Gestational diabetes: the baby in your belly eats with you

Gestational diabetes The baby in the belly eats with you

The belly slowly gets rounder and rounder, and every now and then someone kicks it from the inside. This usually calms the mother. But sometimes it also arouses fears: Is everything okay with me and the child?? Pregnant women have a special way of listening to their bodies. But they miss some things – for example, if their sugar metabolism is out of whack.

Almost four percent of expectant mothers in Germany are diagnosed with gestational diabetes. Since blood glucose testing is not a required routine test in pregnancy, it must be assumed that many more women are likely to develop gestational diabetes, but it goes undetected. The difference between this so-called gestational diabetes and other forms of diabetes is simply that the sugar metabolism no longer functions well for the first time during pregnancy.

The hormones are to blame. Pregnancy hormones such as estrogen, placental lactogen and progestins, which are necessary to maintain the pregnancy, also influence the mother’s metabolism. After all, mother and child need to share food; both should be able to supply their body cells with enough sugar – the fuel from which cells get energy.

Hormones make body cells insensitive

Especially in the second half of pregnancy, the hormones dull the body’s cells: they no longer react so well to the insulin that normally brings sugar into the cells. The result: maternal blood sugar levels rise.

Normally, the pancreas immediately releases more insulin into the bloodstream when sugar levels there rise. In some pregnant women the organ does not supply enough insulin, the blood sugar level in the blood therefore remains high. This often happens between the fifth and seventh month of pregnancy. After birth, blood glucose levels usually settle down again on their own. However, those who were diabetic before pregnancy will remain so after delivery.

Diabetes can cause babies to become oversized in the womb

Too much sugar in the blood endangers mother and child: For the mother, the risk of high blood pressure increases. This can develop into a life-threatening disease called preeclampsia. The worst manifestation is eclampsia, a type of seizure, or the so-called HELLP syndrome, in which the whole organism can collapse. There is also an increased risk of urinary tract infection or vaginitis, which can lead to preterm labor.

A lot of sugar also means a high risk for the unborn child in the womb. The baby’s pancreas needs to make more insulin to cope with high blood sugar levels. This stimulates the growth of fatty tissue. Often such babies become very heavy. If a baby weighs more than 4.5 kilograms at birth, the delivery may be complicated – such children are more often born by cesarean section. Some of these very heavy babies have jaundice, perhaps they are hypoglycemic. If pregnant women ignore their diabetes or only treat themselves from time to time, their children will have a worse start in life: they may then become far too fat and possibly diabetic later on.

Some mothers still suffer from the effects of gestational diabetes later in life. Almost half of all women become diabetic within ten years of giving birth. Most of the time it is then type 2 diabetes. However, women can actively do something about it: Aim for normal weight, good nutrition and plenty of exercise. And this is best done for the whole family.

Taming cravings for sweets

Those affected should avoid highly sugary foods such as cakes or jam as much as possible during pregnancy. The need for sweets can be satisfied with some fresh fruit. But be careful: fruit also raises blood sugar levels, so it’s important to exercise moderation here, too. Wholemeal bread is better than sweet pastries, and rice should always be accompanied by a large portion of vegetables. Light exercise such as walking, cycling or swimming is good for pregnant women and the unborn child – and lowers blood glucose levels. If it remains too high despite proper diet and exercise, women will probably need insulin.


Pregnant women do not feel whether they have too much sugar in their blood. At best, you can notice it by certain signs. This does not include having to drink or go to the toilet all the time; both symptoms are rare in gestational diabetes. However, an alarm sign can be that the child is unusually large. A particularly large amount of amniotic fluid in the uterus may also be a clue. The doctor can determine both with the help of an ultrasound examination.

Your doctor will test your urine at every check-up. However, this test gives him only a rough orientation – it is not sufficient to determine the disease unequivocally. Only measuring blood glucose levels provides a reliable diagnosis.

You should be screened for diabetes as early as the first trimester of pregnancy if any of the following statements apply to you:

  • You are overweight: your body mass index before pregnancy was higher than 27.
  • Your parents or siblings suffer from diabetes.
  • You have had gestational diabetes before.
  • You have had three or more miscarriages.
  • You already have a child who weighed more than 4.5 kilograms at birth.
  • You have had a stillbirth.
  • You have a child with severe congenital malformations.
  • You have a pre-existing condition or are taking medication that affects sugar metabolism.


Up to now, gynecologists do not automatically test for diabetes. However, medical societies recommend that all women, between the 24th week of pregnancy and the 24th month of pregnancy, should take a healthy diet. and 28. To have a so-called glucose tolerance test done during the first week of pregnancy. To do this, you must drink a glass of sugar water on an empty stomach. On an empty stomach and after one and two hours, the doctor’s assistant measures how much sugar is in the blood.

This test shows how well the body can metabolize insulin. However, you will probably have to pay for it yourself if you are not at increased risk of diabetes. However, it is foreseeable that the test will soon become part of routine prenatal care.

In the glucose tolerance test, your fasting value should not exceed 5.3 millimoles per liter (95 milligrams per deciliter) and one hour after drinking should not exceed 10 millimoles per liter (180 milligrams per deciliter) in venous plasma. Two hours later, it should not be higher than 8.5 millimoles per liter (153 milligrams per deciliter). If one of the three values is too high, you have gestational diabetes.

Some doctors offer what’s called a glucose screening test. Drink a glass of water with 50 grams of glucose; you do not need to be fasting. The test shows how high the sugar level is in your blood after one hour if you have eaten normally beforehand. If your blood sugar is above 7.5 millimoles per liter (135 milligrams per deciliter), the doctor will advise a glucose tolerance test. Because it measures more precisely how your sugar metabolism is doing.


Gestational diabetes usually disappears on its own after birth. And the disease is easily treated. With diabetes, it always helps to eat a healthy diet – that is, without too much sugar and without too much fat. Vegetables, fish and whole grains are good choices. It is also advisable to get plenty of exercise, such as walking or doing gymnastics.

Advice on the right diet for gestational diabetes can be given by specially trained diabetes advisors and diabetologists. They will also calculate how many calories you need to keep you and your baby well-fed. And they explain why a lot of exercise helps to lower blood glucose levels.

If your blood glucose level is still too high despite a healthy diet and fitness, you will need insulin. However, this only affects 20 to 30 percent of all women with gestational diabetes. Your specialist will discuss with you how much insulin is best suited to you and how often you should inject it. Special training sessions will teach you how to inject the hormone yourself.

No pills for expectant mothers

Medicines for diabetes cannot be taken by pregnant women. Experts do not yet know enough about whether these so-called oral antidiabetic drugs harm the child in the womb.

If you have gestational diabetes, doctors consider you a high-risk pregnant woman. However, do not let this word frighten you. It is to describe that there may be complications during pregnancy or delivery. In high-risk pregnant women, there is also a slightly increased likelihood that the baby will not be born in good health.

This is what you and your gynecologist can take precautions against. The doctor will keep a close eye on you and your child and offer you additional ultrasound examinations, for example. For the birth, it is best to choose a clinic where the doctors have experience with diabetics. The hospital should also have a neonatal unit in case your child has problems after delivery.

If you need to inject yourself with insulin, your blood glucose will be checked in the hospital two days after delivery. Three to six times a day, a nurse will come to measure so she can do what’s called a blood glucose profile. If your sugar level returns to normal after delivery, you should take a glucose tolerance test six to twelve weeks later.

You should repeat this test every two years. Because even if everything has gone well, your risk of becoming diabetic again is somewhat higher than normal. Also tell the pediatrician that you had gestational diabetes. So it can check your child for possible consequences.


As a pregnant woman with diabetes, one thing will become routine for you: a conscious diet, the success of which you can monitor by measuring your blood glucose level. If the values are good, two daily profiles with four measurements a day or one value a day at alternating times are sufficient; in the case of insulin therapy or fluctuating values, measurements must be taken more frequently.

Go for a walk or swim. Or cycle with a baby bump – that’s possible. If you exercise a lot, your blood sugar level will drop because you use up energy. In addition, your body reacts better to insulin again. You will also feel much fitter yourself and gain less weight. Discuss with your doctor which types of fitness training are suitable.

If you are overweight and want to have a baby, you should lose weight before you get pregnant. This is the case for women whose on body mass index is over 27. Even a few pounds less can lower your risk of gestational diabetes and other complications. Because later, during pregnancy, weight loss is not favorable.

Eat whole-grain products and get vitamins and minerals for yourself and your child from fresh fruits and vegetables. Milk covers your calcium needs. Avoid sweet drinks and sweets.

Five to six smaller meals a day are better than three large portions. To prevent your blood sugar levels from rising too high after a meal, you can spread the foods with carbohydrates evenly across all meals.

Reduce carbohydrates at breakfast if your blood sugar regularly exceeds limits afterward, because the body has particular trouble metabolizing sugar in the morning.

You do not have to eat for two. If you are already very overweight, you should not gain more than seven kilograms during pregnancy. If you have previously weighed too little, you can gain 10 to 14 kilograms.

Expert advice

star.en-Expert Ute Schafer-Graf, gynecologist and diabetologist and expert for gestational diabetes at Sankt Joseph Hospital Berlin, answers your questions:

Can I deliver my baby normally if I have gestational diabetes?

In most cases yes. This depends very much on the course of pregnancy and the growth of the child. If there has not been sufficient therapy, the child may grow too large. Sometimes doctors advise a cesarean section so there are no complications at birth. It is also possible that the birth will be induced around the due date. This is the case, for example, with women who have injected insulin.

Is it likely that I will keep getting gestational diabetes?

There is a 50 percent chance of getting it again if you have had gestational diabetes before. In this case it is always sensible to pay attention to your diet from the beginning of your pregnancy.

Can gestational diabetes lead to miscarriage?

Miscarriages are especially a problem when diabetes is already present. However, with gestational diabetes, premature births do occur. Because women have a higher risk of infection. For example, an infection in the urinary tract can lead to premature birth.

Can injecting insulin harm my baby?

No, insulin does not reach the placenta and therefore does not reach the fetus. However, there is not yet enough experience with the so-called insulin analogues with long-term effect. These agents are therefore not used during pregnancy.


Many pregnant women get a shock when they learn they are diabetic. If the doctor also tells them that they will now have to inject insulin, the worries become even greater. A study now shows that some women with gestational diabetes can at least avoid injections: Tablets with the active ingredient metformin may be sufficient as therapy.

It has been known for some time that metformin tablets can reduce high blood sugar levels and make the body’s cells more sensitive to the metabolic hormone insulin. However, it was not clear until now whether the substance harms the unborn child.

Janet A. Rowan, of the National Women’s Hospital in Auckland, New Zealand, and her colleagues studied 733 women with gestational diabetes. Half of the women injected themselves with conventional insulin, the other half were given metformin tablets.

Findings show: Some pregnant women can do without insulin. However, it turned out that not every affected person is well treated with metformin, some women had to additionally inject themselves with insulin to lower the high blood sugar level. Overall, however, the birth risks were about the same for both types of therapy: if the expectant mother took the tablets, the risk of premature birth increased slightly, but in the insulin group, some babies were more hypoglycemic.

Women who had taken metformin were satisfied with their treatment: after giving birth, a good three-quarters said they would want to take the drug again in a subsequent pregnancy. For comparison: Less than one third of pregnant women wanted to inject insulin again.

The study results show no harmful effect of the drug metformin on the unborn child. However, the researchers write, follow-up examinations of the children would have to clarify whether the therapy is also harmless in the long term. Metformin is highly placental and it cannot be ruled out that the "co-treatment" of the fetus may later have a negative effect on its health. Therefore, the tablets are not approved for pregnant women.

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