Gestational diabetes is said to occur when a woman has too much glucose in her blood at the time of pregnancy. According to a recent study, about 15% of all pregnant women can develop gestational diabetes (1). If not detected on time, gestational diabetes can result in pregnancy complications. This article deals with causes, symptoms, risks, and preventive measures for Gestational diabetes.
Gestational diabetes may sound common, but it has its share of maternal and fetal health complications. However, a prompt diagnosis and treatment can help you sail through a smooth pregnancy. Read to learn more about the causes, symptoms, and complications of gestational diabetes. This article also gives you a brief overview on how to keep your blood sugar levels under control during pregnancy.
What Causes Gestational Diabetes?
During pregnancy, increased levels of certain hormones made in the placenta (the organ that connects the baby by the umbilical cord to the uterus) help shift nutrients from the mother to the developing fetus. Then there are other hormones produced by the placenta that keep the mother’s sugar levels at the desired level, working by resisting the actions of insulin.
Pregnancy causes the body to make extra insulin, but the placental hormones overrule the production of insulin. If the body is unable to meet this additional requirement, the blood sugar rises, and gestational diabetes develops over time (1).
A mother’s pancreas increases the production of insulin more than the normal amount to overcome the effect of pregnancy hormones (2). However, if the body cannot produce enough insulin, the occurrence of gestational diabetes will occur because of rising blood sugar levels. After the delivery, you will probably not have diabetes but will be at risk of getting it again during a further pregnancy or developing diabetes later in life.
What Are the Symptoms of Gestational Diabetes?
There are no visible symptoms of gestational diabetes, however, one may feel very thirsty and have problems with frequent urination, mouth going dry, tiredness, and blurred vision. Snoring can also contribute to this, so let your doctor know if you are snoring more than usual.
Gestational diabetes generally begins between 24 and 28 weeks of pregnancy, and this is the same when the glucose screening test is done (3a). However, if there is a presence of glucose in your urine, or you are at a higher risk of diabetes, then screening is highly recommended. If the screening test comes out to be positive, a follow-up test (a glucose tolerance test, or GTT) is also carried out to confirm gestational diabetes.
How is Gestational Diabetes Diagnosed?
Typically, pregnant women who have gestational diabetes may not show any indicative symptoms. The doctor may perform an Oral Glucose Tolerance Test (OGTT). This can be a one-step or a two-step process to find any abnormal sugar levels.
Currently, The American Association of Obstetricians and Gynecologists (ACOG) recommends universal screening of all pregnant women of South Asian ethnicity (3b). If the risk of gestational diabetes is relatively low but still needs to be checked, another test is conducted called the fasting plasma glucose test. Early detection and proper management of gestational diabetes are crucial to reducing complications in both the mother and baby.
[Read: Glucose Screening Test And Glucose Tolerance Test During Pregnancy]
Am I At Risk of Developing Gestational Diabetes?
Here are a few factors that may put you at risk of developing gestational diabetes (3a).
- You are obese or overweight – BMI > 30.
- There is a presence of glucose in your urine
- There is a history of diabetes in your family.
- Impaired glucose tolerance or impaired fasting glucose.
- Have given birth to a big baby previously.
- A previous incident of having a stillborn baby due to unexplained reasons.
- Have had gestational diabetes in a previous pregnancy.
- You are above the age of 35 years
- A condition called Polycystic Ovarian Syndrome
- There is a history of heart disease
- You have a condition of high blood pressure.
Expectant mothers need to take extra care because having high sugar in the blood can create problems for both the mother and child. But this type of diabetes is not the same as type 1 and type 2 diabetes, it does not last for a lifetime and tends to go away once the baby is born.
Complications With Gestational Diabetes
Once you know you have gestational diabetes and if kept under control, then there is not much need to worry as the likelihood of complications is low. Most often, diet changes and physical activity along with medications are enough to keep gestational diabetes in check.
But if you overlook this issue, the baby receives too much blood sugar and grows larger than normal. This creates problems in delivery and even after birth. Too much sugar in the baby’s blood will make him put on extra weight, especially in the upper body. Thus, passing through the birth canal becomes difficult.
Macrosomia is the condition that occurs when the baby becomes too big, so delivery through the birth canal becomes difficult. There is an increased risk of shoulder dystocia and other birth injuries during labor and delivery.
It also increases the chances of episiotomy or a C-section. Preterm birth is another complication, leading to breathing difficulties or jaundice. Also, in the future, the child will be at a higher risk for type 2 diabetes. Mothers may develop preeclampsia and an increased risk of developing gestational diabetes in later pregnancies (3b).
How Can I Keep My Blood Sugar Levels in Control?
Pregnancy can potentially bring in some complications during the period of gestation, which normally disappear after the delivery. However, it is important to concentrate on your diet and stick to an exercise routine, which together can help you stay away from gestational diabetes. A balanced nutrition from the beginning of the pregnancy keeps your blood sugar levels in check (4).
Here are a few tips that can help you control gestational diabetes.
- Include low Glycemic Index (GI) carbohydrates, which slowly release energy, e.g. cereals, whole-meal bread, and pasta (5).
- Include oily fish and lean meat in the diet, such as mackerel, salmon, and sardines.
- Eat at least five fruits and vegetables daily.
- Minimize the amount of sugar, fatty food, and salt in food. Replace fizzy drinks with fresh fruit juices.
- Use unsaturated fats or oils, e.g. rapeseed oil and olive oil instead of butter.
Keep yourself active during pregnancy, stick to a healthy diet, keep your weight in control and exercise will help to reduce the risk of developing gestational diabetes.
[Read: Top 5 Ways To Control Diabetes During Pregnancy]
Will I Have Diabetes in the Future?
Gestational diabetes does put you at a higher risk of developing diabetes later (6). 50% of women who have gestational diabetes develop diabetes within ten years (7). You are at a higher risk if you are obese. The key to minimizing the risk of developing diabetes in the future lies in making healthy lifestyle choices like healthy eating, active physical life, and keeping your weight in check.
When to Consult a Doctor?
When you are planning for a pregnancy, or during your early pregnancy, it is important to let your doctor know about your medical history. Let your doctor know if you are pregnant and have these conditions
- Over 35 years of age (8).
- You have PCOS (9).
- You are diabetic
- History of Hypertension (10).
- Obese or Overweight
Therefore, the take-home message is to have good sugar level control to avoid all possible risks of gestational diabetes. A few steps towards a healthy lifestyle can work wonders if you are struggling with gestational diabetes. Make sure to discuss the diet plan, safe exercises, and the need for any medications with your healthcare provider to ensure a healthy and smooth pregnancy and delivery.
FAQ’s
1. Am I At the Risk of Developing Gestational Diabetes?
Some preexisting medical conditions and maternal age can contribute to the chances of developing gestational diabetes during pregnancy. However, it is important to get the screening done according to your doctor’s advice, even if you are not likely at risk of developing it.
2. Can Gestational Diabetes Cause Miscarriage?
Untreated gestational diabetes can lead to preterm births, babies born with low birth weight, and, in extreme cases, stillbirths. Hence, it is important to get it screened and managed with proper dietary and lifestyle changes. Your doctor may also prescribe medications to manage extreme insulin resistance during pregnancy.
3. What Is A Major Complication Of Gestational Diabetes?
A well-controlled gestational diabetes will not cause many complications, but if it is left untreated or is poorly controlled, then it can lead to a major complication of macrosomia in the baby. Here, the baby grows larger than usual growth, leading to the risk of birth injuries, shoulder dystocia and the need for a cesarean section.
4. What Is The Risk Of Gestational Diabetes?
Gestational diabetes poses a number of risks to both the mother and the baby. It can lead to preeclampsia, premature birth and increased risk of developing type 2 diabetes mellitus in the mother. The chances of macrosomia and hypoglycemia in the baby are also high. All the above factors increase the chances of a cesarean delivery.
5. Can Gestational Diabetes Be Cured?
Usually, gestational diabetes resolves after birth. With a good blood sugar level control, you can decrease the chances of developing type 2 diabetes in the future. Your doctor will evaluate you again after six to twelve weeks after delivery for diabetes.
References
- Modzelewski R, Stefanowicz-Rutkowska MM, Matuszewski W, Bandurska-Stankiewicz EM. Gestational Diabetes Mellitus-Recent Literature Review. J Clin Med. 2022 Sep 28 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9572242/
- Alfadhli EM. Gestational diabetes mellitus. Saudi Med J. 2015 Apr;36(4):399-406 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4404472/
- Rani PR, Begum J. Screening and Diagnosis of Gestational Diabetes Mellitus, Where Do We Stand. J Clin Diagn Res. 2016 Apr;10 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866200/
- Bryan S. Quintanilla Rodriguez; Elsa S. Vadakekut; Heba Mahdy.- New York Medical College – Metropolitan Hospital Center, American College of Osteopathic Obstetricians and Gynecologists – https://www.ncbi.nlm.nih.gov/books/NBK545196/
- Glycemic Index Foundation – https://www.gisymbol.com/low-gi-explained/
- Diaz-Santana MV, O’Brien KM, Park YM, Sandler DP, Weinberg CR. Persistence of Risk for Type 2 Diabetes After Gestational Diabetes Mellitus. Diabetes Care. 2022 April – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9016728/
- Peter Damm, Azadeh Houshmand-Oeregaard, Louise Kelstrup, Jeannet Lauenborg, Elisabeth R. Mathiesen & Tine D. Clausen – https://link.springer.com/article/10.1007/s00125-016-3985-5
- Merja K. Laine, Hannu Kautiainen, Mika Gissler, Marko Raina, Ilkka Aahos, Kajsa Järvinen, Pirjo Pennanen, Johan G. Eriksson – https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/aogs.13271
- Li X, Liu X, Zuo Y, Gao J, Liu Y, Zheng W. The risk factors of gestational diabetes mellitus in patients with polycystic ovary syndrome: What should we care. Medicine (Baltimore). 2021 Aug – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8341335/
- Hedderson MM, Ferrara A. High blood pressure before and during early pregnancy is associated with an increased risk of gestational diabetes mellitus. Diabetes Care. 2008 Dec;31 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2584196/
