Gestational diabetes is known to carry risks for the fetus and mother during pregnancy. Those risks were thought to disappear postpartum, but a strong link has been well-established between gestational diabetes and the development of type 2 diabetes later in life.
As many as 50%–70% of women with gestational diabetes will develop type 2 diabetes, and 30% of those women will develop the condition within just five years of giving birth, according to Ellen W. Seely, MD, director of clinical research in the Endocrinology, Diabetes and Hypertension Division at Brigham and Women’s Hospital. She says the hospital educates these women on their future risks and intervenes to help them avoid future problems.
In the mother, gestational diabetes is associated with maternal hypertension and a higher risk of Cesarean delivery. In the fetus, the condition is linked to macrosomia (fetal overgrowth). The condition can also result in birth trauma for the newborn as well as neonatal hypoglycemia and jaundice. In addition, babies born to women with gestational diabetes are more likely to have obesity issues by the time they reach adolescence and develop other complications like high blood pressure and type 2 diabetes as adults.
“At least five percent of pregnancies in the United States are complicated by gestational diabetes,” Dr. Seely says. “Among non-white and obese women, that number climbs to 10%–20%. Clinicians have a unique window of opportunity to intervene following a pregnancy complicated by gestational diabetes and before the development of type 2 diabetes. When gestational diabetes goes away postpartum, patients think they are in the clear, only to find out later they are not.”
Encouraging a Healthy Lifestyle During Pregnancy
The Brigham delivers more babies than any other health center in the northeastern United States, and many of these pregnancies are complicated.
At the hospital, pregnant patients with gestational diabetes (which is commonly diagnosed at 24–28 weeks of pregnancy) are provided comprehensive health services through the Pregnancy and Diabetes Program, co-founded by Dr. Seely in 1996. The program brings a multidisciplinary approach to caring for patients with a team that includes a high-risk obstetrician, diabetes specialists, nutritionist, social workers and a nurse practitioner who is a certified diabetes educator.
“In a single visit to a single clinic, patients with gestational diabetes get access to an entire team dedicated to helping them reduce their glucose levels, as well as their obstetrical and ultrasound services,” Dr. Seely says. “This approach allows patients to live their lives instead of constantly being overwhelmed with multiple doctor appointments.”
Because behavior modification is one of the biggest keys to success in glucose management, the Pregnancy and Diabetes team focuses patients on measures such as healthy eating and increased physical activity. These lifestyle changes are effective for about 75% of patients, Dr. Seely says. In the 25% for whom lifestyle changes don’t work, the team offers insulin therapy to normalize blood sugars.
Balance After Baby: Bringing Lifestyle Modifications Home
Dr. Seely and her research group conducted a lifestyle intervention study in women with gestational diabetes called Balance After Baby. Funded by the Centers for Disease Control, the program is designed to extend the healthy eating and exercise lessons learned during pregnancy to the lived-in environment of the home and to lower the risk for the future development of type 2 diabetes.
“Many hospitals with busy obstetrics services have strong programs in gestational diabetes, focusing on what happens during pregnancy,” Dr. Seely says. “At the Brigham, we also focus on what happens after pregnancy. Delivery of the baby is not the end of the story.”
According to Dr. Seely, if women retain the weight they gain during pregnancy for six months to a year, they are more likely to have problems associated with obesity, including type 2 diabetes. Therefore, one of the program’s main goals is to have women lose their pregnancy weight within a year of giving birth.
“We tell our patients that just as they took care of their body—the environment in which the fetus lived during pregnancy—they need to take care of their home environment after the baby is born so the baby and the entire family stay healthy,” Dr. Seely says. “That means creating a healthy home, planning and eating healthy meals, and getting everyone in the family to be more active—together, if possible.”
In the Balance After Baby study, one group of women received routine care after pregnancy, and a second group received a web-based intervention that taught them how to eat healthy and increase their physical activity. Women in the lifestyle intervention program lost weight within a year of giving birth—many reaching their pre-pregnancy levels—while women in the control group gained weight.
A follow-up study by the research team will look at weight gain and loss over two years after pregnancy and check glucose levels to see if the intervention is effective in reducing type 2 diabetes.
“Making lifestyle changes can be hard, so we focus on more than simply advising patients to eat healthy and exercise,” Dr. Seely says. “Instead, we help motivate them to move along the behavioral change spectrum so they will not only make the change, but also maintain the change for the rest of their lives.”