According to the Standards of Medical Care in Diabetes 2014 published by the American Diabetes Association, changes have been made for detecting and diagnosing gestational diabetes. Recommendations suggest screening a woman with risk factors for type 2 diabetes at her first pre-natal visit.  If it is found that she has diabetes during her first trimester, it is called overt type 2 diabetes and treated as such. When diabetes develops in a woman without diabetes after the first trimester of her pregnancy (screened at 24-28 weeks) the diabetes is referred to as gestational diabetes. (1)

what is gestational diabetes steps to help prevent type 2 diabetes after gestational diabetesIt is thought that between 7-18 percent of pregnancies are complicated by gestational diabetes. (2) In women with gestational diabetes, the diabetes may resolve after giving birth but immediately after childbirth, between 5-10 percent of the women are diagnosed with type 2 diabetes. (3) Testing for diabetes should also take place 6-12 weeks after childbirth to check glucose levels. (4) Non-pregnant criteria should be used for testing. (1) It is found that gestational diabetes is a strong risk factor for developing type 2 diabetes.  It is estimated that 35-60 percent of women that have had gestational diabetes will develop type 2 diabetes in the future. (2) It is also thought that children from these pregnancies have a greater chance of developing obesity and type 2 diabetes. (2)

What should a woman do if she has a history of gestational diabetes? 
1. A woman should be tested immediately after giving birth to see if she has developed type 2 diabetes. If the diabetes has resolved, she should have an oral glucose tolerance test (OGTT) done according to American Diabetes Association (ADA) and American Association of Clinical Endocrinologists (AACE) recommendations 6-12 weeks following birth. The American Diabetes Association also recommends a follow-up screening at least once every three years and more frequently depending on risk factors. (5) 

2. If a woman develops diabetes or pre-diabetes right away and would like to breastfeed, she and her doctor should consult the Drugs and Lactation Database (LactMed) to see if there are any problems with a specific medication they are considering. Breastfeeding decreases the risk of the child developing type 2 diabetes and also of becoming overweight. It has been found in one study that for each month of breast feeding until the age of 9 months, the risk of overweight decreases by four percent compared to a baby that was never breastfed. Breastfeeding can result in a 30 percent decrease or more in having an overweight child. (6) 

3. Design a healthy meal plan for your whole family with the help of a registered dietitian. Data from the Nurses’ Health Study two, reviewed the correlation between a Mediterranean-style diet, the Dietary Approaches to Stop Hypertension (DASH) diet or healthy eating guidelines developed by the U.S. Department of Agriculture (the Healthy Eating Index) and the development of type 2 diabetes for women with a history of gestational diabetes. Out of 4,400 women who had gestational diabetes in this study 491 developed type 2 diabetes. The results are:
  • The Mediterranean diet - 40 percent lower risk of developing type 2
  • The Dash Diet - 46 percent lower risk of developing type 2
  • The Healthy Eating Index - 57 percent lower risk of developing type 2
All of these diets promote healthy eating including vegetables, fruits, nuts, legumes and whole grains. The research team advised women to eat a healthy diet and it may help to greatly reduce their chance of developing diabetes in the future. (7)  For more information consult the Healthy Eating Index

4. Healthy weight loss or weight maintenance- It is advised by the American Diabetes Association for a woman to seek dietary counseling (by a registered dietitian) to develop a meal plan designed for healthy weight loss or weight maintenance as needed. (8) In addition, the consult should include a healthy plan for the whole family.
 
5. It is well known that exercise helps to decrease the incidence of diabetes. (9) Women with gestational diabetes should work with their doctor and diabetes educator to design an exercise program to start during pregnancy and safely continue after childbirth. The whole family should be included as interesting research finds that a woman’s husband or partner is the strongest influencer on the amount of exercise she gets. This is true both during the pregnancy and after. (10) Beneficial, fun exercise is healthy for the whole family.

6. Talk to your doctor before getting pregnant again. The discussion should include getting your blood glucose monitored. It is important to know if you have developed diabetes or pre-diabetes so you can plan for a successful pregnancy.

This blog has information on what gestational diabetes is and also on suggestions to do after pregnancy. For more information visit our Gestational Diabetes page or the Centers for Disease Control website.    

Stay healthy while trying to prevent type 2 diabetes after gestational diabetes. Work with your health care team regularly to keep ahead on healthy eating, maintaining a healthy weight and exercise. Have your blood glucose monitored as recommended by your physician. Please ask questions about the blog if you have any. We are always happy to respond!

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