Nutrition Food Groups Tools After Pregnancy Additional Resources

Healthy Beginnings Diabetes and Pregnancy (Spanish)
Healthy Beginnings Diabetes and Pregnancy (Chinese)
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What is Gestational Diabetes?
Gestational diabetes is a temporary form of diabetes caused by the body’s changing hormones and chemistry during pregnancy. Women can have gestational diabetes without knowing it, so all women are tested for diabetes during pregnancy. Your chances of having diabetes in pregnancy are higher if:

• You had high blood sugar during a previous pregnancy.
• You have had other babies who weighed more than 9 pounds at birth.
• You are overweight.
• A close relative, such as a parent, brother, or sister has diabetes.
• You are part of an at-risk ethnic group, including African American, Asian American, Hispanic/Latina, Native American, Native Alaskan, and Pacific Islander.
• You have pre-diabetes or glucose intolerance.

Gestational diabetes usually begins after the first trimester of pregnancy, so most women with this type of diabetes have normal blood sugar values in the first part of pregnancy.

There are several programs at Kaiser Permanente that help women who have diabetes during pregnancy. Usually health professionals teach pregnant women about diabetes, meal planning, use of the blood glucose monitor, and other important information. After that, a doctor or nurse will check on your blood sugar readings and review steps that can be taken to keep the blood sugar as close to normal as possible. This is done both over the telephone and in visits to the medical office. Just remember, your health care team is there for you. Our overall desire is to help you and your baby to be healthy.

What is self blood glucose monitoring?
Daily testing of blood sugar using a small monitor is extremely important for pregnant women with diabetes. This testing is done by obtaining a small drop of blood from the end of a finger. The drop of blood is placed on a test strip in the monitor. The monitor then “reads” the blood sugar level and displays it for you. When you understand how various types and amounts of food affect your blood sugar, you can make the best choices about food selection and portion size.

Some things to remember about blood sugar testing:

• Wash and dry your hands well before testing.
• Do your first test of the day before you eat or drink anything. This is called a “fasting” blood sugar test.
• Do your first test of the day on an empty stomach. This is called a “fasting” test.
• Do your after-meal blood sugar tests 1 hour after you begin your meal.
• Do the finger-stick (to obtain the blood drop) on the sides of your fingertips, not the end or middle of the fingertips.
• There are fine or ultra-fine sized lancets (the needle that pokes your finger to get the blood drop). Try the ultra-fine sized one if the fine size bothers your fingers.
• All blood glucose meters need to be checked frequently. Make sure the meter is coded correctly before using it for the first time and every time you change to a new bottle of test strips. You should also do a quality control check of the strips with the solution provided in your test kit. Refer to the instructions that come with your meter for more details.

If you need assistance with your meter or blood sugar testing, please talk to your doctor, other medical professional, or visit the Health Education center at your facility.

What are the goal blood sugar values?

Time of testing	Plasma Glucose (mg/dl)
Fasting	60-95
1 hour after a meal	<140
2 hours after a meal	<120
2am-3am	>60

What does insulin do?
Insulin helps the body to get glucose from the blood to the muscles and other tissues where it is used as fuel. The major sources of glucose come from sugars and starches. After food is digested in the stomach, glucose enters the blood stream. Without insulin, it cannot get to the cells. Instead, it builds up in the blood and urine.

Women with gestational diabetes may have enough insulin in the first half of pregnancy. However, as pregnancy progresses, the placenta makes hormones that interfere with the effects of insulin on blood glucose (insulin resistance). Insulin resistance increases as the placenta grows and hormone levels increase. Gestational diabetes happens when the pancreas cannot make enough insulin to overcome insulin resistance. It may be necessary to take insulin shots if your body cannot produce enough insulin to keep blood sugar normal.

What does oral medication do?
Your doctor or nurse practitioner may prescribe oral medication instead of insulin. Oral medications, such as glyburide or metformin, are also used to lower blood sugar. Oral medications cause the pancreas to release more insulin or help the body to use its own insulin more effectively. It is important to continue making wise food choices and exercising even when taking oral medication.

How will diabetes affect my pregnancy?
By taking steps that will keep your blood sugar levels as close to normal as possible, you will be doing all you can do to have a healthy and normal pregnancy. These steps include making wise food choices that will give you all the nutrition you need, without extra sugars and fats that can cause problems in diabetes. It will be important to work closely with your health care team. If necessary, your doctor or nurse practitioner may prescribe insulin or oral medication. This could be necessary if your blood sugar is too high, in spite of wise food choices and exercise. If insulin or oral medication is prescribed, you will get all of the help you need to take this medication. Your healthcare team may ask you to check your first morning urine for ketones, a substance your body produces when it does not get enough calories or does not have enough insulin.

How will diabetes affect my baby?
There are no absolute guarantees, but with careful attention to food choices and blood sugar control, it is less likely that there will be any problems. Babies born to mothers whose blood sugar was high at the beginning of pregnancy, have a somewhat greater chance of complications, such as birth defects. However, this risk can be reduced if blood sugars are well controlled before pregnancy. If you have gestational diabetes, the major risk is having a large baby (macrosomia) that may be too big for a vaginal birth. Some babies born to mothers with high blood sugar levels have a sudden drop in blood sugar during the first few hours of life (hypoglycemia).

What about exercise?
Regular physical activity for 15-20 minutes after meals will help your body to lower blood sugar values. Exercise will also assist with controlling your weight, improving your self-image, and reducing your risks for developing heart and blood pressure disease. Walking, doing housework, swimming, riding a stationary bike, or doing upper-body exercises are some example activities. You should avoid vigorous exercise if you have any risk of developing preterm labor. Check with your health care provider before starting or continuing any exercises as you may need to avoid certain activities.

Risks associated with gestational diabetes may include:

Macrosomia is a medical term used to describe a very large baby. The baby could be too big from receiving too much blood sugar from the mother. The growing baby changes the extra blood sugar to fat and may grow too large to fit through the vaginal canal. Injuries to the baby can occur during delivery, such as broken bones, nerve damage, or lack of oxygen.

Hypoglycemia (low blood sugar) may occur if the mother’s blood sugar levels have been consistently high, causing the fetus to have a high level of insulin. After delivery, the baby no longer has the high level of sugar from the mother. As a result, the newborn’s blood sugar becomes very low. Your baby’s blood sugar level will be checked, and if it is too low, the baby may need to have a feeding right away.

Polyhydramnios is a term used for excess amniotic fluid. This happens in about 10% of women with diabetes. Excess fluid can cause premature labor or other problems. Sometimes, the extra fluid can be decreased with procedures or medications.

Breathing difficulties, also called respiratory distress syndrome, are more common in babies of diabetic mothers. This is due to a delay in maturity of the lungs. Your doctor may do special tests for lung maturity before the baby is born.

Stillbirth is something that no one likes to think about. However, babies of some diabetic mothers have a slightly increased chance of stillbirth. You will be instructed to count the number of minutes it takes your baby to move and/or kick 10 times. This is done at home daily, often after you eat dinner. Your provider will be doing special monitoring of your baby during the end of your pregnancy to decrease the chances of stillbirth. Usually special monitoring may start at around 36 weeks for mothers who are on medications (i.e. insulin, glyburide, or metformin). If a mother is not on medications, then special monitoring usually starts at week 40 of your pregnancy.

A-Z Diabetes Dictionary

Carbohydrates
A type of food that usually comes from plants instead of animals. There are simple carbohydrates (sugar, fruit) and complex carbohydrates (vegetables, starches).

Fat
One of three nutrients that supply calories to the body. Included are vegetable oil, lard, margarine, butter, shortening, mayonnaise, and salad dressing.

Health Care Providers
Health care professionals who specialize in the management of certain conditions. In the case of diabetes, health care providers may include an obstetrician, perinatologist, an internal medicine physician, a registered dietitian, a diabetes educator, registered nurse, and a neonatologist .

Hormone
A chemical substance produced within the body which has a “regulatory” effect on the activity of a specific tissue in the body. Estrogen, cortisol, and human placental lactogen are hormones produced by the placenta. They help the mother’s body to prepare her for the pregnancy and birth but also have an anti-insulin effect (see insulin resistance).

Hypoglycemia
A condition where the blood sugar is less than 60. This is dangerous and should be avoided or treated rapidly.

Insulin
A hormone made by the pancreas. Insulin helps glucose leave the blood and enter the muscles and other tissues of the body.

Insulin Resistance
A partial blocking of the effect of insulin. This can be caused by hormones produced by the placenta or by excessive weight gain.

Ketones
A substance produced by the body when it does not get enough calories or does not have enough insulin.

Macrosomia
A term used for a baby that is much larger than normal. This condition may occur when the mother’s blood sugar levels have been higher than normal during pregnancy.

Pancreas
A long gland that lies behind the stomach. The pancreas makes insulin and digestive enzymes.

Placenta
A special organ that joins the mother and fetus. It provides hormones necessary for pregnancy and supplies the fetus with water, oxygen, and nutrients (food) from the mother’s blood.

Protein
A nutrient that often, but not always, comes from animal products. High protein foods include meat, poultry, fish, eggs, hard cheese, cottage cheese, yogurt, and milk. Non-animal sources of protein are nuts and seeds, peanut butter, legumes, whole grains, and tofu.

Self Blood-Glucose Monitoring
A way to test blood sugar at home by pricking the finger, putting a drop of blood on a chemically-treated test strip, and using a machine to read the blood sugar value.

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