Treatment for gestational diabetes includes eating a carefully planned diet, getting plenty of exercise, maintaining a healthy pregnancy weight, monitoring glucose levels and, if necessary, daily insulin injections. 

Diet

To help the  blood sugar level to stay within a normal range (60 to 120 mg/dl): 

• Avoid sugar  and foods high in sugar. 
• Eat complex carbohydrates such as pasta, rice, grains, cereals, crackers, bread, potatoes, dried beans and peas. 
• Eat fiber-rich foods such as whole grain cereals and breads, fruits and vegetables. 
• Avoid saturated fats such as fatty meats, butter, bacon, cream and whole milk cheeses. 
• Eat a snack before bedtime that is protein and carbohydrate based. 
• The doctor will help in determining a diet  plan that fits the woman's needs. 

Exercise 

Talk with the doctor about what exercise program is right for the woman. According  to the American College of Obstetricians and Gynecologists, women are encouraged to exercise at least three or  four days a week, with each session lasting 15  to 30 minutes. Women should avoid very strenuous activity and should not become overheated. If the woman has not exercised prior to pregnancy,  a gradual introduction  to exercise is recommended. Talk with  your doctor regarding individual exercise needs and limitations. 

Maintain  a healthy pregnancy weight 

Optimal weight gain depends on the pre-pregnancy weight of the woman. If the woman is at a desirable weight for her body size  and height,  a weight gain  of 25 to 35 pounds is recommended. If the woman is 20 pounds or more above the desired weight,  a weight gain of 20 to 24 pounds is recommended. If  the woman is underweight, a weight gain of 28 to 36 pounds is recommended. This is dependent  on how underweight the woman is pre-pregnancy. Talk with the doctor about his or her views on how much the woman should gain during the entire pregnancy. 

Monitor glucose levels 

Depending on the severity of the gestational diabetes, the doctor may want  a daily or weekly glucose level  test performed. There are self-blood  glucose monitoring tests available that can be administered at home. These tests are done by using  a special device to obtain a drop of blood  and test for the  blood sugar level.

Daily insulin injections 

Insulin injections may be necessary if the dietary changes and exercising does not bring the  blood sugar level within normal range. When two abnormal values occur in one week, the doctor  may recommend insulin. A typical regimen begins with a small dose  of intermediate-acting and/or regular insulin, taken once or twice daily, with adjustments  to be made as insulin resistance increases. The doctor will explain  the different kinds of insulin, the  right amount of insulin  to take  and when to take it,  and how to change the dosage. 

Additionally, although not a treatment, the doctor may suggest careful monitoring of the baby, using ultrasound, fetal movement records, fetal monitoring  and non-stress  and stress tests. 

• Ultrasound  is used  to determine the position and the size of the baby. 
• Fetal movement records involve the woman recording the number of times  a baby kicks or moves within  a two-hour period. 
• Fetal monitoring involves measuring the baby's heart rate, and the strength and frequency of contractions at the same time. 

During fetal monitoring, the doctor can also do  a non-stress test  on the baby. By rubbing the mother's stomach or introducing loud noises, the baby's movements  and heart rate are measured. If the heart rate goes up, the test is normal. If the heart rate does not accelerate when the baby is externally stimulated, the doctor will do a stress test. 

During the stress test, the mother is given a hormone (called oxytocin) which stimulates internal uterine contractions. During a contraction, the baby is momentarily deprived of its  blood supply and oxygen,  which forces the baby  to respond with a higher heart rate. If  the baby's heart rate slows down rather than speeds up, the baby may be in jeopardy. 

Complications of Gestational Diabetes 

If untreated or poorly controlled, gestational diabetes  can cause the baby to: 

• have macrosomia (excessive weight at birth exceeding 9 pounds, 14 ounces) 
• develop hypoglycemia (low blood sugar) at birth 
• develop jaundice (yellow skin) 
• develop respiratory distress syndrome (breathing difficulties) 
• die after week 28  of pregnancy (called a stillbirth) 
• die in infancy 

Prognosis  

Gestational diabetes usually goes away after pregnancy, but, once a woman has had gestational diabetes,  the chances are 75 percent that it will return in future pregnancies. In  a few women, however, pregnancy uncovers insulin-dependent (Type I) or non-insulin dependent (Type II) diabetes. In other women, gestational diabetes increases their chances of developing Type II diabetes within eight years. 

Questions To Ask Your Doctor About Gestational diabetes 

• What tests  are used to diagnose gestational diabetes? 
• Can diet correct or prevent gestational diabetes? 
• What kind of  diet plan should be followed  and how rigid is it?
• Will insulin injections be needed? 
• Will diabetes harm  the development of the fetus? 
• Could the  baby become a diabetic later on? 
• What are  the chances of remaining a diabetic after delivery or becoming a diabetic later? 

Notes: Dr. Nelson Crumfield

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EditText of this page (last edited June 17, 2010)