Did you know that what happens in pregnancy can affect your health later in life? While much of the focus during pregnancy is on making sure that you are healthy so your baby is healthy, it is important for you to continue to focus on your health long after delivery. For women that have high blood sugar during pregnancy (gestational diabetes), this is especially true.
Gestational diabetes is usually found after a screening test done around month 6 of pregnancy. Glucose is the body’s main source of energy. During pregnancy, the placenta helps transport glucose to your baby so your baby can grow. To do this, the placenta makes hormones that block your response to insulin (the hormone that helps you use and store glucose for energy), so you use less glucose and more gets to your baby. If your pancreas can’t make more insulin to overcome this effect, your blood sugar may rise. In this case, you may be asked to limit carbohydrates (e.g. bread, pasta, starchy vegetables, rice, fruit) in your diet and check your blood sugars. You will also need to stop eating and drinking simple sugars (e.g. juice, soda, sweet tea, candy). If diet changes don’t work well enough, you may also have to take pills or shots during pregnancy to control blood sugars. This is important so that your baby doesn’t get too big, come early, or have other problems.
For most women, blood sugars go back to normal on their own after the baby is born. However, half of all women who have had gestational diabetes may go on to get type 2 diabetes. For this reason, any woman who has had gestational diabetes should get regular screening for diabetes. This is recommended at 6-12 weeks after delivery, usually with an oral glucose tolerance test (like the test done during pregnancy to diagnose gestational diabetes). Women should then have a diabetes screening test every 1-3 years for the rest of their lives. This can be done with an easier, non-fasting blood test called a hemoglobin A1C (HbA1C).
The good news is that type 2 diabetes is preventable. Regular moderate exercise (150 minutes per week) and weight loss of 7% (usually ~10-20 lbs.) has been shown to cut the risk of developing diabetes in half. Continuing low carbohydrate diet habits from pregnancy can help achieve this. The YMCA's Diabetes Prevention Program can help you meet these goals. Your doctor may also recommend using a medicine called metformin to reduce the risk of developing diabetes. In women with gestational diabetes, this may be as effective as diet and exercise in diabetes prevention. For these reasons, it is important to tell your doctor that you had gestational diabetes and get screened regularly.
Despite this, while caring for a new baby, getting to the doctor to get screened for diabetes after pregnancy may not always be the top priority. If you are a woman who had gestational diabetes, there is a study ongoing at Washington University that may interest you. We want to hear about your experience during and after pregnancy and some of the challenges you may have encountered in getting needed follow-up care. For an interview lasting 60-90 minutes, you will be paid $50 cash and transportation and childcare can be provided. Please call Roxy at 314-853-2749 for more information.
Written by: Cynthia Herrick, MD, MPHS - Washington University School of Medicine