For most women, gestational diabetes doesn't cause noticeable signs or symptoms. Rarely, gestational diabetes may cause excessive thirst or increased urination.

When to see a doctor
If possible, seek health care early — when you first think about trying to get pregnant — so your doctor can evaluate your risk of gestational diabetes. Once you become pregnant, your doctor will address gestational diabetes as part of your regular prenatal care. If you develop gestational diabetes, you may need more frequent checkups. These are most likely to occur during the last three months of pregnancy, when your doctor will carefully monitor your blood sugar level. In addition, your doctor may refer you to other health professionals who specialize in diabetes management, such as an endocrinologist, a registered dietitian or a diabetes educator. They can help you learn to manage your blood sugar level during your pregnancy.

To make sure that your blood sugar level has returned to normal after your baby is born, your blood sugar will be checked often right after delivery and again in six weeks. Once you've had gestational diabetes, it's a good idea to have your blood sugar level tested regularly. The frequency of blood sugar level tests will in part depend on your test results soon after you deliver your baby.

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Researchers don't yet know exactly why some women develop gestational diabetes. To understand how gestational diabetes occurs, it can help to understand how glucose is normally processed in the body.

Insulin is a substance produced by your pancreas. After you eat, sugar molecules from food — called glucose — flow into your bloodstream. Insulin helps glucose move from your bloodstream into cells in your body where it can be used as energy.

During pregnancy, the placenta that surrounds your growing baby produces high levels of a variety of hormones. Almost all of them impair the action of insulin in the tissues, thereby raising blood sugar. Modest elevation of blood sugar after meals is normal during pregnancy.

As your baby grows, the placenta produces more and more insulin-interfering hormones. In gestational diabetes, the placental hormones provoke a rise in blood sugar to a level that can affect the growth and development of your baby. Gestational diabetes usually develops during the last half of pregnancy — rarely as early as the 20th week, but often not until later in the pregnancy.

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Any woman can develop gestational diabetes, but some women are at greater risk. Risk factors for gestational diabetes include:

• Being older than age 25. Women older than age 25 are more likely to develop gestational diabetes.
• Family or personal health history. Your risk of developing gestational diabetes increases if you have prediabetes — a precursor to type 2 diabetes — or if a close family member, such as a parent or sibling, has type 2 diabetes. You're also more likely to develop gestational diabetes if you had it during a previous pregnancy, if you delivered a baby who weighed more than 9 pounds, or if you had an unexplained stillbirth.
• Being overweight. You're more likely to develop gestational diabetes if you're significantly overweight with a body mass index (BMI) of 30 or higher.
• Race. For reasons that aren't clear, women who are black, Hispanic, American Indian or Asian are more likely to develop gestational diabetes.

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Most women who have gestational diabetes deliver healthy babies. However, gestational diabetes that's not carefully managed can lead to uncontrolled blood sugar levels and cause problems for you and your baby.

Complications that may affect your baby
If you have gestational diabetes, your baby may be at increased risk of:

• Excess growth. Extra glucose will cross the placenta, which triggers your baby's pancreas to make extra insulin. This can cause your baby to grow too large (macrosomia). Very large babies are more likely to become wedged in the birth canal, sustain birth injuries or require a C-section birth.
• Low blood sugar (hypoglycemia). Sometimes babies of mothers with gestational diabetes develop low blood sugar (hypoglycemia) shortly after birth because their own insulin production is high. Severe episodes of this problem may provoke seizures in the baby. Prompt feedings and sometimes an intravenous glucose solution can return the baby's blood sugar level to normal.
• Respiratory distress syndrome. If your baby is delivered early, respiratory distress syndrome — a condition that makes breathing difficult — is possible. Babies born to women with gestational diabetes have more breathing problems than do those born to women without the problem, even at the same gestational age. Babies who have respiratory distress syndrome might need help breathing until their lungs become stronger.
• Jaundice. This yellowish discoloration of the skin and the whites of the eyes may occur if a baby's liver isn't mature enough to break down a substance called bilirubin, which normally forms when the body recycles old or damaged red blood cells. Although jaundice usually isn't a cause for concern, careful monitoring is important.
• Type 2 diabetes later in life. Babies of mothers who have gestational diabetes have a higher risk of developing obesity and type 2 diabetes later in life.
• Developmental problems. If you have gestational diabetes, your child may have an increased risk of problems with motor skill development, such as walking, jumping, or other activities that require balance and coordination. An increased risk of attention problems or hyperactivity disorders also is a concern.

Rarely, untreated gestational diabetes results in a baby's death either before or shortly after birth.

Complications that may affect you
Gestational diabetes may also increase your personal risk of:

• Preeclampsia. Gestational diabetes increases the risk of preeclampsia, a condition characterized by high blood pressure and excess protein in the urine after the 20th week of pregnancy. Left untreated, preeclampsia can lead to serious or even life-threatening complications for both mother and baby.
• Urinary tract infections. Women with gestational diabetes experience twice the number of urinary tract infections during pregnancy than other pregnant women experience. This is likely due to excess glucose in the urine.
• Future diabetes. If you have gestational diabetes, you're more likely to have it again with a future pregnancy. You're also more likely to develop diabetes — typically type 2 diabetes — as you get older. However, making healthy lifestyle choices such as eating healthy foods and exercising can help reduce the risk of future type 2 diabetes. Of those women with a history of gestational diabetes who reach their ideal body weight after delivery, fewer than 25 percent develop type 2 diabetes.

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In most circumstances, you'll find out that you have gestational diabetes as the result of a screening test performed routinely during your pregnancy. If you have an abnormal test, you'll likely be asked to come in for an appointment promptly. Your doctor will also schedule more frequent regular prenatal appointments to monitor the course of your pregnancy.

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down any symptoms you're experiencing, including any that may seem unrelated to gestational diabetes. Gestational diabetes often does not cause any noticeable symptoms, but keep a log of anything unusual that you notice.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, as well as any vitamins or supplements, that you're taking.
• Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.

• Write down questions to ask your doctor.

  Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For gestational diabetes, some basic questions to ask your doctor include:

  • What can I do to better control my condition?
  • What determines if I need medication to control my blood sugar?
  • What symptoms should prompt me to seek medical attention?
  • Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend?

Don't hesitate to ask additional questions during your appointment at any time that you don't understand something.

What to expect from your doctor
If you haven't seen this doctor before the discovery of gestational diabetes, he or she is likely to ask you a number of questions. Be ready to answer them so that you'll have more time to go over any points you want to spend more time on. Your doctor may ask:

• Have you experienced any symptoms, such as increased thirst or excessive urination? If so, when did they start and how often do you have them?
• Do you have a parent or sibling that has ever been diagnosed with diabetes?
• Have you had gestational diabetes in previous pregnancies?
• Have you had any other problems in other pregnancies?
• If you have other children, how much did each weigh at birth?
• Have you gained or lost a lot of weight at any point in your life?

What you can do in the meantime
If your doctor suspects you have gestational diabetes or you've been diagnosed with this condition, you can help control the condition by making healthy lifestyle choices. Don't delay your appointment to start care for gestational diabetes. Every week counts for you and your baby. Follow your doctor's recommendations, and take good care of yourself. Eat healthy foods, exercise, and take time to learn as much as you can about gestational diabetes.

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Your doctor will likely evaluate your risk factors for gestational diabetes early on in your pregnancy. Most women will have a screening test for gestational diabetes sometime during the second trimester of pregnancy.

Routine screening for gestational diabetes
Screening for gestational diabetes is recommended for most women. Medical experts haven't established a single set of screening guidelines. Some question whether gestational diabetes screening is needed if you're younger than 25 and have no risk factors. Others say that screening all pregnant women — no matter their age — is the best way to catch all cases of gestational diabetes.

Your doctor will recommend a screening schedule based on your specific risk factors. For most women with average risk of gestational diabetes, a blood test known as a glucose challenge test is recommended between weeks 24 and 28 of pregnancy. If you're at a high risk of gestational diabetes, your doctor may test you earlier.

• Initial glucose challenge test. You'll begin the glucose challenge test by drinking a syrupy glucose solution. One hour later, you'll have a blood test to measure your blood sugar level. A blood sugar level below 130 to 140 milligrams per deciliter (mg/dL), or 7.2 to 7.8 millimoles per liter (mmol/L), is usually considered normal on a glucose challenge test, although this may vary at specific clinics or labs. If your blood sugar level is higher than normal, it only means you have a higher risk of gestational diabetes. Your doctor will diagnose you after giving you a follow-up test.
• Follow-up glucose challenge tests. For the follow-up tests, you'll be asked to fast overnight and then have your fasting blood sugar level measured. Then you'll drink another sweet solution — this one containing a higher concentration of glucose — and your blood sugar level will be checked every hour for a period of three hours. If at least two of the blood sugar readings are higher than normal, you'll be diagnosed with gestational diabetes.

If you're diagnosed with gestational diabetes
If you're diagnosed with gestational diabetes, your doctor will likely recommend frequent checkups, especially during the last three months of pregnancy. During these exams, your doctor will carefully monitor your blood sugar level. Your doctor may also ask you to monitor your own blood sugar daily, as part of your treatment plan.

If you're having trouble controlling your blood sugar level, you need insulin, or you have other pregnancy complications, you may need additional tests to assess your baby's general health. These tests are designed to assess the function of the placenta. This is because if your gestational diabetes is difficult to control, it may affect the placenta and endanger the exchange of oxygen and nutrients to the baby. One abnormal test result doesn't necessarily indicate a problem. Your doctor may do additional tests to more accurately assess how your baby is doing.

• Nonstress test. Sensors placed on your stomach are connected to a monitor. This test evaluates increases in fetal heart rate that are expected with fetal movement. If they're absent, the fetus may not be receiving enough oxygen.
• Biophysical profile (BPP). This test combines a nonstress test with a fetal ultrasound. Your doctor assesses your baby's movements, breathing and whether a normal amount of amniotic fluid is present. The components assessing fetal activity indicate the baby's oxygen status at the time the test is done. Decreased fluid means your baby hasn't been urinating enough and could indicate that over time the placenta has not been working as well as it should.
• Fetal movement counting. You may perform this simple test at the same time as the nonstress test or the biophysical profile. You simply count the number of times your baby kicks within a certain time frame. Less movement may mean your baby isn't getting enough oxygen.

Blood sugar testing after you give birth
To make sure that your blood sugar level has returned to normal after your baby is born, your doctor will check your blood sugar levels after delivery and again in six weeks. If your test results are normal, it's a good idea to have your diabetes risk assessed at least every three years. If your blood sugar levels indicate diabetes or prediabetes — a condition in which your blood sugar level is higher than normal, but not high enough to be classified as diabetes — talk with your doctor about starting a diabetes treatment plan.

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Controlling your blood sugar level is essential to keeping your baby healthy and avoiding complications during delivery. Your treatment plan may include:

• Blood sugar monitoring. Your health care provider may ask you to check your blood sugar level four to five times a day — first thing in the morning and after meals — to make sure you're keeping your blood sugar within a healthy range. This may sound inconvenient and difficult, but it'll get easier with practice. To test your blood sugar, you draw a drop of blood from your finger using a small needle (lancet), then place the blood on a test strip inserted into a blood glucose meter — a device that measures and displays your blood sugar level.

  Your health care provider will also monitor your blood sugar level during labor. If your blood sugar rises, your baby may release high levels of insulin — which can lead to low blood sugar right after birth.

• Diet. Eating the right kind and amount of food is one of the best ways to control your blood sugar level. Making healthy food choices also helps prevent excessive weight gain during pregnancy, which can put you at higher risk of complications.

  A healthy diet often means including more fruits, vegetables and whole grains — foods that are high in nutrition and low in fat and calories — into your diet and limiting carbohydrates including sweets. Even so, no single diet is right for every woman. You might want to consult a registered dietitian or a diabetes educator to create a meal plan based on your blood sugar level, height, weight, exercise habits and food preferences.

• Exercise. Exercise lowers your blood sugar level by transporting sugar to your cells, where it's used for energy. Exercise also increases your sensitivity to insulin, which means your body needs less insulin to transport sugar to your cells. And there's more. Regular exercise can help prevent some of the discomforts of pregnancy, such as back pain, muscle cramps, swelling, constipation and difficulty sleeping. It can also help prepare you for labor and delivery.

  With your doctor's OK, aim for moderate aerobic exercise on most days of the week. If you haven't been active for a while, start slowly and build up gradually. Walking, cycling and swimming are often good choices during pregnancy. Ordinary activities such as housework and gardening also count.

• Medication. If diet and exercise aren't enough, you may need insulin injections to lower your blood sugar level. About 15 percent of women who have gestational diabetes need insulin therapy to reach a consistently safe blood glucose level. For some women, an oral medication, such as glyburide, also is an option.

Your baby will need close observation, too. Your doctor may monitor your baby's growth and development with repeated ultrasounds or other tests. If you don't go into labor by your due date — or sometimes earlier — your doctor may induce labor. Delivering your baby after your due date may increase the risk of complications.

After having gestational diabetes, your risk of developing type 2 diabetes later in life increases. Maintaining healthy lifestyle habits, such as a healthy diet and exercise, can help reduce or eliminate this risk.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

It's not easy to live with a condition that can affect your baby's health. And worrying about your baby can make it harder to take care of yourself. You may find yourself eating the wrong foods or forgetting to exercise. Prolonged stress can even cause your blood sugar level to rise.

You'll probably feel better if you learn as much as you can about gestational diabetes. Talk to your health care provider. Read books and articles about gestational diabetes. Join a support group for women who have gestational diabetes. The more you know, the more control you'll feel.

Above all, remember that the very steps that will help control your blood sugar level — such as eating healthy foods and exercising regularly — can help relieve stress and nourish your baby. These activities can also help prevent type 2 diabetes in the future. That makes exercise and good nutrition powerful tools for a healthy pregnancy as well as a healthy life.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

There are no guarantees when it comes to preventing gestational diabetes — but the more healthy habits you can adopt before pregnancy, the better.

• Eat healthy foods. Choose foods low in fat and calories. Focus on fruits, vegetables and whole grains. Strive for variety to help you achieve your goals without compromising taste or nutrition.
• Get more physical activity. Exercising before and during pregnancy has shown to help protect against developing gestational diabetes. Aim for 30 minutes of moderate physical activity a day. Take a brisk daily walk. Ride your bike. Swim laps. If you can't fit in a long workout, break it up into smaller sessions spread throughout the day.
• Lose excess pounds. Weight loss during pregnancy isn't usually recommended. But if you're planning ahead, losing weight may help you have a healthier pregnancy. Focus on permanent changes to your eating and exercise habits. Motivate yourself by remembering the benefits of losing weight, such as a healthier heart, more energy and improved self-esteem.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.