How is gestational diabetes treated?

Photo of a woman holding a romper suit (PantherMedia / Mitar gavric)

Elevated blood sugar levels can usually be lowered enough by changing your diet. Special dietary counseling can help. Some women with gestational diabetes have to inject insulin because they have high blood sugar for a long period of time.

In gestational diabetes (diabetes in pregnancy), women's blood sugar levels are temporarily higher than usual. This is usually not a reason for concern. But gestational diabetes can increase the risk of rare complications in pregnancy and during childbirth. It is diagnosed using a test known as the glucose tolerance test.

What can you do yourself?

Women who have gestational diabetes are advised to change their diet and, in some cases, do more exercise too. The specific measures to be taken can be discussed in a special consultation.

If dietary changes and exercise don't lower the blood sugar levels enough, insulin can help. Women are then advised to see a diabetes specialist.

In order to see whether the measures are helping, the blood sugar levels are measured several times a day for a few weeks. To do this, you prick your fingertip with a small needle, and place a drop of blood on a test strip. The test strip is inserted into an electronic device that measures and displays your blood sugar levels.

What dietary changes are made?

Women can talk with their gynecologist or a dietary counselor about how to change their diet. The most suitable approach will be different for different women, depending on things like how much they weigh, how much exercise they get, and their current diet. Women are typically advised to cut down on carbohydrates ("carbs") because these foods increase blood sugar levels. But it is important to make sure that your diet includes enough fiber, fats and proteins.

Women are also advised to have three not-too-big main meals per day, as well as two to three smaller meals per day. If they are overweight or obese, they are advised to limit their daily calorie intake to a certain amount. But pregnant women shouldn't go on strict diets because their bodies need enough calories during pregnancy.

Can exercise help too?

Another thing that can help reduce blood sugar levels is exercise. The most suitable type of exercise will depend on factors like how fit you are and how your pregnancy is going. It's a good idea to discuss the options with your gynecologist. Types of exercise such as brisk walking, cycling and swimming are usually appropriate. But things like martial arts and ball games are too strenuous or too risky for the unborn child.

Doing at least 30 minutes of more intense physical activity on about three to four days per week can already make a difference.  Brisk walking can quite easily be incorporated into your daily life.

What role does medication play?

Persistently high blood sugar levels can usually only be lowered with insulin injections. Other diabetes medications (such as tablets) haven't been approved for use in pregnant women and aren't recommended for them either. Metformin is the only medication that can be used as an alternative to insulin in pregnant women – in exceptional cases, and off-label only. Studies have shown that it is about as effective as insulin in the treatment of gestational diabetes.

Myo-inositol is a dietary supplement that is claimed to help in the treatment of diabetes, among other things.  But there is a lack of good-quality studies on the benefits and harms of this substance. So it isn't recommended for the treatment of gestational diabetes.

Does treatment help to prevent complications?

Treating gestational diabetes can help to lower the risk of certain complications.

Birth weight

Research has shown that treatment reduces the number of babies with a high birth weight (over 4,000 g):

  • Without treatment, about 16 out of 100 women have a baby with a high birth weight.
  • With treatment, about 7 out of 100 women have a baby with a high birth weight.

But just because a baby is large, there is no reason to worry about his or her health. Most large babies are born healthy. But it can be more difficult to give birth to large babies.

Shoulder dystocia

Treatment can lower the risk of a certain birth complication called shoulder dystocia. This is where it takes longer for the baby’s shoulders to come out after the head has already come out. Sometimes the child gets stuck in the birth canal for a relatively short while, but in rare cases he or she may get stuck for longer. Midwives and doctors then have to react quickly in order to make sure the child gets enough oxygen.

Studies have shown that treatment for gestational diabetes lowers the risk of shoulder dystocia:

  • Without treatment, shoulder dystocia occurs in about 3 to 4 out of 100 births.
  • With treatment, it occurs in about 1 to 2 out of 100 births.

Shoulder dystocia often leads to small injuries in the child and sometimes in the mother too. These usually heal well, though, without any long-term physical consequences.

Other complications

One study suggested that pre-eclampsia is less common in women whose gestational diabetes was treated. Pre-eclampsia is a rare complication of pregnancy, associated with high blood pressure in the mother. Treatment for gestational diabetes didn't affect the likelihood of other complications, such as serious injuries or mortality. It didn't affect the number of Cesarean sections either.

None of the studies provided information about whether treating gestational diabetes has any long-term health benefits for the mother and/or her child – for instance, whether it lowers the risk of developing type 2 diabetes.

Does the treatment have side effects?

Research in this area hasn't specifically looked into the possible disadvantages or harmful effects of treatment for gestational diabetes.

The treatment can involve a bit of effort. For instance, you have to prick your finger several times a day in order to measure your blood sugar levels. Some women find this unpleasant. Changing your diet also requires a bit of discipline. Being diagnosed with gestational diabetes can make women worry, too. This makes it all the more important to be aware that the vast majority of women with gestational diabetes give birth to healthy children.