Gestational diabetes

If you're at average risk of gestational diabetes, you'll likely have a screening test for gestational diabetes during the second trimester. That test often happens between 24 and 28 weeks of pregnancy.

If you're at high risk of diabetes, you may have the screening test earlier in pregnancy. Some pregnant people at high risk for gestational diabetes have the test during their first prenatal visit.

Factors that could put you at high risk of gestational diabetes include being overweight or obese before pregnancy; having a parent or sibling with diabetes; or having had gestational diabetes during an earlier pregnancy.

Tests for gestational diabetes

Screening tests for gestational diabetes most often include:

• Initial glucose challenge test. You drink a syrupy glucose solution. One hour later, you have a blood test to measure your blood sugar level. A blood sugar level of 190 milligrams per deciliter (mg/dL), or 10.6 millimoles per liter (mmol/L), means you have gestational diabetes.

  A blood sugar level below 140 mg/dL (7.8 mmol/L) usually is thought to be within the standard range on a glucose challenge test. But this may vary by clinic or lab.

  If your blood sugar level is higher than expected, you'll need another glucose tolerance test to find out if you have gestational diabetes.

• Follow-up glucose tolerance testing. This test is like the first test. But the sweet drink has even more sugar. Your blood sugar is checked every hour for three hours. If two of the blood sugar readings are higher than expected, that means you have gestational diabetes.

Treatment for gestational diabetes includes:

• Lifestyle changes.
• Blood sugar monitoring.
• Medicine, if needed.

Keeping your blood sugar level in a good range helps keep you and your baby healthy. It also may help you avoid some problems during pregnancy and delivery.

Lifestyle changes

Your lifestyle is an important part of keeping your blood sugar in a healthy range. Because your body is working hard to support your growing baby, it's not a good idea to lose weight during pregnancy. But your healthcare professional can help you set weight gain goals based on your weight before pregnancy.

Healthy lifestyle choices include:

• Healthy diet. A healthy diet focuses on foods that are high in nutrition and fiber and low in fat and calories. It includes fruits, vegetables, whole grains and lean protein. A healthy diet limits refined carbohydrates. These include white bread, white rice and sweets.

  A registered dietitian or a certified diabetes care and education specialist can help you with meal planning. Those plans usually are based on a pregnant person's weight, pregnancy weight gain goals and blood sugar level. The amount of exercise you get, foods you like to eat and your budget also should be part of the planning.

• Staying active. Regular physical activity plays a key role in every wellness plan before, during and after pregnancy. Exercise lowers your blood sugar. And regular exercise can help ease some common discomforts of pregnancy. These might include back pain, muscle cramps, swelling, constipation and sleep problems.

  With your healthcare professional's OK, try to do 30 minutes of moderate exercise most days of the week. If you haven't been active before, start slowly and build up little by little. Walking, cycling and swimming are good choices during pregnancy. Everyday activities such as housework and gardening also count.

Blood sugar monitoring

While you're pregnant, your healthcare team may ask you to check your blood sugar level four or more times a day. Most people need to do that first thing in the morning and after meals. This is to make sure your blood sugar stays within a healthy range.

Medicines

If diet and exercise aren't enough to keep your blood sugar in a healthy range, you may need insulin shots to lower your blood sugar. A small number of people with gestational diabetes need insulin to reach their blood sugar goals.

Some healthcare professionals prescribe medicine taken by mouth to manage blood sugar levels. Others believe that more research is needed to make sure those types of medicines are as safe and work as well as insulin shots for gestational diabetes.

Watching your baby closely

Throughout your pregnancy, your healthcare professional may check your baby with ultrasounds or other tests. If you don't go into labor by your due date, your healthcare professional may start labor. This is called inducing labor. Delivering after your due date could raise the risk of health problems for you and your baby. In some situations, the healthcare team may suggest inducing labor before a pregnancy due date.

Follow-up after delivery

Your healthcare professional checks your blood sugar after delivery and again in 6 to 12 weeks. This is to make sure that your blood sugar has returned to the standard range. If your blood sugar level is back in that range, you'll need to have your diabetes risk checked at least every three years.

If tests show that you have prediabetes, talk with your healthcare professional about steps you can take to help prevent it from turning into type 2 diabetes. If test results show you have type 2 diabetes, work with your healthcare team to make a plan to control it.

It can be stressful to know you have a condition that may affect your baby. The steps that help control blood sugar, such as healthy eating and exercising, may help relieve stress too. They also can nourish your baby and help prevent type 2 diabetes in the future.

It also may ease your stress to learn more about gestational diabetes. Talk to your healthcare team or read books and articles about this condition. You may find a support group for people with gestational diabetes helpful. Ask your healthcare team for guidance.

You'll likely find out you have gestational diabetes from routine screening test during your pregnancy. Your healthcare professional may refer you to other health professionals who specialize in diabetes. These might include an endocrinologist, a certified diabetes care and education specialist, and a registered dietitian.

You may want to ask a family member or friend to go to your appointment with you to help remember all the information you get.

Here's some information to help you get ready for your appointment.

What you can do

When you make the appointment, ask if you need to fast before lab tests or if you need to do anything else to prepare. Make a list of:

• Any symptoms you have. Include those that might not seem linked to gestational diabetes.
• Key personal information, including major stresses or recent life changes other than being pregnant.
• All medicines, vitamins or supplements you take, including the doses and how often you take them.
• Questions to ask your healthcare professional.

Some basic questions to ask include:

• What can I do to help control my condition?
• Can you suggest a registered dietitian or certified diabetes care and education specialist who can help me plan meals, create an exercise program and learn ways to cope?
• Will I need medicine to control my blood sugar?
• For what symptoms should I seek medical attention?
• Are there brochures or other printed materials I can take? What websites do you recommend?

What to expect from your doctor

Your healthcare professional might have questions for you, including:

• Have you been more thirsty than usual or urinated more than usual? If so, when did these symptoms start? How often do you have them?
• Do you have a parent or sibling who has diabetes?
• Have you been pregnant before? Did you have gestational diabetes during your earlier pregnancies?
• Did you have other problems in earlier pregnancies?
• If you have other children, how much did each weigh at birth?