Gain The Right Amount Of Weight
Gaining too much or too quickly during pregnancy can increase the chances for GD, so talk to your doctor about what you should be seeing on the scale. In general, you should aim to gain 25 to 35 pounds if your pre-pregnancy body mass index was in the normal range, 15 to 25 pounds if you were overweight before becoming pregnant, and 11 to 20 pounds if you were obese before coming pregnant.
From the What to Expect editorial team and Heidi Murkoff, author of What to Expect When You’re Expecting. What to Expect follows strict reporting guidelines and uses only credible sources, such as peer-reviewed studies, academic research institutions and highly respected health organizations. Learn how we keep our content accurate and up-to-date by reading our medical review and editorial policy.
Testing For Gestational Diabetes
There are some risk factors that increase your chance of developing gestational diabetes. Your midwife will ask you about these at your booking appointment, which happens around 8-12 weeks of pregnancy. If you have any of the risk factors, youll be offered a test for gestational diabetes when you’re between 24 and 28 weeks pregnant.
Gestational diabetes does not usually cause any symptoms, but some women may have some if their blood glucose levels get too high. Speak to your midwife if you have any concerns. Talk to your midwife if you think you are at risk of developing gestational diabetes, but you havent been offered a screening test.
You dont have to take the test if its offered, but there are a few things to keep in mind:
- if you have gestational diabetes, you will be offered more care during both pregnancy and labour, to help reduce the risk of problems
- for some women, gestational diabetes can be improved by changes in diet and doing more exercise
- if changes in diet and doing more exercise don’t improve gestational diabetes, youll be offered medication or insulin.
“I wasnt obviously skinny, but I wasnt massively obese either I had no symptoms whatsoever. I had no expectation that the test would be anything other than a formality.”
Beth, mum of two
What Is The Glucose Tolerance Test
Prior to the taking the glucose tolerance test, your doctor will ask you to make sure and eat at least 150 mg of carbohydrates for three days prior to the time you will be asked to fast. You will not be permitted to eat or drink anything but sips of water for 14 hours prior to the test, so it is best to schedule the test for first thing in the morning.
Additionally, you should plan to have someone drive you to and from the test since your energy levels may be low and there is a slight possibility you may feel light-headed.
3-Hour Glucose Test
When you arrive, the technician will draw blood to measure your baseline fasting blood glucose level. You will be asked to drink a larger volume of the glucose drink than was used in the initial Glucose Challenge Screening test. Your blood will be drawn and tested every hour for the next three hours.
The following are the values that the American Diabetes Association considers to be abnormal during the Glucose Tolerance Test:
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What Is The Difference Between Blood Glucose Screening And Tolerance Tests
Glucose screening and tolerance tests help healthcare providers check the way your body processes glucose . The screening test is used to determine if you are at risk of having gestational diabetes, and the tolerance test can help determine whether you actually have the condition. This information, and the steps taken in response, are crucial for the health of you and your baby. Youâll need to have your blood drawn, so you might feel dizzy or lightheaded, and you may have slight bruising or bleeding around the spot where blood was drawn, but otherwise the risks associated with these tests are minimal.
What Happens After My Baby Is Born
If you have been injecting insulin to help manage gestational diabetes this usually stops once your baby is born. This is because womens blood glucose levels usually return to the optimal range quite quickly after their babys birth.
Following the birth of your baby, it is important that your babys blood glucose levels are measured to check that their blood glucose is not too low. If it is, this can be treated by feeding your baby breast milk or formula. Breastfeeding is encouraged as this is best for you and your baby.
Your blood glucose levels will be measured for a few days after your baby is born to make sure that they are within the recommended range. Glucose checking times are usually before breakfast and 2 hours after meals. An oral glucose tolerance test is done 6 to 12 weeks after the baby is born to check that your diabetes has gone away.
During COVID-19, recommendations are to delay the OGTT testing for 6 months, if you are not able to social distance at the pathology centre or living in a high-risk area. It is recommended to have an OGTT before your baby is 12 months old or if planning another pregnancy. Be guided by your doctor.
A baby whose mother had gestational diabetes will not be born with diabetes, but they may be at higher risk of developing type 2 diabetes later in life.
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What Are The Complications Of Gestational Diabetes
If your blood sugar levels remain high during your pregnancy, this may lead to pregnancy problems such as a large baby, miscarriage or stillbirth. Having a large baby can lead to complications and injury during the birth, and increase the chances of having intervention in labour such as a caesarean birth. But the baby will not be born with diabetes.
If you have gestational diabetes, you are at higher risk of developing high blood pressure while you are pregnant and a 50% increased risk of developing type 2 diabetes in the future. Your baby is also at greater risk of developing type 2 diabetes in later life.
To reduce your risk of developing type 2 diabetes:
- keep to a healthy weight
- eat a healthy diet
- be physically active
- check your blood glucose levels
You can also call Pregnancy, Birth and Baby on 1800 882 436 to speak to a maternal child health nurse for advice and support.
Education About Insulin Commencement
It is very important that you get information and support from your diabetes educator or doctor on how insulin works, how to give insulin and how to store it.
Insulin sometimes causes blood glucose levels to go too low , so it is very important that you learn the signs and symptoms of this and how to prevent and treat it .
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Group B Streptococcus Test
GBS is a healthy vaginal bacterium however, not all women will test positive. GBS does not usually pass to the baby, but if it does, it can cause serious illness. A vaginal-rectal swab will be done around 35-37 weeks to identify whether you have this bacteria present. If our laboratory identifies that the bacteria is present, you will be treated with antibiotics while in labour.
How Is Gestational Diabetes Diagnosed
Most women are diagnosed using a pathology test, which requires blood samples to be taken before and after a glucose drink. This is known as a pregnancy oral glucose tolerance test . This test is usually performed between 24 and 28 weeks into the pregnancy, or earlier if you are at high risk.
A pregnancy oral glucose tolerance test involves:
- fasting overnight
- having a blood test in the morning
- having a drink containing 75 grams of glucose
- having a blood test one hour after having the drink
- having a blood test 2 hours after having the drink.
Gestational diabetes is diagnosed if any of the results from the test show that your blood glucose is raised.
During COVID-19, further diagnostic guidelines have been added as alternatives to the OGTT where this cannot be performed due to a contagion risk. Check with your doctor or hospital about current guidelines.
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How Common Is It To Fail The 1 Hour Glucose Challenge Test
In general, anywhere from 15-25% of women will fail the glucose challenge test. But keep in mind that failing the 1-hour test does not give you the diagnosis of gestational diabetes.
According to the CDC, the prevalence of gestational diabetes is about 2-10%.
But failing the test should raise some red flags that you need to pay attention to your diet.
Understanding Your Glucose Challenge Screening Results
There are some standard benchmark numbers used to separate those considered at low-risk for gestational diabetes from those who need to graduate to the three-hour blood glucose tolerance test. So whats the one-hour glucose test normal range? According to the Mayo Clinic:
- Blood sugar level below 140 mg/dL is normal and considered passing.
- Blood sugar level between 140 mg/dL and 190 mg/dL is elevated, and requires the follow-up three-hour glucose tolerance test to confirm gestational diabetes
- Blood sugar level of 190 mg/dL or higher indicates gestational diabetes. Your doctor will advise about the need for repeat or secondary testing. When results are this high, though, they may skip this step altogether and begin monitoring and treatment
Dont panic if your doctor or midwife informs you that your one-hour glucose test number comes back elevated . It doesnt necessarily mean you have gestational diabetes. This is just a screening test, and nearly 25 percent of patients fail this initial test, says Pope. A confirmatory three-hour glucose test is next.
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What Is The Normal Range For The 1 Hour Glucose Test
A normal test result for the 1 hour 50-gram glucose test is lower than 140 mg/dL.
- Some clinics will use a lower threshold of 130 mg/dL. This lower level is used if the population is at increased risk of gestational diabetes.
If you happen to have a value greater than 200 mg/dL, then you meet the criteria for the diagnosis of gestational diabetes.
If you take the 2-hour 75g challenge, a normal result is less than 180 mg/dL at the 1-hour mark, and less than 155 mg/dL at the 2-hour mark
In addition, your fasting blood glucose level should be lower than 95 mg/dL for the 2-hour test.
Pregnancy Glucose Tolerance Test Results
As the normal range of glucose tolerance test results may vary depending on the lab or clinic, your doctor is the best resource for information and advice on your specific results and recommended next steps. However, these general guidelines may apply:
If any one of the test results are higher than normal, a new test may be recommended for about four weeks later.
If two or more of the results are higher than normal, your doctor may diagnose you with gestational diabetes.
How To Prepare For The 1
You dont need to do anything special to prepare for a glucose tolerance test. Just make sure you eat and drink normally in the days leading up to the test.
On the day of the test, you may be asked to fast for a period of time before the test. You can usually drink water during this time.
The time period where youre to fast before the test varies, so talk with your provider or the lab to make sure youre doing it to their specifications.
You will likely have blood drawn before you take the glucose. This is to test how much sugar is in your blood when you havent eaten.
Then, youll be asked to drink a sugary solution. The amount of sugar in the solution is about the same as in a can of soda. After you drink the solution, your blood will be drawn one or more times over the next hour.
You might feel a little dizzy after drinking the sugary solution. This is normal. Just make sure you dont drive or operate machinery until the effects wear off.
An hour after you drink that drink they will draw your blood again to see how your body is processing that sugar.
Do You Have To Take A Glucose Screening Test While Pregnant
The U.S. Preventive Services Task Force and American College of Obstetricians and Gynecologists recommend all pregnant people be screened for gestational diabetes. It’s more important now than ever before, given the increasing numbers of pregnant people affected by obesity and a sedentary lifestyle.
Detection and treatment of gestational diabetes can reduce the risk of pregnancy complications like preeclampsia, an overly large baby, high blood pressure, and C-section. “Studies show a significant reduction in serious complications with treatment of gestational diabetes,” reiterates American Family Physician in a review of ACOG guidelines.
Early gestational diabetes screening is recommended for people with certain risk factors, including a history of gestational diabetes, obesity, and known impairment to glucose metabolism, according to American Family Physician.
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How Gestational Diabetes Can Affect Your Pregnancy
Most women with gestational diabetes have otherwise normal pregnancies with healthy babies.
However, gestational diabetes can cause problems such as:
- your baby growing larger than usual this may lead to difficulties during the delivery and increases the likelihood of needing induced labour or a caesarean section
- polyhydramnios too much amniotic fluid in the womb, which can cause premature labour or problems at delivery
- premature birth giving birth before the 37th week of pregnancy
- pre-eclampsia a condition that causes high blood pressure during pregnancy and can lead to pregnancy complications if not treated
- your baby developing low blood sugar or yellowing of the skin and eyes after he or she is born, which may require treatment in hospital
- the loss of your baby though this is rare
Having gestational diabetes also means you’re at an increased risk of developing type 2 diabetes in the future.
What Happens If Your Glucose Screening Test Is Abnormal
If your glucose screening test is elevated or “abnormal,” your body may not be producing enough insulin. Results over 130 mg/dL could be indicative of a problem. However, before your doctor can diagnose you with gestational diabetes, you will need to take a confirmatory three-hour glucose test.
To prepare for this three-hour gestational diabetes test, you will need to fast overnight and then drink a solution with an even higher dose of glucose. Your blood will then be sampled several times over a period of about three hours and tested for abnormal levels of glucose.
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One Hour Glucose Results:
- Glucose test 1 hour after drinking glucose solution < 140
- If they take a fasting test, they likely want it to be less than about 95
Again, if your numbers are greater than this, they will likely ask you to take the 3 hour test.
I have seen people who the numbers were SO high with the 1-hour test, that they just diagnosed them with diabetes and sent them to a dietician for a consult and further testing.
Monitoring Your Blood Glucose Levels
Your medical team will give you a target range for your blood glucose levels. You will need to check these at home while you are pregnant.
You can purchase a blood glucose measuring kit from your local pharmacy or diabetes centre, or from Diabetes Australia in your state or territory call 1800 637 700 for help.
To test your blood glucose levels, you prick your finger with a lancet and put a small drop of blood onto a testing strip. Then you insert the strip into a meter, which reads your blood glucose level.
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Glucose Tolerance Test Results
Itâs worth knowing that approximately 66 percent of pregnant women who take the glucose tolerance test end up not being diagnosed with gestational diabetes. So, just because your provider has ordered a glucose tolerance test during your pregnancy doesnât automatically mean you have gestational diabetes.So, what do the results of the glucose tolerance test indicate? Four blood samples are drawn during a glucose tolerance test. If just one of the four results is higher than normal, your provider may recommend that you make subtle changes to your current pregnancy diet. The provider may have you take another glucose tolerance test after youâve made those changes to check if the results have improved.If more than one of the results is higher than normal, your provider may determine that you have gestational diabetes. The following figures indicate higher than normal blood sugar levels:
Fasting blood sample: Higher than 95 mg/dL
1-hour blood sample: Higher than 180 mg/dL
2-hour blood sample: Higher than 155 mg/dL
3-hour blood sample: Higher than 140 mg/dL .
If itâs determined that you have gestational diabetes, your healthcare provider can help guide you in making changes to help manage it. Eating a healthy diet, exercising during your pregnancy, and taking medication prescribed by your provider have been shown to help control blood sugar and to help keep you and your baby healthy.
What Happens If I Fail My Glucose Test During Pregnancy
Around 24-28 weeks gestation, most practitioners will order a blood glucose test to see if the pregnant patient has gestational diabetes. Gestational diabetes is a high blood sugar condition that 2-5 percent of pregnant women develop during pregnancy. Because this condition rarely causes any visible symptoms, performing a glucose test is the only way to find out if a patient has it. If a patient tests positive for this screening, a glucose tolerance test is needed. A GTT is a longer more definitive test that will tell a patient definitively whether or not she has gestational diabetes.
What Happens Once Diagnosed with Gestational Diabetes?
There are many different plans that a practitioner could set a patient on depending how high the glucose levels were on the glucose tolerance test. Most patients are referred to a high-risk OB-GYN as additional screenings are needed to ensure the fetus is not in any distress and monitor the fetus growth, as a result of this condition.
Patients who are unable to control their glucose levels could need to try medication to aide throughout the rest of their pregnancy. It is important for a patient to discuss her feelings and any side effects of gestational diabetes medication with a doctor while on them.
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