How Does Diabetes Affect My Pregnancy?

Photographed by Ashley Armitage.
Getting tested for gestational diabetes is just another necessary discomfort that comes along with being pregnant, but it is a pretty important one. If you have gestational diabetes, you usually have to make slight lifestyle changes during the rest of your pregnancy to ensure that you — and your baby — are healthy postpartum.
The reason all pregnant people are tested for this, is because gestational diabetes — as the name suggests — is a form of the illness that develops specifically in pregnancy.
"During pregnancy, the placenta makes several hormones that counteract the effect of insulin," says Rebecca Brightman, MD, assistant clinical professor and Ob/Gyn at the Icahn School of Medicine at Mount Sinai. As a result, the pancreas needs to make more insulin to control blood sugar. When the balance gets out of whack, resulting in higher glucose levels, that would be gestational diabetes, Dr. Brightman says.
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If gestational diabetes is controlled, then a pregnant person doesn't have to worry about birth or pregnancy risks any more than someone who doesn't have diabetes. "However, if gestational diabetes is poorly controlled, there can be both maternal and fetal risks," Dr. Brightman says.
For example, a person with gestational diabetes might be at an increased risk of high blood pressure, or preeclampsia, Dr. Brightman says. The baby is also at risk of being significantly larger than average, or "macrosomic," which can increase the risk of needing an emergency C-section. "Macrosomic fetuses face a more challenging delivery and are at risk of traumatic birth injury, shoulder dystocia," she says. Because of these potential complications, people who are diagnosed with gestational diabetes often require more sonograms and more frequent visits to their doctors towards the end of the pregnancy. "This is all in an effort to ensure fetal well-being," she says.
Luckily, if you have gestational diabetes there are some ways to prevent these complications from happening. "Typically most women with GDM can control their blood sugars by watching carbohydrates and monitoring their blood sugar levels," Dr. Brightman says. Often this requires working with your doctor to come up with a food plan that includes what, when, and how much to eat, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDKD).
Diet is important when a person has gestational diabetes, because it can impact blood glucose levels. If your blood glucose is too high, your body might make ketones, which means it's using fat for energy instead of glucose, according to the NIDDKD. And if you don't take steps to manage your glucose, there is an increased risk of still birth, birth trauma, and electrolyte abnormalities in your baby, Dr. Brightman says. Your doctor might ask that you use a blood glucose meter to ensure that you're staying within your target levels. In some cases, people with gestational diabetes might need to take an oral hypoglycemic medication or get insulin injections to maintain normal glucose levels, she says.
So, yes: gestational diabetes affects a person's pregnancy quite significantly. The good news is that it can be well-controlled and diagnosed during the late second and early third trimester. And while it might be a pain to have to take the extra steps to keep your glucose in check, there is a light at the end of the tunnel. Though you'd always want to be tested to be sure you're in the clear, Dr. Brightman says "gestational diabetes usually resolves postpartum."
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