Gestational Diabetes: Protecting Your Health After the Baby Is Born

One-third of women with gestational diabetes will develop prediabetes or type 2. Here, research-proven ways to lower the risk for T2D and heart disease. Part 4 in a series.


loving African American mom and babyThough advocacy groups including ACOG recommend women with gestational diabetes (GD) be screen after giving birth, just half of them are getting these important blood-sugar checks after pregnancy (Photo: Pixabay, Odwarific)

It’s amazing. For most women with gestational diabetes (GD), the high blood sugar that developed during their pregnancy vanishes soon after they give birth.

After your baby is born, the placenta—the organ that delivers nutrient-rich blood to your baby and produces hormones that shape your baby’s growth—detaches and is also delivered.

Hormones from the placenta that trigger GD are no longer coursing through your bloodstream. Whew! Your blood sugar’s back to normal.

But it’s smart to do all you can to keep it within a normal range. According to the American College of Obstetricians and Gynecologists (ACOG), up to 70% of women who’ve had GD will eventually develop type 2 diabetes.1

What the Research Says

Of the women with GD, one-third will have prediabetes or diabetes within just a few years of giving birth. At the same time, women with GD also face a higher risk for high blood pressure, unhealthy levels of heart-threatening blood fats and inflammation. As a result, their risk for heart attack, stroke and coronary artery disease is 66 to 85% higher than for women who did not have GD.2

In a 2014 Kaiser Permanente study3 that tracked the health of 898 women for up to 20 years after a pregnancy, researchers found that those who’d had GD were more likely to develop early signs of artery-clogging during midlife. 

A 2017 University of Iowa study that followed 8,127 women for nearly 23 years found a 63% higher risk for heart disease in those who’d had GD—and discovered that they were at higher risk for low levels of heart-protecting HDL cholesterol.4  In fact, experts now say that pregnancy itself can act as a “stress test” that reveals a woman’s future health risks.5

Many Doctors Miss the Warning Signs

But your doctor may miss warning signs that your blood sugar is rising again. National medical groups focused on women’s health and diabetes prevention—ACOG and the National Diabetes Education Program—have recommended that women’s family doctors screen them for diabetes after GD.

But just half of women with a history of GD are getting these important blood-sugar checks after pregnancy, say researchers from Kaiser Permanente.6 And a 2016 University of Illinois study of 284 women with a history of GD found that one-third had undiagnosed diabetes or prediabetes.7

Researchers know more than ever before about the best strategies for protecting the health of women and their children after GD. Here’s what to know—and do.

#1: Get Regular Blood Sugar Checks 
The American Diabetes Association recommends that women with GD should get an oral glucose tolerance test four to 12 weeks after delivery. You must fast for at least eight hours beforehand. Your blood will be tested at the start of the test, then every 30 to 60 minutes for two to three hours after you drink a very sweet test beverage containing 75 grams of sugar.

The results show how well your body absorbs blood sugar. Normal results are a fasting blood sugar level of 60-100 mg/dL; a one-hour blood sugar level below 200 mg/dL and a 2-hour blood sugar level below 140 mg/dL according to the National Library of Medicine.8 Higher results may indicate you’re at risk for diabetes or have diabetes.

If your results are normal, you should have your blood sugar tested every one to three years according to the American Diabetes Association. Future tests can be with a simple fasting blood-sugar test or a nonfasting A1C test, which measures average blood sugar levels over about the past three months. Your doctor can recommend the best testing schedule for you; you may need more frequent checks if you have a family history of diabetes, were at a higher weight before pregnancy or if you needed medication for GD during your pregnancy.9

#2. Breastfeed Your Baby
Breastfeeding for six months or more slashed a woman’s risk for developing type 2 diabetes by 47% over the next decades, according to a recent, headline-grabbing Kaiser Permanente study10 of 1,238 black and Caucasian women. For women who nursed their new babies for six months or less, diabetes risk was 25% lower compared to women who did not breastfeed at all.

Moms got this powerful breastfeeding “bonus” even if they were at higher risk for eventually developing diabetes due to their weight, family history, lifestyle, race, pre-pregnancy blood sugar levels or gestational diabetes during pregnancy, lead study author Erica P Gunderson, PhD, PhD, MS, MPH, senior research scientist with the Kaiser Permanente Division of Research, told OnTrack Diabetes. Nursing may lower a woman’s long-term risk for diabetes in several ways. “During lactation, fasting blood insulin and glucose levels are lower. Both glucose [blood sugar] and lipids [blood fats] are transferred from the circulatory system into the breast to produce milk,” Dr. Gunderson says. 

This may lighten the workload of pancreatic beta cells, which produce insulin. In addition prolactin, the primary hormone that regulates breastmilk production, may have beneficial effects for the health of insulin-producing cells.  Nursing also uses up some fat stored in fat cells, though the researchers found that weight loss after pregnancy didn’t explain lower diabetes risk later on.

#3. Continue Following a Healthy Diet 
When researchers from the Harvard School of Public Health followed 4,413 women with GD for 15 years, they found that those who kept eating a healthy diet were 40-57%  less likely to develop diabetes as those who ate a less-healthy diet. Women with the lowest risk ate the most produce, whole grains, beans, nuts, fish, seafood and lean protein and ate the smallest amounts of refined carbohydrates, sugary drinks, processed meats and foods high in saturated fat such as fatty meats.11

Healthy eaters also tended to be at a healthier weight, but following a good-for-you diet gave overweight women some protection from diabetes, too. This way of eating may help by keeping blood sugar lower and steadier after meals and by providing vitamins, minerals and other nutrients that shield insulin-producing cells in the pancreas from damage, the researchers say. 

#4. Stay Active
Tuck your baby into a stroller or baby jogger and head out for a walk. When Harvard researchers compared diabetes risk and exercise patterns in 4,445 women who’d had gestational diabetes, they found that a brisk 30-minute walk five days a week cut risk 47%.12  Exercise helps your muscles sip more sugar directly from your bloodstream; it can also help you lose abdominal fat, which releases compounds that interfere with blood-sugar absorption. Don’t wait til you’ve lost your baby weight to start walking–activity helped protect women who were overweight, too.

#5. Work to Get to Healthy Weight
It may take a while after pregnancy, but dropping just 5 to 7% of your weight (8 ½ to 12 pounds if you now weigh 170) could prevent or delay diabetes, according to the NIH.13 In the landmark Diabetes Prevention Program study, women with GD who lost that much weight and got 150 minutes of exercise per week cut their risk for developing diabetes in the next three years by 55 percent.14 Over 10% years, this strategy could reduce your risk by 35%, according to the ADA.

#6. Consider Metformin if your Doctor Recommends It Taking this blood sugar-lowering drug could help. In the Diabetes Prevention Program study, women who’d had GD during pregnancy and who later developed prediabetes cut their risk for progressing to diabetes by 50% over three years with metformin. Over ten years, this medication—a mainstay of drug treatment for type 2 diabetes—could lower your risk by 40% according to the ADA.

#7. Protect Your Heart
Work with your doctor to get the blood-pressure and cholesterol checks you need—and take recommended steps to keep them at healthy levels.

#8. Share your Healthy Habits with Your Growing Child There’s little research on preventing obesity and type 2 diabetes in the daughters and sons of women who’ve had GD. Introducing your child to healthy foods as she or he grows and giving them plenty of opportunities for active fun—from running around on a playground to organized sports to taking a walk with you—could help.

Updated on: June 6, 2019
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Gestational Diabetes: 5 Surprising Facts