Getting diabetes when you’re pregnant leads to high risk of getting type 2 later on

When you are pregnant, your body goes through many changes that can affect your and your baby’s health. One thing doctors routinely screen for is gestational diabetes, a condition that happens during pregnancy when the expecting mother’s body can’t properly regulate blood sugar, causing it to rise.

The condition is important to detect, since it can lead to complications for both mom and baby, including bigger babies that lead to potential birth trauma and higher C-section rates, said Dr. Michael Paidas, chair of obstetrics, gynecology and reproductive sciences for the University of Miami Health System.

Gestational diabetes also can contribute to high blood pressure in pregnant women, called preeclampsia, and health problems later in life including increased risk of type 2 diabetes.

“There is this risk of diabetes subsequent to pregnancy,” Paidas said. “That’s why these patients need to be followed afterwards, as well.”

The Centers for Disease Control and Prevention estimates that 2 to 10 percent of pregnant women develop gestational diabetes in the United States.

You are at higher risk if you had gestational diabetes with a previous pregnancy, are obese and have a strong family history of diabetes, he said. Certain ethnic groups, including African Americans and Hispanics, also are at higher risk.

“In Miami, we are at higher risk because of the ethnic populations that we serve,” Paidas said.

Pregnant women are typically screened for gestational diabetes at the beginning of their third trimester, typically between 24 and 28 weeks. Higher risk patients are screened a little earlier, he said.

A blood test called a glucose screen is done first, where the mom drinks a sweet drink called glucola an hour before blood is drawn. If test results are abnormal, a glucose tolerance test will test blood after the expectant mother fasts overnight, and then one, two and three hours after drinking glucola.

A patient diagnosed with gestational diabetes is taught lifestyle changes to manage it.

Cut the carbs, limit juices and soda

“We counsel the patients, because diets that are heavily carbohydrate are what’s accounting for the gestational diabetes, so you have to modify your diet,” Paidas said. “Typically what happens is we have dietetic counseling and we explain that you need to shift the proportion of carbohydrate” in the diet to maintain a healthy ratio.

Sonia Angel, a dietitian and certified diabetes educator who leads the Diabetes and Nutrition Center at Memorial Regional Hospital in Hollywood, said women with gestational diabetes should follow a healthy diet and exercise plan.

Monitoring blood sugar with a small prick to a finger is the first thing that is taught, she said. Blood sugar levels are taken in the morning before eating and after meals.

Then patients are educated on how to manage the condition through a healthy diet, all while balancing their own health needs with nourishing their babies, Angel said.

“Pregnancy is not a good time for them to diet. So even though they are going through elevated blood sugars, we want to make sure that they have at least three meals and two snacks per day,” she said.

Women with gestational diabetes should avoid primarily refined sugars in the form of juices, sweet drinks and added sugars.

“The other thing we emphasize is to perhaps eat less carbohydrates in the morning hours,” Angel said. “The reason for that is their pregnancy hormone tends to raise their blood sugar more in the morning hours than the rest of the day.”

Eat a protein like eggs, lean ham or cheese in the morning, and save the fruit for an afternoon snack, she said.

Have protein at every meal, and make sure you have enough iron and calcium in your diet.

“I see a tendency lately for people to avoid dairy because they’ve heard the dairy is not that healthy or something like that, but they’re also compromising the amount of calcium they have in their diet,” Angel said. “So I emphasize that they should have at least two to three high calcium foods per day, which is Greek yogurt, cheese or low-fat milk.”

As for iron, get it from proteins like lean beef, chicken and eggs. Vegetarians can get iron from beans and lentils. Pregnant women also should eat a diet high in fiber, because high fiber carbs have a lesser effect on blood sugars and will help prevent constipation, Angel said.

Walking, stretching are important

Exercise also should be part of their daily routine.

“It doesn’t necessarily have to be hard-core cardio, but walking 15 to 30 minutes a day or doing stretching exercises,” Angel said. “Staying active is not only important for a healthy delivery, but also to prevent the blood sugars from going up. So we often tell moms, maybe they can have a 30-minute walk after lunch or dinner — or both.”

Paidas with the University of Miami said if blood sugar levels aren’t being managed by diet and exercise alone, then insulin is used.

“Generally, if we start seeing blood sugars that are 50 percent or more over the threshold, then we start insulin,” he said.

Risk of developing type 2 diabetes

After the pregnancy, women who develop gestational diabetes should continue to keep an eye on their blood sugar level.

“There’s a very high chance, when you look at it over the years, that more than 50 percent will develop type 2 diabetes,” Paidas said. “We consider pregnancy as a stress test for life. ... It’s a common theme to see where pregnancy complications will set the person up for risks afterwards.”