Gestational Diabetes

Gestational diabetes is a type of diabetes that occurs during pregnancy due to hormonal shifts. It is typically characterized by elevated blood sugar levels greater than or equal to190 mg/ dL. This condition is usually diagnosed in the last three months of pregnancy by regular screening tests. It usually resolves after the baby is born. Still, in women belonging to the high–risk category, it may develop into type 2 diabetes. Proper management of blood glucose levels is therefore essential during pregnancy to keep the mother and baby healthy. 

What Causes gestational diabetes?

What are the risk factors for gestational diabetes?

• Previous diagnosis of gestational diabetes, prediabetes, or impaired glucose tolerance.
• Family history of type 2 diabetes.
• Maternal age – The risk of developing gestational diabetes increases with age. Women above 35 years of age are at a higher risk when compared to young expecting mothers.
• Being overweight, obese, or severely obese during pregnancy increases the risk by about 2 to 8 %.
• A previous pregnancy resulted in a child with a higher birth weight ( > 9 lb) or had a birth defect.
• Women who have previously had a miscarriage or stillbirth due to unexplained reasons.
• Hormone disorders such as polycystic ovarian syndrome (PCOS).
• High blood pressure.
• Ethnicity – Women of African American, Afro – Caribbean, Native American, Hispanic, Pacific Islander, or South Asian descent are at a higher risk. 

How is gestational diabetes treated?

The treatment approach is based on medications and lifestyle modifications.

Medications

• Treatment is the go-to option only when dietary and lifestyle changes fail to keep the blood sugar levels within the target range.
• Generally, insulin is prescribed by the physician to maintain the blood glucose levels in pregnant women.
• Insulin – Fast-acting insulin such as insulin aspart is given just before eating to prevent glucose rises after meals.
• Biguanides – Metformin is another frequently recommended medicine that can be taken orally. It acts by inhibiting carbohydrate digestion, decreasing glucose production, and enhancing insulin sensitivity. Women with PCOS are mostly given metformin as it treats the condition and keeps the blood sugar levels in check.

Lifestyle modifications

 Gestational diabetes usually warrants certain dietary changes and lifestyle modifications. These reduce the complications associated with this condition and helps to keep the mother and the child healthy. These are : 

• Monitoring blood sugar levels regularly –
  • Women with gestational diabetes are recommended to monitor their blood sugar levels four or more times a day.
  • A handheld capillary glucose dosage system can be used for self–monitoring. The blood sugar levels must lie within the target range to avoid complications to the mother and fetus. Target ranges for gestational diabetes are as follows :
    • Fasting capillary blood glucose levels < 5.5 mmol/ L
    • 1 hour postprandial capillary blood glucose levels < 8 mmol/ L
    • 2 hour postprandial capillary glucose levels < 2.7 mmol/ L
• Following a healthy eating plan – 
  • A diet comprising 30 – 40 % carbohydrates. that are slowly digested is less likely to cause blood sugar spikes. This includes wholewheat pasta, brown rice, granary bread, bran cereals, pulses, beans, lentils, muesli, and plain porridge.
  • Avoid skipping meals and eat three meals a day.
  • Consume at least five portions of fruits and vegetables daily.
  • Avoid sugary drinks and opt for alternatives like sugar–free drinks.
  • Include lean proteins in the diet.
• Being physically active – 
  • Regular moderately – intense exercise is usually advised to lower blood glucose levels.
  • Get at least 30 minutes of physical activity for 5 days a week. Going for a walk after meals is also beneficial for women with gestational diabetes.

Prevention

Certain precautionary measures can lower the chances of developing gestational diabetes. These are :

• Maintaining a proper diet that is rich in fiber and low in glycemic index.
• Include lots of fruits, vegetables, and whole grains in the diet.
• Opt for whole fruits instead of fruit juices as the sugar content is higher in the latter. 
• Losing extra weight before and during pregnancy helps to have a healthier pregnancy.
• Exercising for at least 30 minutes on most days of the week can help to protect the expecting mother from developing gestational diabetes.
• Going for daily walks and riding a bike is also recommended.
• Consult with the physician to know the healthy amount of weight that can be gained during pregnancy. Gaining more than a reasonable amount of weight in expecting mothers is usually associated with gestational diabetes.
• Getting tested for diabetes during the first prenatal visit, especially if there is a family history of diabetes. 

Complications

Suppose gestational diabetes is not properly treated and controlled. In that case, the mother and the child are more likely to develop the following complications :

• Higher birth weight – Babies who weigh greater than 9 pounds are more likely to become wedged in the birth canal or have birth injuries. Cesarean delivery may be needed for the birth of these babies.
• Premature delivery 
• Birth trauma
• Respiratory distress syndrome – Babies born prematurely to mothers with gestational diabetes are more likely to develop this syndrome.
• Hypoglycemia – In some cases, babies born to mothers with gestational diabetes have low blood sugar levels shortly after birth. This may cause seizures in the baby. Women who take insulin during pregnancy are also susceptible to developing hypoglycemia that can be fatal if not treated quickly.
• High blood pressure (preeclampsia) – Diabetes during pregnancy increases the risk of developing eclampsia. This can lead to premature delivery of the fetus and seizures or strokes in women during labor and delivery.
• Stillbirth – Untreated, gestational diabetes may result in the baby’s death before birth or shortly after birth.       

When to see a doctor?

 A diabetologist or an endocrinologist usually treats gestational diabetes. Seek immediate medical care from these physicians if there is increased thirst or frequent urination. A handheld glucometer used for self–monitoring generally costs around INR 550 to 1500 for 50 – 100 strips.