Diabetes or Diabetes Mellitus is a chronic disease that occurs when the pancreas is no longer able to make insulin, or when the body cannot make good use of the insulin that it produces. Insulin is a hormone that plays a central role in controlling blood sugar levels in your body. 

The common types of diabetes are:

1. Type 1 diabetes: This is a condition in which your immune system destroys insulin-making cells in your pancreas. As a result, your body produces no or very little insulin. Type 1 diabetes is present in approximately 10% of people with diabetes.

2. Type 2 diabetes: This is the most common type of diabetes and accounts for 90% of all diabetes cases. In type 2 diabetes, the body either does not produce enough insulin or does not respond to insulin. As insulin is not produced properly, the blood glucose level keeps on rising, which releases more insulin. This leads to exhaustion of the pancreas, leading to the production of less insulin and increased blood glucose levels.

3. Gestational diabetes (GDM): This type of diabetes is seen in pregnant women and leads to complications in both mother and child and is almost cured after childbirth. GDM predisposes the mother and child to the risk of developing type 2 diabetes later in life.

In today’s article, we will understand gestational diabetes in detail.

Gestational diabetes affects your pregnancy and can affect your baby’s health as well. Pregnancy, also known as gestation, is the time during which one or more offspring (the young ones of living organisms) develop inside you. Pregnancy usually lasts for about 40 weeks (9 months) and is divided into 3 primary segments or trimesters:

  • 1st trimester: Week 1 to the end of week 12 

  • 2nd trimester: Week 13 to the end of week 26 

  • 3rd trimester: Week 27 till the end of your pregnancy

Gestational diabetes has been broadly classified into two types:

a) A1- Women with A1 types of GDMs are able to manage their blood sugar levels by exercising and dieting.

b) A2- Women with A2 type GDM need insulin and other medications. 

Soon after the delivery (childbirth), your blood sugar level reaches back to its normal level. However, once you have had gestational diabetes, you are at risk of type 2 diabetes.

Symptoms of Gestational Diabetes 

If you are suffering from gestational diabetes, you are most likely not to show any symptoms. It is usually during the routine screening that gestational diabetes might be diagnosed. The symptoms of gestational diabetes are mostly mild and they include:

  • You are frequently hungry and tend to eat more than usual

  •  You pee than usual

  •  You feel thirsty very quickly

Other symptoms include fatigue, blurred vision, and snoring. 

Gestational Diabetes Causes 

The main function of the hormone insulin is to move glucose from your blood to your body cells for energy. During pregnancy, your body naturally becomes slightly insulin resistant, so that more glucose is available in your bloodstream to be passed to your baby. The placenta releases certain hormones that increase insulin resistance during your pregnancy. High insulin resistance causes a rise in your blood sugar levels and thus, you may have gestational diabetes.

Risk Factors of Gestational Diabetes 

  • You were overweight before you got pregnant.

  • You have blood sugar levels that are higher than they should be.

  • You have a family history of diabetes.

  • You had gestational diabetes during your earlier pregnancies.

  • You have high blood pressure (hypertension) before your pregnancy.

  •  You have given birth to a baby who was stillborn or had certain birth defects.

  •  You are older than 25 years of age.

  • You have polycystic ovary syndrome (PCOS, is a hormonal disorder seen in women of reproductive age group), or other conditions that are associated with insulin resistance.

Tests and Diagnosis of Gestational Diabetes

This type of diabetes usually happens after the first trimester of your pregnancy. Your doctor will actively screen you for signs of gestational diabetes in the second half (from the beginning of week 13) of your pregnancy. 

If you have no known history of diabetes and normal blood sugar levels at the beginning of your pregnancy, your doctor will likely screen you for gestational diabetes when you’re 24 to 28 weeks pregnant.

The ADA (American Diabetes Association) has recommended the use of either the one- or two-step approach at 24–28 weeks of gestation in pregnant women not previously known to have diabetes. 

The one-step approach involves performing a 75-g OGTT (Oral Glucose Tolerance Test), with plasma glucose measurement when the patient is fasting and after 1 and 2 hours. Optimally, OGTT should be performed in the morning after an overnight fast of at least 8 hours. The diagnosis of GDM is made when any of the following is met or exceeded.

  • Fasting: 92 mg/dL (5.1 mmol/L) 

  • 1 hour: 180 mg/dL (10.0 mmol/L) 

  • 2 hour: 153 mg/dL (8.5 mmol/L)

The two-step approach is a 1-hour (nonfasting) plasma glucose measurement after a 50-g oral glucose load in women at 24-48 weeks' gestation who were not previously diagnosed with diabetes. 

The diagnosis of GDM is made if at least two of the following four plasma glucose levels (measured during OGTT) are met or exceeded:

  • Fasting: 95 mg/dL (5.3 mmol/L)

  • 1 hour: 180 mg/dL (10.0 mmol/L) 

  • 2 hour: 155 mg/dL (8.6 mmol/L) 

  • 3 hour: 140 mg/dL (7.8 mmol/L) 

Women with a history of GDM should have lifelong screening for the development of diabetes or prediabetes at least every 3 years.

Note: Mg/dL or milligrams per deciliter is a measurement that indicates the amount of a particular substance (such as glucose) in a specific amount of blood.

Management of  Gestational Diabetes

If you’re diagnosed with gestational diabetes, your treatment plan will depend on your blood sugar levels throughout the day.

  • You might have to test your blood sugar before and after meals. A blood sugar monitoring device comes in handy when you have to take readings for a certain number of days. After checking your doctor, you may use either:

    • Regular blood glucose monitoring devices, which includes a sensor, transmitter, and a monitor. 

    • Portable blood glucose meters called glucometers. A lancet (a needle-like device) lightly pricks your skin to obtain a small amount of blood and the meter tells you your current blood sugar level. 

  • Your doctor may add insulin injections if needed until you give birth. 

Managing your blood sugar levels helps keep you and your baby healthy. Three lifestyle and dietary tips to follow are:

1. Eat a healthy balanced diet. You have to be mindful of your carbohydrates (main source of glucose) intake. 

  • Healthy carbohydrates include whole grains, beans, peas, lentils, and other legumes, brown rice, starchy vegetables, and low-sugar fruits.

  • Eat two to three servings of protein each day. Include lean meats, poultry, fish, tofu, and nuts in your daily diet.

  • Eat healthy fats such as olive oil, seeds, nuts, and avocados, to keep your blood glucose levels in check.

  • Eat foods low in sugar such as candies, chocolates, colas, ketchup, flavoured yogurts, sports drink, chocolate milk, etc. 

2. Stay active throughout your pregnancy. The best way to prevent insulin resistance is by being active. The more physical exercise you do, the more energy you need, and thus, your insulin will function normally. Staying active will also help reduce weight and prevent your risk of obesity.

  • Light exercises that are usually recommended during pregnancy are walking, jogging, or swimming. 

  • Yoga and meditation during pregnancy are also recommended for staying active, increasing flexibility, and for keeping stress away.

Check with your doctor before starting any new exercise routine. 

3. Go for routine check-ups. Routine check-ups will help your doctor identify gestational diabetes at the earliest. 

Complications in Gestational Diabetes

Gestational diabetes is common among expecting women. However, when not carefully managed it could lead to severe complications for you and your baby which include:

  • Excessive birth weight. Very large babies (weighing more than 9 pounds or 4.08 kgs) increase your risk of cesarean delivery, or C-section (surgical delivery of your baby).

  • Type 2 diabetes at a later stage. If you have gestational diabetes, your baby and you are more likely to develop type 2 diabetes or obesity (a condition in which there is excessive accumulation of body fat) at a later stage in life.

  • Respiratory distress syndrome (breathing disorder in newborns caused by immature lungs). If you have gestational diabetes, your baby is more likely to develop this syndrome and might need help breathing through the lungs until his/her lungs become mature and strong. 

  • High blood pressure and preeclampsia. Gestational diabetes raises your risk of high blood pressure, as well as preeclampsia — a serious complication of pregnancy that causes high blood pressure and other symptoms that can threaten the lives of both, your baby and you.

  • Future gestational diabetes. If you have gestational diabetes during one pregnancy, then you're more likely to get it again during a future pregnancy. 

If you are diagnosed with gestational diabetes, be in touch with your obstetrician/gynaecologist/diabetologist to keep your blood sugar levels in check. GDM can be avoided by following a healthy lifestyle during your pregnancy.

Disclaimer: This article is written by the Practitioner for informational and educational purposes only. The content presented on this page should not be considered as a substitute for medical expertise. Please "DO NOT SELF-MEDICATE" and seek professional help regarding any health conditions or concerns. Practo will not be responsible for any act or omission arising from the interpretation of the content present on this page.