstet Gynecol. 2008;112:1007-1014.
Last reviewed February 2009 by ]]>Rosalyn Carson-DeWitt, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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