“I had gestational diabetes with my first pregnancy, and it wasn’t until I had complications in my second pregnancy that I learned it put me at higher risk. I thought that once the pregnancy was over, I was fine.”
- Women with Lived Experience
What is Gestational Diabetes?
Diabetes is a disease in which your body either can't produce insulin or can't properly use the insulin it produces to regulate glucose (sugar) levels. Generally, the food we eat is turned into glucose that our bodies use for fuel. The pancreas (an organ located near the stomach) releases insulin to stimulate the cells and the liver to absorb the glucose. When this does not happen, high levels of sugar can build up in the blood and lead to numerous health complications including kidney disease, retinopathy (eye damage), neuropathy (nerve damage) and heart disease.
During pregnancy, from hormone changes and the development of the fetus, there is added demand on the body to produce sufficient insulin. Gestational diabetes occurs when your body cannot produce enough insulin to handle these effects. If appropriate steps are taken to control blood glucose, a healthy delivery can be expected. However, your baby is at increased risk of being large (over 9lbs) which can cause difficulties with delivery, having abnormal blood sugar levels and developing Type 2 diabetes later in life. For most women, blood glucose levels return to normal after delivery but developing gestational diabetes increases the risk for Type 2 diabetes later in life. Gestational diabetes also increases the risk of preeclampsia (complication of high blood pressure during pregnancy and post-partum) and for pre-mature cardiovascular disease.
Risk Factors
It is recommended by Diabetes Canada that all women who do not already have a diabetes diagnosis be offered screening for gestational diabetes between 24 – 28 weeks of pregnancy. This is done with the oral glucose tolerance test which measures your body’s glucose level after consuming a high sugar drink. Although all pregnant women are recommended to be screened for diabetes, some may be more at risk than others for developing the condition and may be screened earlier. Factors that increase the risk of developing gestational diabetes include:
- Age (being 35 years or older)
- Ethnicity (being of Aboriginal, Hispanic, Asian, South Asian, or African descent)
- Obesity or an elevated waist circumference
- Having a diagnosis of pre-diabetes or Type I or Type II diabetes, high blood pressure, high cholesterol, or schizophrenia
- Giving birth to a baby weighing more than 9lbs
- Previous pregnancy with gestational diabetes
- Having a diagnosis of polycystic ovary syndrome (PCOS), or acanthosis nigricans (a skin disorder)
- Use of corticosteroids during pregnancy
Treatment
The first line of treatment for gestational diabetes is maintaining physical activity and healthy nutrition. However, some women may need medications in the form of insulin injections or oral pills to help control their blood glucose levels. Checking and keeping track of your blood glucose helps both you and your health care professionals manage your gestational diabetes, keeping yourself and your growing baby healthy. Diabetes Canada recommends the following glucose target ranges for women with gestational diabetes but consult your healthcare practitioner to discuss your specific target range.
| Target Blood Glucose Before a Meal | Target Blood Glucose 1-Hour After a Meal |
Target Blood Glucose 2-Hours After a Meal |
|
| Women with Gestational Diabetes | < 5.3mmol/L | < 7.8 mmol/L | < 6.7mmol/L |
What You Can Do
- Attend all your pre-natal appointments for continuous monitoring of your health and the health of your baby.
- Monitor your blood sugar. Checking and keeping track of your glucose levels helps manage your gestational diabetes. Use the Pregnancy Passport Tool to help you track.
- Maintain physical activity. Pregnant women should aim for 30 minutes of moderate activity most days of the week. However, with some complications such as high blood pressure and preeclampsia it may not be recommended. Consult with your healthcare team before engaging in physical activity.
- Aim for a healthy diet of fruits and vegetables, whole grains, healthy fats, and protein (lean meats and/or plant based). Choose items that are high in salt, sugar and fat less often.
- Get tested for diabetes after pregnancy. The guidelines from Diabetes Canada recommend that women be screened for diabetes between 6 weeks and 6 months postpartum with an oral glucose tolerance test. Additionally, screening for diabetes should also take place before planning another pregnancy and at least every three years.
Gestational Diabetes and Heart Disease
Although most women who develop gestational diabetes will recover and deliver healthy babies, there are lasting complications. Research has shown that 30% of women who had gestational diabetes developed Type 2 diabetes within the next 15 years. Additionally, women who have had gestational diabetes are twice as likely to have a heart attack or stroke within 10 years after giving birth. Heart disease and stroke occur three to five times more often in people with diabetes.
There are several risk factors for developing Type 2 diabetes that are also risk factors for developing heart disease such as high blood pressure, high cholesterol, excess body weight, people who smoke, family history and ethnicity. The good news is that health behaviours play a leading role in cardiovascular health, and it is estimated that 80-90% of premature heart disease can be prevented with lifestyle modifications.
Know Your Risk
Speak to your healthcare provider. Inform your healthcare provider about your pregnancy history, including the number of pregnancies, history of preeclampsia, gestational hypertension and/or gestational diabetes, number of miscarriages and/or stillbirths. It is also important to note any family history of diabetes, high blood pressure, high cholesterol, or heart disease. Don't have a healthcare provider or need help interacting with your healthcare provider? Click here to learn more.
Know your numbers. It is recommended that women who have had gestational diabetes be routinely screened for risk of heart disease. This includes checking blood pressure, cholesterol, and glucose levels. Use the Pregnancy Passport Tool to help you track.
Reduce the Risk
There are a number of lifestyle factors that help reduce the risk of heart disease. You can improve your chances of being heart healthy by being aware of the risks and keeping the following factors in optimal range.
- Smoking cessation. Quitting smoking is the most important thing you can do to positively affect your heart health. It is never too late to quit.
- Get moving. Aim to engage in at least 150 minutes of moderate to vigorous exercise every week. That is an average of 30 minutes per day and can be broken down to as little as 10 minutes at a time.
- Follow a healthy heart diet. Look to incorporate lots of fruits and vegetables, whole grains, lean meat and/or plant-based proteins into all your meals. Reduce the number of foods that have high saturated fat and high salt content.
- Aim to achieve your best weight. Best weight is the weight you can maintain when living the healthiest life you are able.
- Reduce your alcohol intake. Less is best. We recommend you do not drink alcohol. But if you do, no more than 2 drinks/day or 6 drinks/week.
- Manage stress. Make time for yourself and discover what helps you relax. Stay connected to others and seek support if stress becomes a concern.