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In gestational diabetes, blood sugar usually returns to normal soon after delivery however it can put a mother at risk for developing Type II diabetes. 

James W. Brann, MD

Your Pregnancy MD
Pregnancy Week Twenty Nine

At 29 weeks pregnant, look out for signs of preterm labor. Plus mom's physical changes, overview on breastfeeding and restless leg syndrome.
Pregnancy at 29 Weeks

Your Body’s Development

Your uterus grows to roughly 3 to 4 inches above your navel. You may have gained as much as 26 pounds now. Congratulations, you definitely look and feel pregnant!

You have now entered your third trimester. This is an important time for both you and your baby. During your third trimester you may start thinking about labor and delivery. If you haven’t already you might also start preparing your nursery and your home for the arrival of your newborn baby.

Most women experience some heartburn, even if they haven’t previously. This can result from the pressure your belly places on your stomach as it continues to grow and expand. Make sure you pay attention to your baby’s movements as you continue your pregnancy journey. You will start noticing patterns of sleeping and activity in your baby. If you notice for any reason your baby’s movements seem abnormal or less vigorous be sure to contact your healthcare provider for guidance.

Be sure you eat several small meals per day. This will help with heartburn but also ensure that you are getting the nutrients you and your baby need to grow and develop during the final stages of pregnancy. You’ll also find you feel better if you drink plenty of water during the third trimester. This will help with constipation and fluid retention. Contrary to popular belief drinking fluid does not contribute to fluid retention, it helps flush excess fluid from your body.

Be sure to spend plenty of time enjoying your pregnancy and your baby now at 29 weeks pregnant and in the upcoming weeks. In the blink of an eye you will realize you are being whisked away to labor and delivery. While the last couple of weeks of your pregnancy may seem long indeed, you’ll find you look back and marvel at how quickly your pregnancy actually proceeded. You should also take some time to pamper yourself if you can during the last weeks of your pregnancy. If you haven’t considered a prenatal massage get one. You can also consider a nice pedicure, which will keep your toes looking spectacular right up until delivery. These small luxuries will be hard to come by after your baby is born, so you might as well enjoy them while you can.

Most experienced parents will also tell you to take some time during the last trimester to spend some quality one on one time with your partner. Having a baby changes everything, and generally make life a lot more chaotic (albeit wonderfully so). Your partner will appreciate the one on one time together before your baby arrives. Once your baby arrives you will find a lot of your time (most of it) is spent carrying for your special delivery.

Your Growing Baby at 29 Weeks Pregnant

Your Baby at 29 Weeks of Pregnancy
Your Baby at 29 Weeks of Pregnancy

During pregnancy week 29 your baby weighs in at just under 2.6 pounds and is already more than 15.2 inches long!
Your baby has entered his third trimester. Congratulations! You’ve reached the last developmental stages before the birth of your baby. Now you will start experiencing numerous new symptoms, including rapid weight gain.

Your baby’s muscles start to mature and develop as well as your baby’s lungs. Your baby’s brain also continues maturing, forming billions and billions of neurons each and every day. Now more so than ever it is vital that you eat right and eat enough each day. Your baby will be absorbing plenty of nutrients to pack on pounds and prepare for delivery.

Your baby’s brain continues to mature, and the surface is starting to develop groves. In the next few weeks, your baby’s brain will be busy developing billions of neurons!

Your baby’s sleep-wake cycle is now well developed, but he or she spends most of his or her time sleeping. Your baby has started to develop REM (rapid-eye-movement) sleep, or the dreaming stage of sleep. Don’t you wonder what your little bundle of joy is dreaming about?

Fine, downy hair called lanugo covers your baby’s body. Since your unborn baby does not have a lot of body fat, lanugo hair grows to insulate and regulate baby’s body temperature. Sometimes it is shed in utero, and in other cases, it falls off during the first few weeks of your baby’s life. If this fine hair is swallowed by the baby in utero, it eventually comes out as meconium, or the baby’s first poop!

Your baby’s bones are now fully developed, but they are still soft and pliable. The skull will continue to be soft and flexible until the very end, so that your baby can easily go through the birth canal.

High Blood Sugar in Pregnancy or Gestational Diabetes

Gestational diabetes, test blood sugar at 29 weeks pregnant.

Gestational diabetes is a form of diabetes that occurs during pregnancy. The term ‘gestational’ refers to pregnancy. When a woman develops high blood glucose (sugar) during pregnancy but has never had elevated blood glucose in the past, she is diagnosed with gestational diabetes.

Gestational diabetes affects how the cells use glucose, the body’s main fuel source. Gestational diabetes causes high blood glucose levels that can adversely affect pregnancy and the baby’s health. The good news is that expectant mothers can help control gestational diabetes by exercising and eating healthy foods ensuring a healthy pregnancy and baby. Gestational diabetes mellitus and type II diabetes mellitus are different problems but have some key similarities. In either case, your insulin is not working well or it is not being produced in sufficient supply to keep blood glucose levels normal.

In pregnancy, some insulin resistance is expected, as the placenta makes hormones that work against insulin. But as long as the pancreas can keep up with the demand to counteract the pregnancy hormones from the placenta, blood glucose levels can remain normal. If the pancreas cannot keep up, then gestational diabetes is the result.

Risks Factors for Gestational Diabetes

Pregnant women with any of the following appear to be at an increased risk for developing gestational diabetes; the risk increases when multiple risk factors are present. They include:

  • Obesity
  • Glycosuria – sugar in your urine
  • Family history of diabetes
  • You have a prior history of gestational diabetes in previous pregnancies
  • If you are of Black, Hispanic, Asian or American Indian descent
  • Over the age of 25

Screening and Diagnosis of Gestational Diabetes

All of the screening and diagnostic tests for diabetes involve drinking a cola (glucose-containing drink) and blood glucose measurements. If the tests identify gestational diabetes, you will be asked to change your diet, have more frequency prenatal visits, and start monitoring your blood glucose levels at home.

Who should be screened for gestational diabetes?

The American College of Obstetrics and Gynecologists recommends that every pregnant women should be screened for gestational diabetes.

During pregnancy when should diabetes screening be performed?

The American College of Obstetrics and Gynecologists recommends in the absence of a high degree of suspicion for undiagnosed diabetes that universal screening be performed at 24 to 28 weeks of pregnancy.

You can be screened as early as your first prenatal visit if you are obese, have a history of previous gestational diabetes, sugar in your urine sample is found, or a family history of diabetes.

How to screen for gestational diabetes?

There is not an accepted worldwide standard for diabetic screening in pregnancy. The current approach in the United States is to first do a screening test and follow it by a diagnostic test if the screen was positive (called a two-step approach).

Two step approach

The two step approach starts with a 50 gram glucose (cola) drink that is given without concern for the time of your last meal. Your glucose blood level is measured one hour later. If your glucose level is less than 130 mg/dl then you do not have gestational diabetes and no further testing is required. On the other hand if your glucose level is greater than 130 mg/dl then you will undergo further testing.

If you require further testing the test can be performed by two different methods.

  • 100 gram three hour oral glucose tolerance test
  • 75 gram two hour oral glucose tolerance test

The 100 gram three hour oral GTT is most commonly used during pregnancy in the United States. The test is recommended by both ACOG and by a 2013 NIH Consensus Conference. For the test to show you have gestational diabetes you need to have two elevated glucose values after drinking the cola. Abnormal results are as follows:

  • Fasting blood sugar greater than 95 mg/dl
  • One hour blood sugar greater than 180 mg/dl
  • Two hour blood sugar greater than 155 mg/dl
  • Three hour blood sugar greater than 140 mg/dl

The 75 gram two hour oral GTT is recommended by the IADPSG and ADA (International Association of Diabetes and Pregnancy Study Groups (IADPSG) and American Diabetes Association). The reduce glucose in this test is more convenient, better tolerated, and more sensitive for identifying a pregnancy at risk for diabetes than the 100 gram three hour oral GTT.

Only one elevated blood glucose value is needed after drinking the cola to identify gestational diabetes. The abnormal results are as follows:

  • Fasting blood sugar greater than 92 mg/dl
  • One hour blood sugar great than 180 mg/dl
  • Two hour blood sugar greater than 153 mg/dl

Using Diet to Control Blood Glucose Levels

After you have been diagnosed with gestational diabetes you should receive nutritional counseling by either your physician or a registered dietitian. They will educate and place you on an appropriate diabetes diet. The main goals of a diabetic diet or nutrition therapy for Gestational Diabetes is to:

  • (1) Develop excellent control of your gestational diabetes and thus avoiding the complications associated with high blood glucose levels. Your diet should maintain a fasting blood glucose of less than 95 mg/dl and 120 mg/dl two hours after eating.
  • (2) A gestational diabetic diet should allow for adequate weight gain. The American College of Obstetricians and Gynecologist recommend the following guidelines for weight gain in pregnancy. If you are underweight you should gain approximately 34 pounds, 25 to 35 pounds if you are normal weight and 15 to 20 pounds if you are overweight.
  • (3) The diet should prevent ketosis, which is the breakdown of fat to produce energy instead of the normal utilization of carbohydrates.
  • (4) The gestational diabetes diet should contribute to the growth and wellbeing of your baby.

A normal meal plan during pregnancy for gestational diabetes should include three small meals and two to four snacks. The snacks will allow you to adjust your carbohydrate intake to normalize post meal glucose levels. Blood glucose levels after a meal are directly dependent on the amount of carbohydrate in your meal or snack. Therefore you can adjust the amount of carbohydrates in your diet to blunt the post meal glucose rise.

The best way to minimize the amount of carbohydrates in your meals is to minimize eating bread, rice, cereal, pasta, tortillas, potatoes and sweet fruits and juices (simple sugars). You can also increase the amount of complex carbohydrates (low glycemic index foods) that you eat. Starches and vegetables are complex carbohydrates that will raise your blood glucose less than the simple sugars.

Healthy carbs or complex carbohydrates are found in vegetables, fruits and whole grains (beans, legumes, sweet potatoes and yams). Complex carbohydrates take longer for the body to process thus stabilizing blood sugar levels. Whereas unhealthy carbs or simple carbohydrates break down into sugar fast. Simple carbohydrates are found in highly processed foods like cookies, candies, white flour, pastas and chips.

Each meal should consist of:

  • 40% carbohydrates (whole grains, brown rice, quinoa)
  • 20% protein (chicken, fish, lean meats)
  • 40% fat (avocado, olive oil, nuts)

Protein and fiber should be eaten at every meal, including snacks, to stay full throughout the day while eating adequate calories for both mother and fetus. If you are hungry at bedtime, try a couple slices of turkey breast wrapped around a roasted red pepper slice or some cottage cheese with blueberries. Adjustments in the meal plans can always be adjusted based on a mother’s appetite, self-glucose monitoring and weight gain pattern. If a mother requires insulin therapy, then it will be important to maintain consistent carbohydrates at every meal to facilitate any adjustments needed in insulin.

Maintaining a healthy weight and sticking to your diabetic diet during pregnancy can help ensure a smooth delivery and a healthy baby. Your diabetic diet can help you avoid insulin therapy of gestational diabetes and decrease the chances of having a larger than normal baby.

The following are some general dietary recommendations:

  • Do not eat high-calorie snacks and desserts.
  • Eat at least five servings a day of vegetables and fruits. Some fruits can increase your blood sugar level so make sure not to over indulge Make sure not to eat a lot of starchy vegetables such as potatoes.
  • Foods with whole grains are best. Avoid eating white bread, white rice, or regular pasta.
  • If you like meat, only eat a small amount and not every day. It is best to remove the skin from chickens before eating.
  • Use only low-fat dairy products.
  • Use liquid oils instead of solid fats like butter when.

Using Exercise to Control Blood Glucose Levels

Regular exercise during pregnancy has been shown to improve glycemic control by increasing tissue sensitivity to insulin. In others words; insulin is more efficient in moving glucose into the cells with exercise. As a result, your blood glucose levels are decreased and the need for insulin may be avoided.

The ADA encourages a moderate exercise program as a part of the treatment plan for women with Gestational diabetes. The American College of Obstetricians and Gynecologists (ACOG) also recommends 30 minutes of moderate exercise every day as long your doctor has not set limits to your physical activity.

One of the best ways to help control glucose levels is through resistance training. This can be accomplished at your local gym or fitness center that offers circuit training where one moves from one exercise machine to another working every muscle group in the body. A resistance-training program performed three times per week for 20-30 minutes is a very efficient way to help normalize blood sugar levels. It is always wise to meet with a nationally certified personal trainer that is knowledgeable about working with pregnant women.

Whether you go to a fitness center or stay at home to exercise; some form of regular exercise is very beneficial for women with gestational diabetes. A sensible initial exercise regimen can include 10 minutes of warm up and stretching, followed by 20 minutes of aerobic exercise including walking, riding a stationary bike or rowing.

You should exercise at regular intervals three to five days per week. As you build up your stamina you can increase both the duration and intensity of your exercise program and start to include resistance exercises with weights. You should try and perform resistance type of exercises at least twice a week. The resistance exercises should include the large muscle groups of both the upper and lower body. Start with 10 repetitions for each set and slowly increase the number of sets performed.

Pregnant women with gestational diabetes that are fit and have a higher endurance for exercise can exercise more vigorously for a shorter period of time. An example of a more vigorous aerobic exercise routine would be cycling at 90% of your maximal heart rate for 60 seconds, rest for 60 seconds and repeated for a total of 10 cycles. This should only take about 20 minutes and will help to achieve good glycemic control.

Discovering that one has gestational diabetes can be a shock however it can also be a wake-up call to change eating habits, exercise regularly and develop a healthy lifestyle. Exercise helps keep your weight under control during pregnancy and that is the key to preventing high blood sugar levels.

Here are more tips to consider for a healthy exercise program:

  • Consult Your Doctor FIRST – before beginning any exercise program. It is more than likely safe to exercise while pregnant with gestational diabetes, as long as there is no danger of pre-term labor or other circumstances where it would not be a good idea. Your doctor can warn you of any limitations or concerns when it comes to the amount of exercise or specific movements while going through your workout.
  • Begin Exercise Slowly – starting an exercise program is to be commended however it is important to begin slowly when pregnant. Water aerobics, yoga and walking are all good exercises to begin with however be aware of outdoor temperatures when walking and even though the water temperature in a pool might be cool, your body will still heat up and can be dangerous for the developing baby.
  • Stay Hydrated – drinking water is important, especially when pregnant and exercising. Drinking plenty of purified water prevents dehydration that in turns prevents pre-term labor and an increase in the body’s temperature, both a risk for you and your baby.
  • Always Warm-up And Cool-Down – warming up before exercise and cooling down at the end is important especially during pregnancy. Warming up gets the muscles ready to exercise and helps avoid stiffness, soreness and injuries. Cooling down helps prevent excessive tightness in the muscles and helps bring the heart rate back to normal.
  • Stretching – Precautions must be taken when it comes to stretching for pregnant women, as you are capable of over-stretching. During the beginning months of pregnancy, a hormone is released known as relaxin that makes joints, ligaments and muscles extra flexible. If these areas of the body are over-stretched, it can affect future exercise routines, be cautious and notify your instructor that you are pregnant so they can advise you as you go.
  • Know and Understand Your Heart Rate – It is recommended that thirty minutes of exercise a day is fine for a pregnant woman. A good rule of thumb is that you should be capable of carrying on a conversation comfortably during your exercise program.
  • Insulin Levels – You should be careful if you are taking insulin and exercising. Both will lower your blood sugar levels and together may lower your blood sugar more than you expect.

Using Insulin to Control Blood Glucose Levels

If a normal blood glucose level (“normoglycemia”) cannot be maintained by a diabetic diet and exercise, then starting insulin may be required.

Taking insulin to control diabetes may be necessary and your doctor can make recommendations and adjust dosages to meet your body’s needs.

Insulin Therapy

Despite the common belief, it is not necessary to be hospitalized to begin an insulin regimen however educating women with gestational diabetes involves teaching techniques for injecting insulin, and self-monitoring of blood glucose levels that may require the expert help of the hospital nursing staff as an outpatient.

Women with gestational diabetes are placed on insulin therapy when target glucose levels are still too high despite changes in diet and exercise. Dosage varies depending on ethnicity, obesity and degree of hyperglycemia (high blood sugar) to achieve control of glucose levels, however most doses range from 0.7 – 2 units of insulin per kilogram of your current pregnancy weight.

Types of insulin

There are many different types of insulin preparations and they are categorized by how quickly they start to work, when they peak, and how long they last. The major categories are as follows:

  • Rapid acting insulin: Two new rapid acting insulin preparations (Lispro and Aspart) have been studied extensively in pregnancy and are shown to be safe, with minimal transfer to baby, and do not cause birth defects. These two new insulin preparations work better than the long time standard Human Regular Insulin preparation. Both Lispro and Aspart insulins reduce the risk of delayed low blood sugar levels after eating that is seen with regular insulin.
  • Intermediate acting and long-acting insulin: The newer longer acting insulin types (glargine insulin and determir insulin) have not been studied as extensively in pregnancy for their safety and effectiveness as NPH insulin (“an intermediate acting insulin”). Therefore the use of NPH insulin is still the number one choice when a longer acting insulin is needed to control maternal glucose levels that is safe and effective.

Insulin treatment protocol

Most physicians have found that starting with the simplest protocol and increase the complexity of the insulin therapy as needed is a useful approach. The dose and type of insulin that is initially used is calculated based upon the degree of your high blood glucose levels noted during home monitoring.

The Simplest Insulin Treatment Protocol

Typically, regardless of body weight, a patient whose glucose elevations are mostly high after a meal is prescribed a starting total insulin dose of 30 units (20 units of intermediate acting insulin) and 10 units of rapid acting insulin) in the morning prior to breakfast.

A More Complex Insulin Treatment Protocol

If the simple insulin treatment protocol fails to adequately lower your blood glucose level you should then use a more complex alternative approach to insulin therapy. One such insulin treatment protocol is described below:

If your fasting blood glucose level remains high then you should add an intermediate acting insulin before bedtime, such as NPH. The initial treatment dose should be 0.2 units/kg of pregnancy weight.

If your blood glucose level remains high after meals add the short acting insulin Aspart or Lispro before you eat. The initial treatment dose should be calculated at 1.5 units for every 10 grams of carbohydrate eating for breakfast and 1.0 unit for every 10 grams of carbohydrate eating during lunch and dinner.

Home Glucose Monitoring

The insulin dose you will need during pregnancy will require frequent home or self-monitoring. You should monitor your glucose level at least four times each day to regulate your insulin therapy. The best time to measure your blood sugar level is fasting, and two hours after each meal.

The Treatment of High Blood Glucose with Oral Anti-Hyperglycemic Medications

The oral anti-hyperglycemic treatments for gestational diabetes have not been approved by the United States Food and Drug Administration (FDA). The only time that an oral agent should be used is when a pregnant women fails to control her glucose levels with diet and refuses to take insulin. In this situation the oral agent that is recommended to be used is Glyburide.

Glyburide is an oral anti-hyperglycemic drug that despite it not being endorsed by ADA and ACOG is becoming more prevalent to treat mild to moderate gestational diabetes. Glyburide, like insulin, can cause low blood sugar (“hypoglycemia”). It must be taken 30 to 60 minutes before a meal, instead of with your meals to be beneficial. Pregnant gestational diabetic women who are contemplating using glyburide should understand there is limited information regarding its safety in pregnancy.

Prenatal Care – Managing Gestational Diabetes

Your physician has several challenges that have to be addressed when caring for your pregnancy with gestational diabetes. Your physician or team of physicians must be knowledgeable in the risks to you and your baby, know how to perform fetal monitoring and growth assessment with an obstetrical ultrasound, expertise in the timing and route of delivery, and understand glycemic nutrition management.

Antenatal fetal testing — In the third trimester, usually around the 32nd week of pregnancy, most physicians start antenatal testing twice weekly to prevent the rare fetal loss. The frequency of testing and the type of tests used vary for each physician. The three most commonly used tests among physicians are the nonstress test, biophysical profile, and contraction stress test.

Nonstress testing — To perform a nonstress test, your physician will monitor the baby’s heart rate by placing a small ultrasound listening device on your abdomen. This device will record the changes in the baby’s heart rate over a 30 minute period of time. The normal heart rate is between 110 and 160 beats each minute. It is the variation in rate that your physician will use to make sure that your baby is fine. Your physician is looking for an increase in the heart rate (called “accelerations”) by at least 15 beats per minute over a period of 15 seconds. If accelerations are seen twice in 20 minutes the test is considered reactive or reassuring. If no accelerations in the heart rate is seen in 40 minutes further testing may be required.

Baby’s Biophysical Profile — The Biophysical profile test is easily performed and an accurate way of predicting a baby that is having trouble or not The test includes five components, nonstress testing and four ultrasound measurements. The ultrasound is used to evaluate fetal movement, fetal tone, fetal breathing and AFI or amniotic fluid volume. The AFI or amniotic fluid volume is an important component of the test. A low volume (“oligohydramnios”) may be a sign of problems; where as a normal volume is reassuring.

Each component of the biophysical profile is scored individually and giving a score of 0 (absent) to 2 (normal). The maximum score possible is 10. The higher the score the more reassuring the test.

  • A score of 8 to 10 is reassuring of fetal well-being
  • A score of 6 is an equivocal test result and should be repeated within 24 hours
  • A score of 4 or less suggests that fetal asphyxia may occur in less than a week and needs immediate attention.

Contraction Stress Test – A contraction stress test or CST is an aggressive test to evaluate the wellbeing of your baby. It involves starting an IV and giving you a medication called oxytocin to start your contractions. The baby’s heart rate and your contractions are monitored. The premise of the test is based on the fact that the contractions will simulate your own labor contractions and will demonstrate how the baby will react during real labor.

The CST results are interpreted as follows:

  • Positive (nonreassuring) – A positive or non-reassuring test demonstrates decreases in the baby’s heart rate called late decelerations. Further testing and/or delivery is required.
  • Negative (reassuring) – A negative (reassuring) test has no decrease in the baby’s heart rate. This is reassuring and no further evaluation is needed.
  • Equivocal – An equivocal or suspicious test demonstrates intermittent heart rate slowing and requires further assessment by biophysical profile, and ultrasound.
  • Unsatisfactory – An unsatisfactory test means that there are fewer than 3 contractions in 10 minutes.

Evaluation of Fetal Growth

The recognition that a baby is growing faster than normal (“large for gestational age”) is very important for the physician. The evaluation of fetal growth is usually started at 36 weeks of pregnancy. The potential for a large baby is evaluated by serial or frequent ultrasound exams.

When accelerated fetal growth is identified it can help the physician manage the last part of your pregnancy with more precision. Your physician will then be able to discuss the risks and benefits of timing of delivery. You may benefit from induction of labor before the baby grows too big or schedule a cesarean section if the fetal size exceeds 4500grams.

Timing of delivery — Timing of when to deliver your baby in women with gestational diabetes is a key management decision for physicians. The benefit of early or on time deliver is to avoid a late stillbirth and prevent a difficult delivery as seen with continued growth of your baby. The risk of shoulder entrapment (“shoulder dystocia”) and cesarean delivery goes up as the size of the baby increases.

The current accepted thinking for pregnancies of women that have keep a normal glucose level with diet and exercise alone should have an induction of labor around your due date. (40 to 41 weeks of pregnancy).

If you have had your glucose levels controlled with insulin then your physician should discuss induction of labor at 39 weeks of pregnancy with you. Delivery at 39 has significantly lowered the risk of delivery stillborn babies.

Scheduled cesarean delivery — Your physician will offer you a scheduled cesarean delivery to reduce the risk of birth trauma from a large baby; if the estimated fetal weight of the baby is greater than 4500 grams. Before you agree to a scheduled cesarean delivery your physician should discuss:

  • That it is very difficult to accurately predict the birth weight by ultrasound or any other method.
  • The risks of a cesarean delivery for a pregnancy complicated by diabetes.
  • The management of future pregnancies due to a prior cesarean delivery.

Labor and Delivery Management — When you are in labor the most important thing your physician has to do is to make sure that your blood glucose level remains normal. The risk of an elevated blood glucose level is not to you but to the baby after birth. The baby will react adversely to the loss of the high glucose load after birth by developing low blood sugar, jaundice, and a low blood calcium. The severity of these complications is related to the severity of your uncontrolled high blood glucose.

To help maintain a normal blood glucose level while in labor your physician may have to use insulin. Women with gestational diabetes who had normal glucose levels that were controlled by diet and exercise alone usually do not need insulin therapy while in labor. Insulin therapy is usually need when women with gestational diabetes used insulin to maintain normal glucose levels while pregnant.

Postpartum Follow-up —After delivery a women with gestational diabetes should not worry about their diet and can resume their normal eating habits. This is because the antiinsulin hormones that were secreted from the placenta dissipate rapidly after giving birth. Since the antiinsulin hormones are no longer available to influence the action of insulin, most women can return to pre-pregnancy glycemic control immediately

Your physician will still monitor your blood glucose levels for the first 24 hours after a vaginal delivery and 48 hours after a cesarean delivery to make sure they have not missed an undiagnosed type 2 diabetes mellitus problem.

Since you are at risk for recurrent gestational diabetes and overt diabetes later in life your physician will schedule an oral glucose tolerance test at your six weeks post-partum visit.

Future Risks of Gestational Diabetes after Delivery

The majority of women with gestational diabetes find that their blood glucose levels are normal following child birth. However, with subsequent pregnancies they are at a high risk for developing recurrent gestational diabetes and overt diabetes when not pregnant.

Recurrence — Disappointedly up to two-thirds of women with a history of gestational diabetes will again develop it in subsequent pregnancies. The women who have a recurrence tend to be older, more pregnancies, and greater weight gain between pregnancies than women that do not have a recurrence.

Long-term risk —There is a direct predictive value that you will develop type 2 diabetes if you have a history of gestational diabetes. Twenty percent of women that had gestational diabetes will have an abnormal glucose screening in the first six weeks after delivery.

Follow-up and prevention of type 2 diabetes— ACOG and the ADA are in agreement that all women with a history of previous gestational diabetes should have a glucose tolerance test 6 to 12 weeks after childbirth and every three years thereafter.. The risk of recurrent gestational diabetes in subsequent pregnancies and developing type 2 diabetes is real. With lifestyle changes such as losing weight and exercise you can reduce the incidence of both illnesses.

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