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After having gestational diabetes twice, I really, really want to be a success story. I want to do everything I can to reduce my chances of having type 2 diabetes. In thinking about this, I decided to do a deep dive on what the research has to say; I’ve heard different things from different doctors/experts on the odds of developing type 2 after having GD. My deep dive has revealed some very interesting information.
Of course, as you know, I’m not a medical professional or a medical researcher. I’m just a mom using Google. So here are my findings, for whatever they’re worth.
If I have GD, what happens after I have my baby?
Per Lily Nichols’ Real Food for Gestational Diabetes: “Your doctor should test your blood sugar between 6-12 weeks postpartum and again a round your child’s first birthday…If your numbers are abnormal, your doctor should check again 1 year later, as many women “convert” to type 2 diabetes if they don’t make changes to their diet and exercise habits. If your numbers at the one-year screening come back normal, your doctor should repeat screening at minimum every 3 years (some continue to check annually).”
After my first GD pregnancy, I struggled with high blood sugars for about 3 months postpartum and was closely monitored. I finally got the “all clear” to stop checking my blood sugar, but was told I needed to have my A1C tested every year for the rest of my life. My doctor in my second GD pregnancy had me tested at 6 weeks postpartum and I scored in the normal range.
But what can postpartum moms do besides having a blood test once a year? What are the odds of developing type 2 diabetes, and what can we do to prevent that from happening?
Gestational diabetes and type 2: what are the odds?
The depressing part: the odds of developing type 2 after a GD pregnancy are high. Most experts say 50% (per the CDC) or even up to 60%. According to Frank Hu, MD at the Harvard School of Public Health, gestational diabetes “increases the likelihood that women will develop type 2 diabetes later in life. ‘They have a three- to sevenfold higher risk of developing type 2 within five to 10 years”. There are some interesting reasons why this happens; here is one explanation: according to Dr. Lorraine Lipscombe at Women’s College Hospital, developing gestational diabetes is actually an early symptom of an abnormal ability to secrete insulin, eventually leading to type 2 diabetes. “Women get gestational diabetes because they have risk factors for Type 2 diabetes, but it hasn’t developed yet…As they get older, especially if they gain weight or if they have an unhealthy diet, or they have other factors that play into the increased challenge to the pancreas, then eventually the pancreas has to work harder, and eventually it fails to the point where they get Type 2 diabetes.”
But before you quit on me, keep reading!
Gestational diabetes and type 2: risk factors
Several different factors play into the odds of developing type 2, including ethnicity. You also have a higher chance of developing type 2 later if you needed to take insulin during a gestational diabetes pregnancy. According to a literature review by Noctor and Dunne, some factors have been found to have an association with future type 2 diabetes, including PCOS, and higher glucose values during pregnancy.
Polycystic ovary syndrome is a condition in which women produce higher amounts of testosterone and other androgen hormones than average; these elevated hormone levels cause symptoms such as irregular periods, infertility, weight gain, acne, and excess body hair. (Yeah, it’s super fun!) Pregnant women with PCOS are at least twice as likely to develop gestational diabetes. A study in Denmark found that women with PCOS were also four times more likely to develop type 2 diabetes, by an average age of 31 years (compared to an average age of 35 for women without PCOS).
Another interesting finding is that women with high fasting blood sugars seem to have more risk of type 2 than those with just high post-meal blood sugars: “A systematic review and meta-analysis of over 650,000 women found that women with gestational diabetes are seven times more likely to develop type 2 diabetes than women with no blood sugar issues during pregnancy. Women who have high fasting blood sugar during pregnancy have a higher risk of developing type 2 diabetes compared to women with high post-meal blood sugars” (from Lily Nichols’ “Real Food for Gestational Diabetes”). (For more on what causes high fasting blood sugars and what to do about them, check out this excellent article from Gestational Diabetes UK.)
Lifestyle factors and type 2 diabetes
The encouraging part about the odds of developing type 2 diabetes after a GD pregnancy: first, that the odds are 60%, not 100% (lol). Second, “Although the lifetime risk of Type 2 diabetes for women with gestational diabetes may be as high as 50 per cent, it is not a certainty. Research suggests that lifestyle can play an important role in managing those risks for women who have had gestational diabetes.” Let’s look in more depth at some of those lifestyle factors.
Obesity and type 2 diabetes
According to a study by Susan Chu at the CDC, higher pre-pregnancy weight is strongly correlated with risk of gestational diabetes, as well as type 2 diabetes after giving birth. A study by Kim, England, Wilson, Bish, Satten, and Dietz in the American Journal of Public Health indicated that obesity significantly increases the risk of gestational diabetes. The authors of this study also indicated that “to the extent that prepregnancy overweight and obesity cause GDM, reducing prepregnancy weight in these women should reduce diabetes-related adverse pregnancy outcomes. Sustaining this weight loss beyond pregnancy should reduce women’s future risk for type 2 diabetes.” In other words, making lifestyle changes to reduce obesity will reduce the risk of type 2.
In her book Real Food for Gestational Diabetes, Lily Nichols states, “Women who lose just 7-10% of their body weight have a 50% reduced risk of developing type 2 diabetes. That means if you weigh 175 pounds, you only need to lose 12-18 pounds to fully halve your risk of diabetes. Pretty amazing!” This is my new favorite quote from the book. I’m going to read it every time I get discouraged with trying to lose weight.
Low-carb diets and type 2 diabetes
There is research to support the effectiveness of low-carb diets in preventing type 2 diabetes. A study at Ohio State University found that patients were able to reduce their metabolic syndrome (high blood pressure, high blood glucose and excess body fat around the waist) by changing to a low-carb diet, even though they did not lose a significant amount of weight. Many studies have found that low-carb diets are effective in managing blood sugar for people with both type 1 and type 2 diabetes.
Also, if you have PCOS, here’s some good news: research is beginning to show that low-carb diets are one way to reduce obesity and treat symptoms in women with PCOS. So if you have PCOS and had gestational diabetes, a low carb diet may help you reduce your risk of developing type 2.
Exercise and type 2 diabetes
A literature review in Diabetes Care magazine indicated that increasing physical activity can decrease the risk of developing gestational diabetes, as well as type 2 diabetes later. Exercise is encouraged by the American Diabetes Association as a way to manage blood sugar, reduce risk of heart attack, and promote overall health. A Finnish study on diabetes prevention found that individuals who increased their physical activity level (more than participants who did not increase their activity level) were 65% less likely to develop type 2 diabetes.
Moderate aerobic exercise improves blood glucose and insulin action; resistance exercise has also been shown to improve blood glucose levels. Physical activity can also reduce insulin action in the liver.
High Intensity Interval Training workouts (aka HIIT) help to reduce blood sugar levels and may help prevent type 2 diabetes. Check out this article for an example of a HIIT workout, and this post for more on prenatal/postnatal workout examples.
In summation, the odds of developing type 2 diabetes after a pregnancy are at least 50%, and may be higher depending on individual factors such as ethnicity, blood glucose levels during pregnancy, and underlying conditions such as PCOS.
You can reduce your risk of developing type 2 diabetes by managing your weight, eating a low-carb diet, and exercising. Of course there are no guarantees, but there is still a lot in our control. There is a lot to feel hopeful about!
I feel very hopeful about reducing my risk of type 2 diabetes. I love how I feel when I’m eating healthy and taking better care of me.
What have you been told by your medical care providers about reducing your risk of type 2 diabetes? Share in the comments!