Q1. What is Gestational Diabetes?

A. Gestational diabetes mellitus (sometimes referred to as GDM) is a form of diabetes that occurs during pregnancy and usually goes away after the baby is born. It is diagnosed when higher than normal blood glucose levels first appear during pregnancy. Between 5% and 10% of pregnant women will develop gestational diabetes and this usually occurs around the 24th to 28th week of pregnancy. All women are tested for gestational diabetes as part of the 24-28 week routine examination with their physician/ gynaecologist. Women who have one or more of the risk factors are advised to have a diabetes test when pregnancy is confirmed then again at 24 weeks if diabetes was not detected in early pregnancy. 

Q2. Who should be screened?

A. While there is no one reason for why women develop gestational diabetes, you are at risk of developing gestational diabetes if you:

  • Are over 25 years of age 
  • Have a family history of type 2 diabetes 
  • Are overweight
  • Have had gestational diabetes during previous pregnancies 
  • Have previously had Polycystic Ovary Syndrome
  • Have previously given birth to a large baby 
  • Have a family history of gestational diabetes 

Q3. How is GDM diagnosed?

A.For gestational diabetes, the American College of Obstetricians and Gynecologists (ACOG) recommends a two-step procedure, wherein the first step is a 50g glucose dose. If it results in a blood glucose level of more than 7.8 mmol/L (140 mg/dL), it is followed by a 100-gram glucose dose. The diagnosis of gestational diabetes is then defined by a blood glucose level exceeding the cutoff value on at least two intervals, with cutoffs as follows:

  • Before glucose intake (fasting): 5.3 mmol/L (95 mg/dL)
  • 1 hour after drinking the glucose solution: 10 mmol/L (180 mg/dL)
  • 2 hours: 8.6 mmol/L (155 mg/dL)
  • 3 hours: 7.8 mmol/L (140 mg/dL).

Q4. What happens to your baby when you have gestational diabetes? 

A. Extra glucose stays in your blood and your baby receives more sugar than it needs — and stores it as fat. Possible outcomes include a large baby, more chance of having a cesarean delivery, and slightly more risk of fetal and neonatal death. Babies born to women with diabetes also need monitoring after birth. Low blood sugars can lead to problems for your baby, including seizures. 

Q 5. How can you control your blood sugar with GDM?

A. You can still have a healthy baby if you focus on good habits. There are three things you can do to help make sure your blood sugar levels are stable during your pregnancy: Regularly check your blood glucose. Typically, that means taking a fasting blood sugar reading in the morning and then checking the levels two hours after each meal. Limit carbohydrates (rice, pasta and bread) and simple sugars in your diet. Exercise regularly. Physical activity helps your body use insulin better, which helps control your blood sugar. 

Q 6. What is the medical management of GDM?

 A. Despite their best efforts, some pregnant women still have blood sugars that are too high. In that case, you might need medical management “If diet and exercise alone don’t work, in most cases, we use insulin. Insulin injections are superficial shots that you give yourself between one and four times per day. Insulin does not cross the placenta, and therefore, it does not affect the baby. Your doctor may prescribe oral medications, but only as a second line of therapy because they do cross the placenta in small amounts. “We would recommend oral hyperglycemia agents such as METFORMIN which works to decrease your body’s resistance to insulin.

 Q 7. Will you still have diabetes after you have your baby?

A. For most women with gestational diabetes, things go back to normal after their babies are born. But your doctor likely will check for type 2 diabetes postpartum — typically from six to 12 weeks after delivery. “And approximately 10 percent of the women who have gestational diabetes actually end up having type 2 diabetes, ” he says. “In reality, they may have met the criteria for diabetes prior to the pregnancy. It was just undiagnosed.” Also, research shows that about half of those who have gestational diabetes develop type 2 diabetes within the next 10 years. So it’s a good idea to continue to watch your diet, exercise regularly and get checked for type 2 diabetes annually after your baby is born.