Gestational Diabetes Mellitus – Part 4

In the previous article, we discussed about the management of gestational diabetes mellitus. In this final part, we will talk about what happens to gestational diabetes after the delivery of the baby and the future risks to the mother.

After Delivery Of The Baby

Once the baby is delivered and the placenta removed from the uterus (womb), the blood glucose levels in the mother with gestational diabetes will usually return to normal.

This happens in 90 to 95% of mothers who have gestational diabetes.

Most of the time, blood glucose monitoring is usually stopped in a woman with gestational diabetes after delivery of the baby. The woman is also allowed to resume normal diet without need for carbohydrate restriction.

Repeat Oral Glucose Tolerance Test (OGTT)

The 75-g oral glucose tolerance test (OGTT) need to be repeated 6 to 12 weeks after the delivery of the baby to determine the mother’s blood glucose status after the pregnancy.

This time, only the 0 minute and 120 minute blood tests for glucose is necessary.

In 90 to 95% of mothers with gestational diabetes, blood glucose will revert to normal levels with normal OGTT results.

In 5 to 10% of mothers, the OGTT can either show that the woman has prediabetes or actual type 2 diabetes mellitus.

Having Prediabetes After A Pregnancy With Gestational Diabetes

If your fasting (or 0 minute) blood glucose level is between 5.6 and 6.9 mmol/L (or between 100 and 125 mg/dL) and/or your post-glucose load (or 120 minute) blood glucose level is between 7.8 and 11.0 mmol/L (or between 140 and 198 mg/dL), you have prediabetes.

Having prediabetes means that your blood glucose levels are already higher than normal but not high enough to be classified as type 2 diabetes.

Having prediabetes increases your risk of developing type 2 diabetes in the future.

Steps to take to reduce the risk of developing type 2 diabetes if you have prediabetes:

  • Eating healthily with reduced portion sizes of carbohydrates
  • Being physically active on most days of the week
  • Reducing your body weight to the healthy range

If you have prediabetes, you will need to be tested for for type 2 diabetes again every one to two years.

Having Type 2 Diabetes After A Pregnancy With Gestational Diabetes

In a small minority of women with gestational diabetes, the high blood glucose levels do not return to normal after the delivery of the baby. Post-delivery OGTT will confirm the diagnosis of type 2 diabetes.

If your fasting (or 0 minute) blood glucose level is 7.0 mmol/L (126 mg/dL) or higher OR your post-glucose load (or 120 minute) blood glucose level is 11.1 mmol/L (200 mg/dL) or higher, you have type 2 diabetes mellitus.

If you are confirmed to have type 2 diabetes, you will need to see a doctor for management of your blood glucose levels.

Steps to take to manage blood glucose levels if you have type 2 diabetes:

  • Eating healthily with reduced portion sizes of carbohydrates
  • Being physically active – at least 30 minutes of intermediate intensity physical activity (for example, brisk walking, slow jogging) on at least 3 days in a week
  • Reducing your body weight to the healthy range
  • Taking blood glucose lowering medication(s) prescribed by your doctor

Benefits Of Breastfeeding

Breastfeeding has many important benefits, both for the mother and the baby. These include benefits for the baby’s immune system, growth and development. It can help with bonding between the mother and the baby. Breastfeeding has also been shown to have long-term health benefits for both the mother and baby.

Breastfeeding your baby as soon as possible after delivery and then at least
every three to four hours during the first few days will help maintain your baby’s blood glucose levels.

If your blood glucose levels are high and not well controlled in the few weeks before delivery, your newborn baby is at risk of developing low blood glucose levels (hypoglycemia).

You will be advised by your doctor to breastfeed more often. Sometimes supplement feeding with cow’s milk may be necessary for your baby to prevent low blood glucose levels, especially if your breast milk supply is still low.

Future Risks

Once you have had gestational diabetes during pregnancy, you are at a higher risk of developing type 2 diabetes later in life.

Approximately 50% of women who have had gestational diabetes will develop type 2 diabetes within the subsequent 10 to 20 years. It is important to eat healthily and be physically active to reduce your risk of developing type 2 diabetes. You should also have screening for type 2 diabetes done every one to three years.

If you have another subsequent pregnancy, there is a higher chance that you will develop gestational diabetes again. If you change obstetrician for the subsequent pregnancy, you should let your new obstetrician know that you have a history of gestational diabetes.