Gestational diabetes is defined as a woman without diabetes previously develops high blood sugar levels in her pregnancy .It affects around 3-9% of pregnancies overall , and is especially common in the last trimester of pregnancy. It occurs due to the several hormonal changes in pregnancy that predisposes insulin resistance. (1)
It increases the risk of developing preeclampsia, depression and having a C-section during pregnancy. In 90% of cases, gestational diabetes resolves once the baby is born. But these women are at a higher risk of developing type 2 diabetes later on in life. It affects certain ethnic groups more like Asians, American Indians , Indigenous Australians and Pacific Islanders.
Pregnancy is one of the most beautiful times in a woman’s life. But this beautiful time does come with a lot of perks such as mood swings, dietary changes, health issues and more. Gestational diabetes is one of the problems faced by expecting mothers even when they never had diabetes before.
It is still a controversial topic that while few women suffer from gestational diabetes, others do not. One of the vital reasons can be that it is genetic, that is, maybe someone in the family is suffering or had suffered from diabetes earlier. Some other noteworthy reasons can be that the mother is overweight before she gets pregnant.
Symptoms of Gestational Diabetes During Pregnancy:
Gestational diabetes often has no symptoms, or mild ones such as being thirstier than normal or having to urinate more. Some of the symptoms are listed below:
- Increased thirst
- Increased fatigue and tiredness
- Excessive hunger
- Increased frequency of urination.
- Frequent urinary tract infections and yeast infections.
- Blurred vision.
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Cause of Gestational Diabetes During Pregnancy:
Insulin is a hormone produced by pancreas that metabolizes glucose into energy. When insulin levels fall, blood sugar levels rise. During pregnancy, the placenta produces hormones which causes rise in sugar levels. If your body cannot handle this rise in blood glucose by making enough insulin, you get gestational diabetes. It is influenced by genetic and certain other risk factors as well.
Risk Factors for Diabetes in Pregnancy: (2)
You are more likely to develop diabetes during pregnancy if you have any of the following risk factors.
- Overweight or obesity before pregnancy.
- Genetic : If you have a Family member with diabetes
- Pre diabetes: If you had blood sugars higher than they should be before pregnancy.
- If you have a history of gestational diabetes in previous pregnancies.
- Have other related medical conditions like high blood pressure etc.
- Fetal macrosomia : If you have given birth to a large baby in previous pregnancies.
- If you have given birth to stillborn or baby with birth defects in previous pregnancies.
- Older maternal age at conception.
- If you are carrying twins.
- If you have PCOS, acanthosis nigricans or insulin resistance conditions.
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How to Diagnose Gestational Diabetes:
Routine screening occurs at 24-28 weeks of pregnancy, or sooner if you have risk factors or history of diabetes in the family or previous pregnancies.
1. One step test:
- Your doctor will start by testing your fasting blood sugar levels.
- You will be asked to drink a solution containing 75 grams of glucose.
- Your blood sugar levels will be tested after one hour and 2 hours consecutively.
- You are diagnosed with gestational diabetes if you have any of the following sugar values :
Fasting : > 95 mg/dL
1 hour : > 180 mg/dL
2 hours :> 150 mg/dL
2. Two step test:
- For the two step test , fasting is not required.
- You will be asked to drink a solution containing 100 gms of glucose in it.
- Your blood sugar levels will be tested 1,2 and 3 hours later.
- You will be diagnosed with gestational diabetes if you have any one of the following sugar values :
Fasting : > 95-105 mg/dL
1 hour : > 180-190 mg/dL
2 hours : > 155-165 mg/dL
3 hours : > 140-145 mg/dL.
Treatment of Gestational Diabetes:
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If you have been diagnosed with gestational diabetes, your treatment plan will be customized according to your sugar levels.
- Usually, first the sugar levels are tried to manage by proper diet, restricting sugar intake and regular exercise combined with frequent monitoring of glucose levels.
- Healthy diet: It focuses on all the food groups fruits, vegetables and whole grains, foods that are high in nutrition and low in calories .Limit intake of processed food, sugar foods , preserved foods and drinks. You may want to consult a dietician to create customized meal plans for you according to your blood sugar levels.
- Regular exercise: Regular exercise improves overall well being and health during pregnancy. It lowers blood sugar levels and increases insulin sensitivity. Exercise also relieves back pain, cramps and general discomfort associated with pregnancy. With your doctor’s consent, aim for a mild workout and include exercises like walking and swimming in your daily routine.
- The next step would be adding a safe oral hypoglycemic drug, approved in pregnancy to reduce the sugar levels, coupled with healthy diet, sugar restriction and regular exercise.
- According to Mayo clinic, around 10-20 % women with gestational diabetes need insulin to help control their sugar levels.
- Along with medication, you are encouraged to monitor your blood sugar levels frequently, with a portable hand held glucose monitoring device.
- Your doctor will also inform you about the side effects of insulin injections and tell you what to do if your blood sugar levels fall too low or rise to too high!
- Close monitoring of your baby: Your doctor might want to monitor your baby’s development closely with repeated ultrasounds or other tests. Post dated pregnancies in gestational diabetes might increase the risk of complications in you or your baby.
Complications of Gestational Diabetes in Mother and Baby:
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If your blood sugar levels are not controlled and are consistently high throughout pregnancy, it can lead to complications and affect the health of your child.
1. Fetal macrosomia: Large baby with high birth weight above 4 kilograms.
2. Neonatal hypoglycemia: Low sugar levels in baby after birth.
3. Shoulder dystocia due to large baby and difficulty in normal delivery
4. Respiratory distress in the newborn.
5. Pre ecclampsia: Increased risk of high blood pressure in the mother
6. C-section: A woman with poorly controlled gestational diabetes has a higher chance of requiring a C-section to deliver her baby.
7. Increased risk for the babies to develop obesity and type 2 diabetes as adults.
8. Polyhydramnios : Excessive amniotic fluid in the womb, which can cause premature labour and preterm delivery.
9. Increased incidence of jaundice in the newborn.
10. Increased risk of still birth and birth defects.
How To Prevent Gestational Diabetes:
- If you are overweight and are planning to get pregnant sometime in the future then you should lower the BMI range to normal by proper diet and exercise. Lowering the BMI can help in preventing gestational diabetes.
- When you are pregnant, visit a doctor during your early pregnancy and make sure that you inform him about any family history of diabetes. Early screening can help in detecting gestational diabetes early.
- You should also stick to a healthy pregnancy diet regardless of what other people tell you and maintain your sugar intake. Craving for sugar is often high in pregnant women, but make sure you do not over indulge in sugar, or else it will lead to gestational diabetes.
- A proper exercise routine, after consulting your doctor, has to be followed to regulate hormonal imbalance and sugar levels.
Disclaimer: The information provided in this article is for educational purposes only. It is not intended to be construed nor is a substitute for professional medical advice. If you have signs of gestational diabetes, consult your nearest healthcare provider for diagnosis and treatment.
Frequently Asked Questions:
1. Can gestational diabetes cause miscarriage?
Answer: If a woman has very high uncontrolled blood sugar levels for a prolonged period of time , it increases the risk of miscarriage. Also, high blood sugar levels in the mother predispose to birth defects, which in turn may cause miscarriages.
2. When should we get tested for gestational diabetes during pregnancy?
Answer: Gestational diabetes usually occurs in the second half of the pregnancy. You should get tested between 24-28 weeks or sooner if you are at high risk.
3. What are the safe blood sugar levels in pregnant women?
Answer : Fasting blood sugar : < 100 mg/dL
- 1 hour after meals : <140 mg/Dl
- 2 hours after meals : <120 mg/Dl .
Even if your diabetes disappears after your baby is born, it is necessary to be careful about diabetes for the next child birth. You should have your blood sugar levels checked 6-12 weeks after giving birth, and once every year after that even though the results are normal. Some research indicates that a woman with gestational diabetes is at higher risk for developing type 2 diabetes and obesity in later life.
If you have had gestational diabetes before, make sure you undergo regular screening and maintain a healthy lifestyle before planning another pregnancy. We hope this article could provide information and alleviate all your fears regarding gestational diabetes. Do let us know!!