Diabetes and Pregnancy Also called: Gestational diabetes

Diabetes is a disease in which your blood glucose, or blood sugar, levels are too high. When you are pregnant, high blood sugar levels are not good for your baby.

About seven out of every 100 pregnant women in the United States get gestational diabetes. Gestational diabetes is diabetes that happens for the first time when a woman is pregnant. Most of the time, it goes away after you have your baby. But it does increase your risk for developing type 2 diabetes later on. Your child is also at risk for obesity and type 2 diabetes.

Most women get a test to check for diabetes during their second trimester of pregnancy. Women at higher risk may get a test earlier.

If you already have diabetes, the best time to control your blood sugar is before you get pregnant. High blood sugar levels can be harmful to your baby during the first weeks of pregnancy – even before you know you are pregnant. To keep you and your baby healthy, it is important to keep your blood sugar as close to normal as possible before and during pregnancy.

Either type of diabetes during pregnancy increases the chances of problems for you and your baby. To help lower the chances talk to your health care team about:

• A meal plan for your pregnancy
• A safe exercise plan
• How often to test your blood sugar
• Taking your medicine as prescribed. Your medicine plan may need to change during pregnancy.

If you have diabetes and plan to have a baby, you should try to get your blood glucose levels close to your target range before you get pregnant.

Staying in your target range during pregnancy, which may be different than when you aren’t pregnant, is also important. High blood glucose, also called blood sugar, can harm your baby during the first weeks of pregnancy, even before you know you are pregnant. If you have diabetes and are already pregnant, see your doctor as soon as possible to make a plan to manage your diabetes. Working with your health care team and following your diabetes management plan can help you have a healthy pregnancy and a healthy baby.

If you develop diabetes for the first time while you are pregnant, you have gestational diabetes.

How can diabetes affect my baby?

A baby’s organs, such as the brain, heart, kidneys, and lungs, start forming during the first 8 weeks of pregnancy. High blood glucose levels can be harmful during this early stage and can increase the chance that your baby will have birth defects, such as heart defects or defects of the brain or spine.

High blood glucose levels during pregnancy can also increase the chance that your baby will be born too early, weigh too much, or have breathing problems or low blood glucose right after birth.

High blood glucose also can increase the chance that you will have a miscarriage NIH external link or a stillborn baby.¹ Stillborn means the baby dies in the womb during the second half of pregnancy.

How can my diabetes affect me during pregnancy?

Hormonal and other changes in your body during pregnancy affect your blood glucose levels, so you might need to change how you manage your diabetes. Even if you’ve had diabetes for years, you may need to change your meal plan, physical activity routine, and medicines. If you have been taking an oral diabetes medicine, you may need to switch to insulin. As you get closer to your due date, your management plan might change again.

What health problems could I develop during pregnancy because of my diabetes?

Pregnancy can worsen certain long-term diabetes problems, such as eye problems and kidney disease, especially if your blood glucose levels are too high.

You also have a greater chance of developing preeclampsia, sometimes called toxemia, which is when you develop high blood pressure and too much protein in your urine during the second half of pregnancy. Preeclampsia NIH external link can cause serious or life-threatening problems for you and your baby. The only cure for preeclampsia is to give birth. If you have preeclampsia and have reached 37 weeks of pregnancy, your doctor may want to deliver your baby early. Before 37 weeks, you and your doctor may consider other options to help your baby develop as much as possible before he or she is born.

How can I prepare for pregnancy if I have diabetes?

If you have diabetes, keeping your blood glucose as close to normal as possible before and during your pregnancy is important to stay healthy and have a healthy baby. Getting checkups before and during pregnancy, following your diabetes meal plan, being physically active as your health care team advises, and taking diabetes medicines if you need to will help you manage your diabetes. Stopping smoking and taking vitamins as your doctor advises also can help you and your baby stay healthy.

Work with your health care team

Regular visits with members of a health care team who are experts in diabetes and pregnancy will ensure that you and your baby get the best care. Your health care team may include

• a medical doctor who specializes in diabetes care, such as an endocrinologist or a diabetologist
• an obstetrician with experience treating women with diabetes
• a diabetes educator who can help you manage your diabetes
• a nurse practitioner NIH external link who provides prenatal care NIH external link during your pregnancy
• a registered dietitian to help with meal planning
• specialists who diagnose and treat diabetes-related problems, such as vision problems, kidney disease, and heart disease
• a social worker or psychologist to help you cope with stress, worry, and the extra demands of pregnancy

You are the most important member of the team. Your health care team can give you expert advice, but you are the one who must manage your diabetes every day.

Stress is a normal psychological and physical reaction to the demands of life. A small amount of stress can be good, motivating you to perform well. But many challenges daily, such as sitting in traffic, meeting deadlines and paying bills, can push you beyond your ability to cope.

Your brain comes hard-wired with an alarm system for your protection. When your brain perceives a threat, it signals your body to release a burst of hormones that increase your heart rate and raise your blood pressure. This “fight-or-flight” response fuels you to deal with the threat.

Once the threat is gone, your body is meant to return to a normal, relaxed state. Unfortunately, the nonstop complications of modern life and its demands and expectations mean that some people’s alarm systems rarely shut off.

Stress management gives you a range of tools to reset and to recalibrate your alarm system. It can help your mind and body adapt (resilience). Without it, your body might always be on high alert. Over time, chronic stress can lead to serious health problems.

Don’t wait until stress damages your health, relationships or quality of life. Start practicing stress management techniques today.

Stress symptoms: Effects on your body and behavior

Stress symptoms may be affecting your health, even though you might not realize it. You may think illness is to blame for that irritating headache, your frequent insomnia or your decreased productivity at work. But stress may actually be the cause.

Common effects of stress

Indeed, stress symptoms can affect your body, your thoughts and feelings, and your behavior. Being able to recognize common stress symptoms can help you manage them. Stress that’s left unchecked can contribute to many health problems, such as high blood pressure, heart disease, obesity and diabetes.

Common effects of stress

On your body	On your mood	On your behavior
Headache	Anxiety	Overeating or undereating
Muscle tension or pain	Restlessness	Angry outbursts
Chest pain	Lack of motivation or focus	Drug or alcohol misuse
Fatigue	Feeling overwhelmed	Tobacco use
Change in sex drive	Irritability or anger	Social withdrawal
Stomach upset	Sadness or depression	Exercising less often
Sleep problems

Act to manage stress

If you have stress symptoms, taking steps to manage your stress can have many health benefits. Explore stress management strategies, such as:

• Getting regular physical activity
• Practicing relaxation techniques, such as deep breathing, meditation, yoga, tai chi or massage
• Keeping a sense of humor
• Spending time with family and friends
• Setting aside time for hobbies, such as reading a book or listening to music

Aim to find active ways to manage your stress. Inactive ways to manage stress — such as watching television, surfing the internet or playing video games — may seem relaxing, but they may increase your stress over the long term.

And be sure to get plenty of sleep and eat a healthy, balanced diet. Avoid tobacco use, excess caffeine and alcohol, and the use of illegal substances.

When to seek help

If you’re not sure if stress is the cause or if you’ve taken steps to control your stress but your symptoms continue, see your doctor. Your healthcare provider may want to check for other potential causes. Or consider seeing a professional counselor or therapist, who can help you identify sources of your stress and learn new coping tools.

Also, get emergency help immediately if you have chest pain, especially if you also have shortness of breath, jaw or back pain, pain radiating into your shoulder and arm, sweating, dizziness, or nausea. These may be warning signs of a heart attack and not simply stress symptoms.

1. Skipping breakfast aids weigh loss

The common adage that breakfast is the most important meal of the day may or may not be true, but it seems unlikely that skipping the morning meal aids weight loss.

The rationale behind this strategy is that missing one meal a day leads to a lower overall intake of calories. However, the story is not so straightforward.

One study, published in 2010, analyzed food intake information from 2,184 people aged 9–15 years. Twenty years later, the researchers asked for the same information again.

They compared data from people who had skipped breakfast during childhood and adulthood with data from those who had never skipped breakfast or had done so only in adulthood.

Compared with the other groups, the participants who skipped breakfast during both childhood and adulthood tended to have larger waist circumferences, higher fasting insulin levels, and higher total cholesterol levels.

Sometimes, people who skip breakfast eat more during the rest of the day to counteract the deficit. But one 2013 study

found that missing breakfast does not lead to eating more at lunch. The authors conclude that “Skipping breakfast may be an effective means to reduce daily energy intake in some adults.”

However, these researchers only monitored the participants’ food intake at lunch, not dinner. And the study only included 24 participants, so we should be wary of drawing solid conclusions from the findings.

A much larger 2007 study, which involved more than 25,000 adolescents, looked for links between skipping breakfast and having overweight. The researchers also assessed the roles of alcohol intake and levels of inactivity.

The scientists found that skipping breakfast had a stronger association with overweight than either alcohol consumption or levels of inactivity.

A 2020 systematic review and meta-analysis that appears in the journal Obesity Research & Clinical Practice concurs. After analyzing the results of 45 previous studies, the authors concluded:

“Skipping breakfast is associated with overweight/obesity, and skipping breakfast increases the risk of overweight/obesity.”

2. ‘Fat-burning’ foods can aid weight loss

Certain foods are referred to as “fat-burning.” This sounds too good to be true, and it probably is.
Some people claim that foods such pineapple, ginger, onions, avocados, asparagus, celery, chilies, broccoli, green tea, and garlic speed up the body’s metabolism, thereby helping the body burn fat.

There is little scientific evidence, however, that these foods can help reduce weight.

3. Weight loss supplements can help

Proponents of certain supplements claim that they, too, help the body burn fat. In reality, these are generally ineffective, dangerous, or both. The Food and Drug Administration (FDA) report that they have “found hundreds of products that are marketed as dietary supplements but actually contain hidden active ingredients contained in prescription drugs, unsafe ingredients in drugs that have been removed from the market, or compounds that have not been adequately studied in humans.”

Jason Humbert, a senior regulatory manager at the FDA, adds:

“We’ve also found weight loss products marketed as supplements that contain dangerous concoctions of hidden ingredients, including active ingredients contained in approved seizure medications, blood pressure medications, and antidepressants.”

4. Low fat foods aid weight loss

Of course, reduced fat or low fat foods are likely to contain less fat. However, these products sometimes compensate with added sugar or salt. Checking labeling is key.

Also, it is worth noting that “reduced fat” does not necessarily mean “low fat,” but simply that the fat content of a product is lower than the full-fat version.

5. Thou shalt not snack

People may believe that snacking is a cardinal sin of dieting. In some cases, though, snacking can help people manage their caloric intake more effectively. It is not so much snacking itself, but what one snacks upon that that counts.

Snacking may be more complex than it first appears. While some snack on celery and others on cookies, some people might snack because they are hungry and others because they are bored.

Having a piece of fruit or some low fat yogurt between meals, for instance, might reduce food cravings, keeping a person from overeating at mealtimes or resorting to more energy-dense snacks.

Some research has shown that people with obesity are more likely to snack than people without the condition. In this case, switching from unhealthful to healthful snacks may aid in weight loss, if this is a goal.

In general, snacking is multifaceted — it may support or hinder weight loss efforts, and in some cases it may have little effect. Older research, from 2007, investigated the role of snacking in weight loss. In the yearlong study, the researchers asked one group of participants to have three meals a day, without snacking. A second group was asked to have three meals and three snacks daily. Individuals in both groups consumed equivalent amounts of energy each day.

At the end of the study, the authors found no difference in weight loss between the two groups; snacking, it seems, neither helped nor hindered.

Another study, from 2011, investigated the “relationship between eating frequency and weight loss maintenance.” The researchers recruited participants who had previously had overweight or obesity but who had since maintained healthy weights.

They compared these individuals’ eating patterns with those of people with obesity and people with healthy weights who had never had overweight.

The team found that participants with healthy weights ate more snacks than those who had lost weight — and that people with overweight ate the fewest snacks.

Overall, the authors concluded that “Eating frequency, particularly in regard to a pattern of three meals and two snacks per day, may be important in weight loss maintenance.”

6. No treats allowed

This follows on from the myth above. Of course, limiting sugary, high fat treats is important, but cutting them out entirely is unnecessary and could be counterproductive.

As the British Heart Foundation explain:

“Depriving yourself of all the foods you enjoy won’t work. You’ll eventually give into temptation and abandon your efforts. There’s no harm in allowing yourself a treat now and again.”

7. Some sugars are worse than others

There is a rumor that minimally processed sugars, such as those in maple syrup or honey, are more healthful than white sugar. In reality, our bodies process sugar in the same way — regardless of its source. The gut reduces all sugars into monosaccharides.

Rather than looking at sugar processing, it is more important to note the amount of sugar in any food. All types of sugar provide around 4 calories per gram.

8. Cut out all sugar

Following on from the myth above, we know that all sugar is high in calories. However, a person looking to lose weight does not need to mercilessly cut sugar from their diet.

As with all things, moderation is key. It may instead be a good idea to avoid products with added sugar.

9. Artificial sweeteners are healthful

To lower their sugar intakes, many people opt for low- or no-calorie sweeteners, such as aspartame. This may reduce the number of calories consumed, but some studies have linked artificial, or nonnutritive, sweeteners to weight gain.

A systematic review and meta-analysis published in 2017 analyzed 37 existing studies involving a total of 406,910 participants to investigate the impact of sweeteners on cardiometabolic health.

According to the researchers, “Observational data suggest that routine intake of nonnutritive sweeteners may be associated with increased BMI [body mass index] and cardiometabolic risk.”

However, not all studies have reached this conclusion. Researchers and health experts continue to discuss the effects of nonnutritive sweeteners on weight loss and metabolic health.

10. You can target fat in specific areas

Some people are particularly keen to lose fat from certain areas, such as the thighs or abdomen. In reality, this targeting is not possible. All bodies respond differently to weight loss, and we cannot choose which bits of fat will go first.

However, if weight loss is paired with exercises to tone a particular area, it can give the impression of more region-specific weight loss.

11. This fad diet is excellent

Vast legions of diets have become fashionable only to fade into obscurity, making room for more. As the Centers for Disease Control and Prevention (CDC)

explain in a nutshell:

“[Fad] diets limit your nutritional intake, can be unhealthy, and tend to fail in the long run.”

The take-home

Overall, losing weight can be challenging. Our bodies evolved during leaner times, so they are primed to take on energy and store it. However, many of us live in a world where calories are readily available, and our bodies still store this energy as if it’s going out of fashion.

In general, reducing the caloric intake and exercising is the most reliable approach to weight loss. With that said, people with chronic diseases, including diabetes and obesity, should speak with their doctors before beginning a new weight loss regime.

It is also worth remembering that if anything seems too good to be true, it probably is — any “weight loss miracle” is unlikely to be miraculous. Most foods are not inherently unhealthful, but it is a good idea to consume high-sugar and high-fat foods sparingly.

For anyone embarking on a healthful weight loss program this year, good luck. 

A study found hitting the 8,000-step goal just one to two days per week is still associated with a significant reduction in all-cause and cardiovascular mortality. Third Eye Images/Getty Images

• Current research suggests that walking 8,000 brisk steps or more per day may be the sweet spot for receiving the health benefits walking provides.
• People who have trouble finding time to walk each day of the week will be encouraged by a new study that demonstrates walking just one to two days is still associated with a significant reduction in all-cause and cardiovascular mortality.
• The study’s authors found that each additional day walked confers greater benefits.

Briskly walking 8,000 or more steps each day of the week is associated with a significant decrease in all-cause and cardiovascular mortality. A new study finds, however, that people taking just 8,000 steps one or two days a week are also less likely to die over a 10-year follow-up period.

The study published in JAMA Network Open found that over a decade of follow-up, people 20 years or older who took 8,000 or more steps on one or two days a week were 14.9% less likely to die compared to people who were sedentary.

The risk of death dropped as the number of days involved increased. For example, exercising from three to seven days a week was associated with a 16.5% reduction in all-cause and cardiovascular deaths.

The same pattern held true for people meeting step goals of 6,000 to 10,000 steps.

Previous research found that mortality risk decreases up to 10,000 steps per day for people younger than 60 and 8,000 for people older than 60.

‘Weekend warrior’ style of exercising

The study’s findings pertain to both “weekend warriors,” people who confine their exercise to non-work days, and to people who steal a few hours to walk during the week.

The study cites recent data showing the average American takes just 4,800 steps a day, too few to provide much of a health benefit.

“Brisk walking” is defined as walking three miles an hour. If you can speak song lyrics but not sing them, you are walking briskly.

The current study compared data from the U.S. 2005 and 2006 National Health and Nutrition Examination Survey with the National Death Index up to the year 2019. It incorporated accelerometer data from 3,101 participants 20 years or older and was a nationally representative sample. It included a similar number of women and men, and 50.9% were White, 21.5% Black, 23.7% Hispanic, and 3.9% other race and ethnicity.

The participants most likely to walk 8,000 or more steps every day were more likely to be young, male, Hispanic, insured, and married. They were also typically never-smokers and were less likely to be obese or have comorbidities.

A daily challenge of walking 8,000 steps

For many people, walking 8,000 steps each day requires a significant commitment of time. 8,000 steps are about four miles, which, walking at three miles per hour, comes to a total of about an hour and 20 minutes every day. Steps can be taken simultaneously or in shorter periods of brisk walking.

The study was led by Dr. Kosuke Inoue of Kyoto University in Japan, collaborating with researchers from UCLA in California. Dr. Inoue explained why the study was undertaken:

“We started this study to answer the question one of my patients asked during an outpatient clinic: ‘It is hard for me to keep sufficient steps every day. Is it okay to focus on walking only during the weekend?’”

Steps studies often consider the value of a week’s worth of various step goals, and Dr. Inoue saw a lack of evidence regarding the possible benefits of walking just a few days a week.

“Given that a lack of time is one of the major barriers to exercise in modern society,” said Dr. Inoue, “our findings provide useful information to recommend walking even for a couple of days per week to reduce mortality risk.”

“This is one of the first studies to use direct measures of daily steps using a wearable accelerometer over a 10-year followup period,” said Dr. Paul Arciero, a professor in the Health and Human Physiological Sciences Department at Skidmore College, who was not involved in the study.

How walking benefits overall health

Walking is viewed as a simple, low impact means of making a person’s life less sedentary. A sedentary lifestyle has been linked to an increased risk of all-cause and cardiovascular mortality.

“Further, a sedentary lifestyle drastically increases the risk of cardiometabolic disease such as abdominal obesity, hypertension (high blood pressure), type 2 diabetes, stroke, heart disease, and certain inflammatory conditions and cancers,” said Dr. Arciero.

According to Harvard Medical School, taking one’s steps has additional, less-obvious benefits. Walking offsets the effect of weight-promoting genes, reduces breast cancer risk, and boosts one’s immune system. It can also lessen arthritis-based joint pain, and even a 15-minute walk can curb a craving for chocolate, both generally and in response to stress.

Dealing with limited time for walking

The study’s findings should provide valuable information for clinicians and health professionals, said Dr. Inoue. He suggested a reader’s takeaway should be that for people who have difficulties engaging in regular exercise, “achieving recommended daily steps only a couple of days per week can have meaningful health benefits.”

Describing the study’s conclusions as “encouraging,” Dr. Arciero suggested the study may help people who don’t have enough time to walk 8,000 steps a day overcome feelings that walking less is pointless.

“We now have scientific evidence that proves this mindset is not true, and even a couple of days is beneficial!” said Dr. Arciero.

He said the study underscores the value of increasing one’s daily step count:

“Always a good reminder that any amount of walking, even one to two days per week, is still better than no walking.”