Prenatal Monitoring and Care
The Lasting Impact of Gestational Diabetes on Mothers & Children: Q&A with Judith Fradkin, MD, NIDDK, National Institutes of Health
Dr. Judith E. Fradkin is director of the Division of Diabetes, Endocrinology, and Metabolic Diseases in the National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health. In her 30-year career at NIDDK, Dr. Fradkin has created or directed a diverse array of high-impact clinical and basic research programs. Dr. Fradkin graduated from Harvard College, earned her M.D. from the University of California at San Francisco in 1975, and completed an internship and residency at Harvard’s Beth Israel Hospital in Boston. In addition to her oversight of major biomedical research programs, she serves as an endocrinology consultant at the National Naval Medical Center in Bethesda, MD. In 2003 Dr. Fradkin received the American Medical Association’s Dr. Nathan Davis Award for outstanding public service in the advancement of public health.
Q: What is gestational diabetes?
A: Gestational diabetes is diabetes that is found for the first time when a woman is pregnant. Diabetes means that your blood glucose (also called blood sugar) is too high. You and your baby use glucose for energy. But too much glucose in your blood can be harmful and when you are pregnant, too much glucose is not good for you or your baby.
Changing hormones and weight gain are part of a healthy pregnancy. Both changes make it harder for your body’s insulin to do its job. When that happens, glucose levels may increase in your blood, leading to gestational diabetes.
Pregnant women are tested for gestational diabetes between weeks 24 and 28 of their pregnancy using a simple blood test. Gestational diabetes occurs more frequently among women with a family history of diabetes; overweight and obese women; and, African-American, Hispanic/Latina and American Indian women.
Even though gestational diabetes is, by definition, diabetes diagnosed during pregnancy, sometimes diabetes doesn’t go away after delivery. Even if glucose returns to normal after pregnancy, a history of gestational diabetes has a lifelong impact on the mother’s risk for developing diabetes. Diabetes is a serious disease that if not managed can lead to health problems with your heart, kidneys, eyes and nerves. And the mom isn’t the only one at risk—her child of that pregnancy may be at an increased risk for developing obesity and type 2 diabetes later in life. The good news is there are steps a woman can take to prevent or delay diabetes and lower that risk for both herself and her child.
Q: Why is gestational diabetes a concern during pregnancy?
A: Gestational diabetes may increase a woman’s risk of high blood pressure during pregnancy and could increase the need for cesarean section at delivery. Untreated or uncontrolled gestational diabetes can mean problems for the baby, such as being born very large and with extra fat, which can make delivery difficult and more dangerous for the baby. These babies may also experience low blood glucose right after birth as well as breathing problems.
Q: What types of prenatal monitoring and care are needed for gestational diabetes?
A: Managing gestational diabetes means taking steps to keep blood glucose levels in a target range. Many women who have gestational diabetes see a dietitian or a diabetes educator during pregnancy. Women with gestational diabetes can control their blood glucose with healthy eating, being active and by monitoring their blood glucose. Some women many need insulin or other medications. All women with gestational diabetes should work closely with their health care team to help ensure a healthy outcome for both mother and baby.
Q: What is the long-term impact of gestational diabetes on the health of mother and baby?
A: Having gestational diabetes increases a woman’s future chances of developing diabetes. About half will develop diabetes over the next 10 years. Additionally, the children of pregnancies where the mother had gestational diabetes may also be at increased risk for obesity and type 2 diabetes throughout their lives.
Q: What follow-up monitoring or care do women with gestational diabetes need after delivery?
A: Women with a history of gestational diabetes should be tested for diabetes 6 to 12 weeks after their baby is born. In many cases, their blood glucose levels return to the normal after delivery. Although they no longer have gestational diabetes, they are at high risk for developing diabetes in the future. Having gestational diabetes increases a woman’s future chances of developing diabetes by 35-60 percent. Any woman who had gestational diabetes should get tested for diabetes at least every three years to ensure early detection of diabetes if it does occur. This follow up testing is very important and usually consists of a simple blood test. The test can not only detect diabetes, but also a condition called pre-diabetes in which the glucose levels are higher than normal but not as high as in diabetes.
Women who had gestational diabetes and later have pre-diabetes are at especially high risk for diabetes, but can lower that risk by losing weight or taking the drug metformin. It is important that both the ob/gyn and primary care provider note the woman’s history of gestational diabetes in her health records. Women with a history of gestational diabetes should also talk to their health care provider about earlier screening for gestational diabetes in future pregnancies.
Q: How do gestational diabetes pregnancies affect the healthcare needs of children?
A: Because the children born from pregnancies affected by gestational diabetes may also be at increased risk for obesity and type 2 diabetes, it’s a good idea for mothers to let their child’s doctor know that they had gestational diabetes while they were pregnant with that child. This is an important part of the child’s health history and can alert the child’s doctor to monitor growth charts more closely. It is important to find any indication of overweight early so it can be addressed accordingly—such as following a healthy eating plan and being more active. These steps are good for everyone in the family.
Q: What can women who have experienced gestational diabetes do in the postpartum phase to protect their own health, and their infants’?
A: Many women who develop gestational diabetes see a dietitian or a diabetes educator to guide them in developing healthy habits during pregnancy. But what many women don’t realize is that it’s just as important to keep up with those healthy habits even after the baby is born.
For women who had gestational diabetes, it is important to get tested for diabetes 6-12 weeks after their baby is born, and at least every three years after that. Even after the baby is born, it is important for these women to reach and maintain a healthy weight by making healthy food choices, such as following an eating plan lower in fat and calories and high in fiber, and being active for at least 30 minutes, 5 days a week. Even if women with a history of gestational diabetes do not reach their “goal” weight, research shows that maintaining a healthy lifestyle can help lower their chances for developing diabetes in the future.
Like all mothers, women with gestational diabetes are encouraged to breastfeed their babies, if possible. Breastfeeding may help protect against childhood obesity, which is a risk factor for type 2 diabetes. For moms, breastfeeding can help them more quickly return to their pre-pregnancy weight.
Q: What can partners in health do to help?
A: Health care professionals can help raise awareness of the future health risks that having GDM places on both mother and child. Health care professionals can counsel women with a history of gestational diabetes about their future risk for developing diabetes and the healthy habits that can protect them and their child from developing obesity and type 2 diabetes. They should encourage their patients to be tested 6-12 weeks post-partum and at least every three years after that.
Health care professionals should also strongly encourage women with a history of gestational diabetes to continue the healthy habits they practiced during pregnancy and to continue to maintain a healthy lifestyle that will benefit the entire family. It’s important to remind the mom that just because the diabetes may “go away” after the baby is born, her risk for diabetes – and her baby’s risk for obesity and type 2 diabetes – doesn’t go away.
The National Diabetes Education Program, jointly sponsored by the NIH, the Centers for Disease Control and Prevention, with support from over 200 partner organizations, provides diabetes education to improve the treatment and outcomes for people with diabetes, promote early diagnosis, and prevent or delay the onset of diabetes. For more information, including “It’s Never Too Early …to Prevent Diabetes,” a free tip sheet for women with a history of gestational diabetes, call the NDEP at 1-888-693-NDEP (1-888-693-6337) or visit www.YourDiabetesInfo.org/GDM.