Ellen Seely, MD, Director of Clinical Research in the Division of Endocrinology, Diabetes and Hypertension at Brigham and Women’s Hospital discusses the health risks associated with gestational diabetes mellitus (GDM) during and after pregnancy. Dr. Seely also describes Balance After Baby, a web-based program designed to educate women on eating healthfully and increasing their physical activity, with the goal of helping them lose their pregnancy weight within a year of giving birth.
GDM is a type of diabetes that occurs only in pregnancy. It comes on in the second half of pregnancy and it goes away after delivery. In the US it’s estimated that five percent of all pregnancies are complicated by GDM. The rates of GDM are higher in Hispanic and non-white populations, ranging from ten to 20 percent of all pregnancies.
Obesity is one of the main risk factors for GDM. In the United States, most health centers screen all women for gestational diabetes because obesity is becoming so common in the overall population.
Gestational diabetes can impact the health of the mother and the fetus, as well as the newborn. Women with GDM have an increased risk of preeclampsia, which is a type of high blood pressure that develops during pregnancy. Preeclampsia is a serious condition that can lead to early delivery. Women who have gestational diabetes may also have larger babies, increasing their risk of cesarean section.
While GDM goes away after pregnancy, the health risks persist. Research has found that 50 to 70 percent of women who have gestational diabetes may develop Type 2 diabetes later in life. Research has also found that babies born to mothers with GDM, have a higher birth weight and may become obese during adolescence, increasing their risk of developing diabetes and other conditions such as high blood pressure.
The Pregnancy and Diabetes Program at Brigham and Women’s Hospital offers multidisciplinary care to women with GDM. The program includes a high risk obstetrician, two diabetes specialists, a nutritionist, and a nurse practitioner who is certified in diabetes education. The first approach to treatment is to control blood glucose levels with healthy eating and physical activity. Lifestyle changes, healthy eating and physical activity, are effective in controlling blood glucose levels about 75 percent of women with GDM. If the lifestyle changes don't work, insulin therapy is started to control a mother’s blood sugar for the rest of her pregnancy.
Learn more about the Pregnancy and Diabetes Program at Brigham and Women’s Hospital:
Read the Gestational Diabetes: Managing Risk During and After Pregnancy video transcript:
Here is Dr. Seely's response to your question.
Type 2 diabetes may have many effects on pregnancy including resulting in large sized babies and increased need for cesarean section. Controlling blood glucose in pregnancy is very important for all women with diabetes.
Women who had Type 2 diabetes prior to pregnancy may have increased risk of birth defects if the mother’s glucose levels were high in the first months of pregnancy. Women with diabetes should discuss the impact of their diabetes on their pregnancy with their obstetrical provider.
Some viewers have asked what they should do if they have been unable to lose weight after delivery. Here is Dr. Seely's response:
"Many women have difficulty losing their pregnancy weight. There can be a number of reasons for this. One common reason is that although the women are eating very healthy food, the portions sizes may be too large. Seeing a dietician or nutritionist can be very helpful in this situation.
Another reason is that some women develop underactive thyroid (hypothyroidism) about 6 months after delivery. Many of these women recover but some have long lasting underactive thyroid which slows metabolism and decreases the ability to lose weight. Women who are not losing their pregnancy weight over the year after delivery despite eating healthy and engaging in physical activity should see their care provider for advice."
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