Gestational Diabetes in Pregnancy

When a woman is pregnant, her body changes in a lot of ways. Besides the sudden change in hormone levels, there are also other biological factors that change, such as the blood sugar levels. Put simply, gestational diabetes is not uncommon.

What Is Gestational Diabetes?

As the name indicates, this is the type of diabetes that occurs in women at the time of gestation that is during pregnancy. Pregnancy causes the blood sugar levels to surge in some women which leads to gestational diabetes. In some women, the insulin levels might drop during pregnancy causing the blood sugar levels to increase. Blood sugar levels in the body are normally kept under control by the body’s natural insulin levels.

Gestational diabetes can occur in women who have normally never had diabetes, and it might get resolved after delivery. Women in their second and third trimesters are more prone to gestational diabetes

Causes of Gestational Diabetes

Fluctuation in insulin levels in the body is the main cause of gestational diabetes. During the process of digestion, , carbohydrates from the foods consumed are broken down to glucose (sugars) in order release energy. This energy is used by the human body to carry out daily activities. Under normal conditions insulin produced in the pancreas helps move this sugar to the cells and prevents rise in sugar levels in the body.

During pregnancy, a membrane called placenta is formed that is responsible for supplying oxygen and nutrients from mother to the delveloping baby. However, along with its normal function, placenta also releases several hormones that tend to interfere with the natural hormonal mechanisms of the mother’s body. It is known to disrupt and interfere with the production of insulin as a result of which there is rise in blood sugar levels devoid of enough insulin to break it down. This is the scenario where a mother may develop gestational diabetes.

Another factor associated with gestational diabetes is weight. It is observed that obesity is closely linked to the body being insulin resistant. If the mother is overweight before conception, she may be a high risk candidate for gestational diabetes. Alternatively, keeping a check on weight gain during pregnancy is equally important.

Are You at Risk of Developing Gestational Diabetes?

One in seven women in India are at a risk of developing diabetes during pregnancy. But some women are more at risk than the others. Here are some factors that increase the risk of gestational diabetes:

• High BMI: Those who were overweight before pregnancy are more at risk. Women gain extra weight during pregnancy, and already being overweight only makes it difficult for the body to regulate the blood sugar levels.
• Rapid Weight Gain During Pregnancy: While the exact relationship between weight gain and gestational diabetes is not clear, experts opine that it is caused by an increase in insulin resistance by affecting the beta cells in the pancreas which are responsible for insulin production. The capacity of the beta cells to secrete insulin reduces, leading to gestational diabetes.
• Family Medical History : A family history of diabetes type II, especially if a sibling or the mother had it makes the mother a promising candidate for acquring gestational diabetes in her pregnancy.
• Previous Pregnancy History: If you’ve had diabetes in your past pregnancies, doctors keep you under strict vigilance and monitor you blood sugar levels regularly as the chances of it resurfacing is quite likely.
• Age: People who are 25 years or older are at a higher risk of gestational diabetes. Infact, higher the age higher are the chances of susceptibility to gestational diabetes.
• Other Medical Conditions: Women with PCOS or a history of PCOS (polycystic ovary syndrome) are susceptible to gestational diabetes as one of the symptomps of this disorder includes increased probability of insulin resistance.

Can I Lower My Chances of Getting Gestational Diabetes?

Whether you belong to the category of women who are at higher risk for gestational diabetes or not, you can definitely lower the risk of acquiring it. Working on your diet and exercise routines can help. Here are some steps to take:

1. Include more dietary fibre in your meals: This can be done by increasing the intake of whole grains, fresh vegetables and fruits. Increasing the daily fibre intake by 10 gm can reduce the risk of gestational diabetes by around 26%.
2. Say no to unhealthy food : Cut down the intake of sweet foods and those that are carb-laden. Stay away from unhealthy nibbling to tackle hunger pangs.
3. Eating frequency: Eating frequent small meals would be a healthier choice than eating large portions in one meal.
4. Choose wisely: Include a variety of foods so that you get a fair share of all the required daily nutrients in your diet.
5. Include physical activity in your routine: Staying active can help reduce the risk of diabetes during pregnancy. Swimming and walking are the two most recommended choices for pregnant women. Mild exercises can be chosen based on your health and on how far along you are in your pregnancy. Always consult your doctor before finalising your exercise routine.
6. Keep a weight check: Maintaining a healthy weight before and after pregnancy is crucial in maintaining healthy blood glucose levels.

Common Signs and Symptoms

There are not many pronounced symptoms that can indicate gestational diabetes,and hence your doctor would suggest a complete health check up at around 24-28^th week of your pregnancy as this is the period where women are most likely to be diagnosed with high blood sugar levels. In case you are already at risk owing to factors listed above, this screening is suggested much earlier. However, here are some signs that might come as a warning and if you encounter them, do seek a medical intervention immediately:

• Feeling thirsty too often even after adequate consumption of water and other fluids.
• Frequent urination.
• Feeling excessively exhausted (pregnancy, the third trimester in general, can leave women tired, but unexplained tiredness even when your activity levels are less throughout the day might indicate a possibility of gestational diabetes.)
• Dryness of the mouth.
• Blurriness in the vision.
• Frequent infections .

Several conditions that are common during pregnancy might be signs of gestational diabetes. Pregnancy and diabetes together can leave the pregnant

mother exhausted. Usually, screening for gestational diabetes is done during the second trimester. However, if any of the above-mentioned symptoms are more pronounced, you might want to discuss them with your gynaecologist to decide if you need to be screened for diabetes.

How Does Gestational Diabetes Affect Pregnancy?

Mother’s blood sugar level usually restores to normal after their delivery. However , there are certain risks that are prevalant during pregnancy that you must be cautious about.

• Preeclampsia: Gestational diabetes impacts are experienced by both the mother and the baby if the condition is not treated. One of the commonly associated side effect of untreated gestational diabetes is preeclampsia. This is a condition which is said to occur mostly in the final trimester. The two main characteristics of preeclampsia include elevated protein levels in the urine which can be found in a routine test and the rise in blood pressure. The condition worsens if not treated on time. The harmful effects include preterm labor and also miscarriage in some rare cases.
• Stillbirth: The risk increases when the pregnant mother diagnosed with gestational diabetes carries the baby for more than 40 weeks. In this case the risk of stillbirth increases.
• Developing type II diabetes: These are the mothers who are very likely to develop type II diabetes as they grow old.

All the above mentioned complications only indicate the risks that are associated with the untreated cases. Gestational diabetes simply increases the vulnerability to several conditions. But a proper diet and exercise routine can help in most cases.

How Gestational Diabetes Affects the Baby

Sometimes, the effects of gestational diabetes on the baby might be slightly more severe than on the mother. When the placenta interferes with the insulin levels, it in turn, gets affected by the elevated blood sugar levels. In most cases, women with gestational diabetes who receive treatment on time have healthy babies, but leaving the condition untreated might have some impact on the baby:

• Macrosomia: Elevated sugar levels in the mother’s blood are passed on to the baby. higher sugar levels in baby’s blood causes baby’s pancreas to react by secreting higher levels of insulin. This sometimes leads to macrosomia, a condition where the foetus weighs 9 pounds or more. Such cases might call for a C-section. If delivered normally, the baby might suffer from minor injuries, birth trauma or shoulder dystocia.
• Hypoglycemic baby: Babies might be born with low blood sugar, also called hypoglycaemia, due to the surge in insulin levels.
• Breathing problems: Some babies born to a mother with gestational diabetes experience slight difficulties in breathing. Some even acquire respiratory distress syndrome where additional oxygen supply may have to be provided to the baby after birth.
• Nutrient deficiency: The baby might carry low levels of magnesium and calcium which may cause spasms, cramps, jitters. These can be tackled with suitable supplements.
• Risk of jaundice: These babies are at a higher risk of developing jaundice after birth. This can easily be treated but might make the baby feel weak. The baby may need immediate medical attention.
• Type II diabetes: The babies might be at a higher risk of developing type II diabetes when they grow up.

Remember that these are only the extreme effects of the condition. In many cases, babies stay unaffected by mother’s diabetes. A safe option would be to identify the problem at the earliest and keep the blood sugar levels within normal levels not only to ensure your health, but that of your baby too.

Screening Guidelines for Gestational Diabetes

In most cases, gestational diabetes test is performed between weeks 24 and 28 of pregnancy. . Here are the two main tests that help find if the mother has high or low blood sugar during pregnancy. Follow-up tests and additional screening might be added as required based on the results.

Screening glucose challenge test (GCT)- non-fasting test

The patient who appears for this test is given an oral glucose solution. One hour later, a blood sample is drawn to evaluate the blood glucose levels. Higher levels indicate an inability to process the glucose consumed and the patient would be advised to take the OGTT.

Oral Glucose Tolerance Testing (OGTT)- fasting test

The patient needs to appear empty stomach for this test. A blood sample is drawn, and the patient is given an oral glucose solution. A second blood sample is drawn one hour later and the third one, after another hour. The test takes 2 hours to perform, and the patient is advised not to eat or drink anything in the interval. This helps ensure accurate results. If the blood glucose levels fall in the gestational diabetes range, the patient might be prescribed medications or put be put on a diet.

Diagnosis of Gestational Diabetes

Right at the beginning of pregnancy, the doctor asks the mother-to-be a few questions regarding medical and family history to rule out the risks of gestational diabetes. Throughout the pregnancy, any warning signs are monitored and evaluated. If nothing appears abnormal, the routine GCT is prescribed at the right time. The test results help diagnose gestational diabetes.

Treatment of Gestational Diabetes

Gestational diabetes can be easily managed by making simple lifestyle changes. . A fibre-rich, low-carb diet consumed as frequent small portions might help alleviate the blood glucose levels. Based on the results of the OGTT, the doctor might also suggest mild exercises. The blood sugar levels will be tested again after a gap to check for any difference. If the levels fall back to normal, you will simply be advised to continue your diet and exercises. The doctor might keep a check on your f the baby’s health periodically. If the blood sugar levels don’t drop to normal, you might be prescribed medications or insulin shots to bring it down.

How to Control Sugar Level During Pregnancy

The simple way to control your sugar level is to work on your diet. Tweaks to what you eat and when you eat go a long way in improving your general health during pregnancy.

Gestational diabetes diet plan-

here is a sample of how your diet plan should ideally be like:

Source: https://www.allinahealth.org/health-conditions-and-treatments/health-library/patient-education/gestational-diabetes/healthy-eating-physical-activity-stress-management/basic-meal-planning/

Your dietician might however prescribe a personalised diet chart based on your test results.

Blood Glucose Levels for Pregnant Women

Ideal blood glucose levels differ for pregnant women who had diabetes before they got pregnant and for women with gestational diabetes. Here is a general guideline on blood sugar levels during pregnancy. Do remember that every pregnancy is different and your doctor is the best person to take a call on your health.

Source: http://www.webmd.com/diabetes/gestational-diabetes-guide/normal-blood-sugar-levels-chart-pregnant-women.

How Can One Prevent Gestational Diabetes?

.Being aware and equipped with all pre-requisite information is the first step towards prevention. Not only will it help you understand all the risk factors involved but alsoprepare you for what lies ahead. Talk to your doctor about your medical history to rule out any risks, and screen for diabetes at early stages, if required. Be stringent about the diet and exercise plan prescribed for you to maintain normal sugar level during pregnancy. Sweet cravings are common in some women but unhealthy snacks and a high-sugar diet will do more harm than good.

What Happens to Mom and Baby After Delivery?

In most cases, nothing! The mother gets back to her usual healthy self, and the blood sugar levels drop back to normal, and the baby is healthy and happy. But in the worst cases where the damage is severe due to very high blood sugar levels, late diagnosis, or if the mother’s body did not respond well to the medication, the effects might be seen on the mother and the baby. Subsequent tests might be scheduled for both to rule out the occurrence of type II diabetes in the mother and hypoglycaemia in the baby.

It is important to strive to maintain a healthy weight and to continue healthy diet and exercise habits after delivery too. This helps reduce the risk of developing diabetes in later stages of life and during the next pregnancy. Do not skip the follow-up sessions for yourself as well as for the baby after delivery. Continue breastfeeding while also ensuring that you consume a nutrient-rich diet. This will help achieve optimum weight and ensure the best health of the mother and the baby.