Gestational diabetes second pregnancy

4 Practical Tips to Help Avoid Gestational Diabetes

Pregnancy can be stressful – there’s a lot to think about and even avoid during those nine months. Taking the right supplements. Avoiding certain types of fish and raw foods. Steering clear of some medications. Controlling blood sugar. The list goes on.

Attempting to control blood sugar should be amongst the most important on that list, as one in seven pregnant women develop gestational diabetes. This condition happens during pregnancy when the body becomes more resistant to insulin and doesn’t make the proper amount of insulin to regulate blood sugar.

There are two main reasons to avoid gestational diabetes. First, moms who are diagnosed with gestational diabetes are at greater risk for developing type 2 diabetes 5-10 years down the road. Second, babies of moms with gestational diabetes are at greater risk for having a heavier birth weight, a cesarean delivery, and birth complications. Kids of moms with gestational diabetes are also at a higher risk of struggling with obesity, and developing type 2 diabetes later in life.

The good news is that healthy lifestyle choices can help you avoid gestational diabetes, and if you do end up with the condition, it can be well managed with the proper medical interventions.

With so much to think about during pregnancy, here is a practical list of things women can do to help avoid the condition.

  1. Achieve a healthy weight and make good lifestyle choices before conception

    It’s much easier to achieve a healthy weight when your body isn’t supporting two people. Controlling your weight and blood sugar before pregnancy will give you and your baby a healthy start.

  2. Exercise

    Exercise can help prevent too much weight gain during pregnancy, which in turn helps lower your risk for gestational diabetes. It also helps your body be more sensitive to the insulin your pancreas is making allowing better blood sugar control. Shoot for 30 minutes of moderate intensity, low-impact cardiovascular exercises most days per week. Walking, swimming, stationary biking, and the elliptical are all good choices. Please check in with your doctor before beginning any exercise program.

  3. Eat good-for-you foods

    Achieving a healthy diet will help you achieve a heathy amount of weight gain during pregnancy. Eat controlled portions of healthy carbs, such as whole grains, non-starchy vegetables, fruits, beans, legumes and low-fat dairy. Stick to lean proteins and foods with healthy fats such as nuts. Limit added sugar and avoid sugary beverages as much as possible. Drink lots of water.

  4. Keep your OB appointments

    Make sure you attend all of your scheduled doctor’s visits. Around weeks 24-28, you will be screened for gestational diabetes. If you are diagnosed with the condition, it will be important to see a Certified Diabetes Educator or Registered Dietitian. He or she will help you with lifestyle management as well as glucose monitoring.

While these tips can definitely help you prevent gestational diabetes, some individuals will still struggle to control their blood sugar despite living a healthy lifestyle. Some moms will need further intervention such as insulin injections. However, when blood sugars are kept in a good range, know that by doing so you are giving yourself and your baby the healthiest possible start.

The Risk of Recurrent Gestational Diabetes

If you’ve had gestational diabetes, there’s about a 45 to 65 percent chance that you’ll develop gestational diabetes again during future pregnancies. Specific risk factors for gestational diabetes include:

  • Race. Gestational diabetes is more common in African-Americans, American Indians, Asian-Americans, and Hispanic Americans.
  • Number of pregnancies. The risk of recurrent gestational diabetes increases with the number of pregnancies you have.
  • Insulin. If you needed insulin to control your sugar during your first pregnancy, your risk of gestational diabetes is higher.
  • Your baby’s weight. If your first baby was overly large at birth, you are more likely to have gestational diabetes in the future.
  • Your weight. If you are overweight, especially if you weigh over 190 pounds before your pregnancy, you are at higher risk for recurrent gestational diabetes. Your risk may also be increased if you gain weight between pregnancies or if you eat a high-fat diet.

What Can You Do to Decrease Your Risk of Gestational Diabetes?

Although there is no absolute way to prevent gestational diabetes during your next pregnancy, you can decrease your risk. Some gestational diabetes risk factors like your racial background cannot be changed, but there are risks you can control:

  • Your blood sugar. The American Diabetes Association recommends that women who have had gestational diabetes check their blood sugar regularly. Keep in mind that elevated blood sugar levels early in pregnancy can lead to serious birth defects. If you are thinking about getting pregnant again, have your blood sugar checked first and make sure it is well controlled.
  • Your weight. Being overweight increases your risk for all types of diabetes. Find out what your ideal body weight is. If you are more than 20 percent overweight, you are definitely at risk. Even if you only lose about 5 percent of your body weight, it will improve your body’s ability to process glucose and will lower your risk of diabetes substantially.
  • Your activity level. Being physically inactive is a big risk factor for diabetes. When you exercise, you use up glucose in your blood and enhance your body’s sensitivity to its own insulin. Walk, jog, dance, swim, or ride a bike — any activity that gets you moving for at least 30 minutes a day is a great way to reduce your risk.
  • Your diet. Women who eat a diet high in fiber prior to becoming pregnant are less likely to get gestational diabetes. One study found that every 10 grams of fiber in your daily diet can decrease your risk of gestational diabetes by 26 percent. Get your fiber through a diet rich in fruits, vegetables, and whole grains and keep your calories from fat to fewer than 30 percent of your total diet.
  • Your general health. Along with eating a healthy diet and getting enough exercise, make sure your blood pressure is under control and monitor your cholesterol. See your doctor regularly, and if you need medication to help control your cholesterol or blood pressure make sure you take it as directed. If you smoke, you need to stop.

Managing your risk factors is well worth the effort. Remember that having gestational diabetes not only increases your risk for having diabetes during another pregnancy, it also increases your risk of developing type 2 diabetes later in life. The healthy lifestyle changes you put into place now will increase your chances of a future healthy pregnancy. Continuing these good habits into the future will also improve your odds of a longer and healthier life to enjoy with your children.

I’ve had gestational diabetes before. Will I get it again?

You may do. Two out of three mums who have had gestational diabetes in one pregnancy go on to develop it in their subsequent pregnancies. The good news is, there’s lots you can do to reduce your chances of getting it this time around.
There are many factors that affect how likely you are to develop gestational diabetes. While some of these, such as your ethnic origins, are out of your control, there are others that you can do something about. Making positive changes now will only benefit you and your next baby.
Be a healthy weight
Aim to be a healthy weight before you get pregnant. Try to bring your BMI (body mass index) below 25. A BMI of 25 or over is classed as overweight.
Try not to put on weight between pregnancies. If you knew your BMI before your last baby, try not to add more than three BMI points to your pre-baby score. Putting on weight may mean you’re more likely to develop gestational diabetes again. It may also increase your risk of developing type 2 diabetes in later life.
Eat a healthy diet

Choose unrefined food or whole foods, such as wholemeal and wholegrain breads and cereals, brown rice and wholemeal pastas. Your body has to work hard to turn these carbohydrates into sugars, making them a healthier choice.
Make sure you eat plenty of fruits and vegetables too. Although try to keep fruit to mealtimes. Due to the natural sugar content, fruit eaten as a snack may increase your blood sugar level significantly.
Try to eat foods low in saturated fats. Trim meat well to remove any fat, and grill rather than fry foods. If you do fry food, use polyunsaturated or monounsaturated oils, such as olive oil and sunflower oil. These oils are great for salad dressings, too.
It’ll help to keep gestational diabetes at bay if you eat regular meals at about the same time each day. If you want a snack choose complex carbohydrates such as bread, cereals, rice and pasta.
Take regular exercise
You can make a real difference by improving your fitness. Taking regular exercise in the year before you become pregnant will reduce your risk of developing gestational diabetes by about half.
Try to keep exercising once you’re expecting as well. There are plenty of safe exercises to do during pregnancy, such as yoga, Pilates, walking and swimming.
Don’t smoke
Smoking increases and possibly doubles your risk of developing gestational diabetes. It’s best to try to stop smoking before you get pregnant. Talk to your doctor if you’re finding it hard to quit.

Space your babies
When you get pregnant is not always something that’s under your control. But if you can, it is best to space your babies. Give yourself time to lose extra baby weight and achieve a healthy BMI.
Talk to your doctor well before you plan to get pregnant. Together, you can create a sensible exercise and eating plan that works for you. If your BMI is over 30, your doctor may also advise a higher dose of folic acid, which you should take for at least three months before you become pregnant.
Gestational diabetes rarely develops before 20 weeks. But because you’ve had it before, your midwife will arrange an early glucose tolerance test to check your sugar levels before you reach 20 weeks.
Learn how to prepare your body for another baby.

Carrying a Boy May Increase Mom’s Risk of Gestational Diabetes

With commenary by Baiju Shah, MD, PhD, associate professor of medicine, University of Toronto

Women who develop gestational diabetes mellitus—diabetes that occurs during pregnancy—are at greater risk of gestational diabetes in their next pregnancy. Having gestatational diabetes also puts you at risk for type 2 diabetes. Yet, predicting who will develop either type of diabetes has been difficult. Research has pointed to certain risk factors including ethnicity, age, obesity, and infant birth weight. Now a new study, published in the Journal of Clinical Endocrinology and Metabolism, has found that the gender of the baby is a risk factor as well.

Gestational diabetes mellitus (GDM) is caused by a defect in pancreatic β-cells, reducing their ability to produce enough insulin to compensate for insulin resistance, which typically occurs in the second half of a woman’s pregnancy. Insulin resistance occurs in all pregnant women, but those whose bodies can’t produce enough insulin will develop GDM.

The laregescale study of more than 640,000 pregnancies, found that women carrying a boy had a slightly increased risk of GDM. “We hypothesize that pregnancy with a boy leads to worse pregnancy-associated metabolic changes than pregnancy with a girl—this is why we see a higher rate of GDM in women carrying a boy,” says the study’s lead author, Baiju Shah, MD, PhD, associate professor of medicine, University of Toronto.

“Male fetuses seem to impact the mother’s metabolism—specifically, her pancreatic β-cells’ ability to produce insulin—more than female fetuses do,” he says. “But how the fetus causes this impact on the mother’s metabolism is not understood.”

Interestingly, the study found that if a woman had GDM in her first pregnancy, having a boy had no effect on her risk of having GDM in subsequent pregnancies. That’s probably because women with GDM in their first pregnancy are at such a high risk of having GDM again in the second pregnancy—around 40 percent—that the effect of the baby’s gender doesn’t make much difference, says Dr. Shah.

On the other hand, women who had GDM in their first pregnancy had a greater risk of developing type 2 diabetes post pregnancy if they had a girl. This suggests that these women likely have overall poorer metabolic functions to begin with since they developed GDM despite not carrying the “riskier” boy. This underlying risk puts them at increased risk of type 2 diabetes after the pregnancy.

The study adds to the literature about risk of gestational diabetes in women. “I think it’s worthwhile for women and their obstetricians to recognize that although we often worry about how the mother’s health and behaviors can impact the baby, we perhaps need to start thinking about how the baby can affect the mother’s health,” says Dr. Shah.

Women carrying boys should be aware of their increased risk of GDM. And women who had GDM and carried a girl through pregnancy may want to be more vigilant post-delivery and focus more on reducing their risks of type 2 diabetes through eating healthy, exercising and maintaining a healthy weight.

Last updated on 02/15/2017 Continue Reading Bariatric Surgery Before Pregnancy Lowers Risk for Gestational Diabetes View Sources

Maternal health: An unexpected diabetes diagnosis

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Most women anticipate some discomfort during pregnancy. But there can be serious problems, too. Here is how Maria Castillo of New Rochelle coped with a scary diagnosis:

Castillo had no reason to worry when she became pregnant with her second child last year. After all, she delivered her daughter, Ashley, now a thriving 4-year-old, without a hitch.

And she was feeling great when she visited her doctor at 27 weeks for a routine second-trimester checkup. So when Castillo’s lab tests came back this time around, she was shocked to learn that she had gestational diabetes, a condition in which pregnant women without previously diagnosed diabetes develop high blood glucose, or sugar, levels.

If left untreated, gestational diabetes puts a growing baby at an increased risk of excessive birth weight (which can lead to birth trauma or a C-section), respiratory distress, jaundice — even death. Mothers also have a higher chance of having high blood pressure and other complications that can threaten her life, and that of the child.

“It was scary,” says Castillo. “I had so many questions.”

Castillo’s obstetrician referred her to Dr. Patricia Connor Devine, who specializes in high-risk pregnancies at Bronxville’s Lawrence Hospital Center. Devine gave Castillo some good news: Mothers-to-be can help control gestational diabetes by keeping a close eye on blood-sugar levels, eating healthy foods, exercising and, if necessary, taking medication.

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Maria Castillo of New Rochelle was diagnosed with gestational diabetes while pregnant with her son, Allen. ( Video by Carucha L. Meuse / The Journal News)

A determined Castillo immediately took charge, instituting major lifestyle changes. It was tricky at first, but she soon learned how to test her blood sugar. Four times a day — first thing in the morning and after every meal — she would prick her finger with a small needle and place a drop of blood on a test strip. She then inserted the strip into a device that measured her sugar level, which she was told should not rise over 120 (milligrams per deciliter).

Keeping a food diary and tracking her sugar levels quickly taught her that she could no longer indulge in treats like pizza and tortillas.

She also had to cut out a favorite drink — soda. But the sacrifice paid off: Because of Castillo’s careful monitoring and dietary shifts, she didn’t need insulin injections or other drugs.

“She was an incredibly compliant patient,” says Devine.

Researchers don’t know what causes gestational diabetes, but any woman can get the disease, which affects up to an estimated 18 percent of pregnancies, according to the American Diabetes Association. However, some women like Castillo are at a greater risk.

She’s 35, and women over 25 are more likely to develop the condition. There is a strong family history of diabetes, which includes Castillo’s older sister, who had gestational diabetes as well. And Castillo is Hispanic, having emigrated from Mexico in 2001; for reasons that are unclear, pregnancy-related diabetes is more prevalent among African-American, Hispanic, American Indian and Asian women.

But because Castillo took such good care of herself after being diagnosed, her son, Allen, was born on Dec. 10, 2013, free of complications, and at a normal weight of 6½ pounds.

“He eats a lot,” she says. “His health is good.”

Castillo’s post-pregnancy health is good, too. The diabetes vanished after childbirth; all of her blood sugar tests have come back normal since then, which is typical. Yet Castillo must stay vigilant: Women who have had gestational diabetes are more than seven times as likely to develop Type 2 diabetes later in life.

“I tell patients this is a warning flag,” says Devine.

That means Castillo is continuing to eat better, and she’s passing along those habits to the rest of the family. She’s serving smaller portions at mealtime, and is trying to lure her partner, Alvaro Mendoza, away from soda by offering water flavored with lemons or strawberries instead. Plus, she plans to join a gym and currently attends a nutrition class at her daughter’s pre-school to learn more.

“Before, you eat whatever (you want),” she says. “Now, I go to a class, where they help you to eat smart.”

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Gestational Diabetes: Causes, Complications and Treatment

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For years, doctors believed that gestational diabetes affected three to five percent of all pregnancies. However, new diagnostic criteria puts the number closer to 10 percent according to the Centers for Disease Control and Prevention. The condition, which can strike any pregnant woman, usually develops in the second trimester between weeks 24 and 28, and typically resolves after baby is born.

If gestational diabetes is treated and well-managed throughout your pregnancy, “there’s no reason you can’t deliver a very healthy baby,” says Patricia Devine, M.D., perinatologist at New York-Presbyterian Hospital in New York City.

But gestational diabetes that goes untreated, or isn’t carefully monitored, can be harmful for both mother and baby. Consult our guide for risk factors, signs of gestational diabetes, and treatment options.

RELATED: 8 Things You Didn’t Know About Gestational Diabetes

What is Gestational Diabetes?

Gestational diabetes, or diabetes that is diagnosed during pregnancy in a woman who previously did not have diabetes, occurs when the pancreas fails to produce enough insulin to regulate blood sugar efficiently. “A hormone produced by the placenta makes a woman essentially resistant to her own insulin,” Dr. Devine explains.

Serious pregnancy complications include preeclampsia (a serious high blood pressure condition that can be fatal), preterm delivery, and delivery of overweight babies, often via Cesarean section. About 50% of women diagnosed with gestational diabetes in the United States eventually develop type II diabetes.

Unlike Type 1 or Type 2 diabetes, gestational diabetes only affects pregnant women. People who have type 1 diabetes, sometimes referred to as juvenile diabetes, are generally born with it. Type 2 diabetes accounts for 95 percent of all cases of diabetes in the U.S.; it occurs in adulthood and is triggered by lifestyle factors such as obesity and lack of physical activity.

RELATED: The OMG Guide to Gestational Diabetes

What Causes Gestational Diabetes?

It’s unclear why some women develop gestational diabetes while others do not. Doctors theorize that genetic predisposition, environmental issues (such as obesity prior to pregnancy), and/or behavioral factors (such as diet and exercise habits) may contribute.

The Centers for Disease Control and Prevention (CDC) reports that 2% to 10% of pregnancies are affected by gestational diabetes. Obesity stands out as the major risk factor for the disease, just like with type 2 diabetes. According to a 2014 CDC study, women who’ve never been diabetic before but who have high blood sugar during pregnancy can develop gestational diabetes. The Centers found a link between increasing rates of gestational diabetes and a rise in obesity in the U.S.

For women who’ve gained a significant amount of weight during pregnancy and are “borderline” diabetic, Elizabeth Pryor, M.D., FACOG, recommends discussing with your doctor the development of a diet plan so that you can minimize weight gain for the remainder of the pregnancy.

“Women who gain significant weight in pregnancy tend to deliver large babies,” said Dr. Pryor. “If your diabetes test is borderline, your doctor may consider repeating it later in pregnancy. Certain things that you can avoid that may help include soda drinks, juices, and ice cream. These are common culprits.”

Although the condition can strike any pregnant woman, there are several factors that could increase your chances of developing it. Risk factors include the following according to March of Dimes:

  • You’re older than 25.
  • You’re overweight or you gained a lot of weight during pregnancy.
  • You have a family history of diabetes. This means that one or more of your family members has diabetes.
  • You’re African-American, Native American, Asian, Hispanic or Pacific Islander. These women are more likely to have gestational diabetes than others.
  • You had gestational diabetes in a past pregnancy.
  • You had a baby in a past pregnancy who weighed more than 9 pounds or was stillborn.

RELATED: Tips for Healthy Pregnancy Weight Gain

Gestational Diabetes Symptoms

Many women with gestational diabetes have either no symptoms or very mild symptoms. Possible symptoms include fatigue, excessive thirst, blurred vision, frequent urination, weight loss despite an increased appetite, nausea, and vomiting.

If you’ve had gestational diabetes in a previous pregnancy, you have a 60 percent chance of developing it again, according to the American Diabetes Association. Additionally, half of all women with a history of gestational diabetes develop type 2 diabetes within 10 years of the onset of their gestational diabetes, so it’s important to maintain good exercise and nutritional habits after your baby is born.

RELATED: Warning Signs of Gestational Diabetes and Preeclampsia

Gestational Diabetes Diagnosis

Gestational diabetes usually develops around the 24th week of pregnancy, so you’ll probably be tested between 24 and 28 weeks. Pregnant women are given a gestational diabetes test in the form of a standard glucose screening that consists of swallowing a concentrated glucose substance and having blood-sugar levels tested one hour later.

If elevated blood-sugar levels are detected, a more thorough glucose tolerance test will be given, which involves an overnight fast, drinking another glucose beverage, and more blood work.

RELATED: What to Expect from a Glucose Tolerance Test

Gestational Diabetes Treatment

Your doctor will recommend diet modifications, such as limiting carbohydrates, and regular exercise to get the condition under control quickly and normalize blood sugar levels. But some women may require daily glucose testing and more intensive treatment, such as insulin injections.

Also, taking certain supplements—vitamin D and calcium, specifically—may lower blood sugar readings and improve other measures of metabolic health that can suffer with gestational diabetes, according to an Iranian study from 2014. The research, which was published in the journal Diabetologia, compared blood levels of women with gestational diabetes—some of whom had been given vitamin D and calcium supplements, and some of whom were given placebo pills—and found that “fasting blood glucose and cholesterol levels improved” in the supplement group but not the placebo group, according to the New York Times.

The findings come with a caveat, however:

“Vitamin D has some toxic effects on women and their babies, so we cannot recommend that all women should take it,” said the study’s senior author, Ahmad Esmaillzadeh, M.D., an associate professor at the Isfahan University of Medical Sciences. “But we can recommend it for people with gestational diabetes who are vitamin D deficient.”

RELATED: What to Eat: A Gestational Diabetes Diet Plan

Gestational Diabetes Complications

You can help minimize your baby’s chances of developing complications by carefully managing your gestational diabetes. The condition can cause a newborn to grow very big in utero (over 9 pounds), which may result in a traumatic delivery in which your baby could be injured. Having a very large baby also dramatically increases your chances of needing a cesarean section.

What’s more, “children of women with gestational diabetes are at risk for developing type 2 diabetes themselves,” says Danielle Downs, Ph.D., an associate professor of kinesiology and obstetrics and gynecology at Pennsylvania State University who conducts research on gestational diabetes.

But even normal-size babies who are born to mothers with untreated GDM are at greater risk of becoming overweight kindergarteners—and, consequently, overweight adults.

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  • By Andrea Dashiell

Parents Magazine

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