Gestational Diabetes – Risk Factors Diagnosis and Treatment

Gestational Diabetes – Risk Factors Diagnosis and Treatment

Pregnancy can be an exciting experience for a woman. But ironically, it is also associated with some of the severe challenges. One major challenge which many women in the world are still unaware of is gestational diabetes.

Gestational Diabetes

The term gestational diabetes is specifically referred to diabetes that occurs during pregnancy. The condition is also known as gestational diabetes mellitus (GDM). This is a temporary type of diabetes and different from type 1 and type 2 diabetes which are chronic in nature.

Diabetes in pregnancy occurs when a woman develops high blood sugar. Gestational diabetes typically develops in 24-28th weeks of pregnancy. As per Center for Disease Control and Prevention, about 9.2 percent of pregnancies will end up in developing gestational diabetes.

If a woman develops gestational diabetes during pregnancy, it means either she had diabetes before or she will develop type 2 diabetes afterward at some point in her life. According to International Diabetes Federation (IDF), about 50 percent of women with the history of gestational diabetes would develop type 2 diabetes within 5-10 years. Also, if gestational diabetes is managed poorly, chances are that your child would also get the disease along with other risk factors during pregnancy and delivery. This accounts for 1 in 7 birth, as per IDF.

What are the symptoms of gestational diabetes?

Generally, gestational diabetes doesn’t cause any noticeable symptoms in most of the women. Very rarely one would experience some mild symptoms like:

  • Blurred vision
  • Fatigue
  • Feeling more thirsty
  • Frequent need for urination

Causes of gestational diabetes

Experts don’t know what exactly causes gestational diabetes, but hormones do play a role. A pregnant woman produces higher levels of some hormones. These include:

  • Estrogen
  • Human placental lactogen
  • Hormones which increases resistance to insulin

The above-mentioned hormones affect the placenta and help in sustaining the pregnancy. Gradually, over the course of pregnancy, the levels of these hormones increase in the body. Moreover, they might interfere with insulin, the hormone which is responsible for regulating blood sugar in the body. Insulin helps move glucose out of the blood into the cells where it is used for energy.

If a pregnant woman lacks adequate amount of insulin or have high levels of hormones that prevent insulin from performing its duties properly, it may give rise to blood glucose in the body. This may cause gestational diabetes.

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What are the risk factors for gestational diabetes?

Any pregnant woman can develop gestational diabetes but some are at greater risk. Some factors include:

  • Age over 25
  • Family history of diabetes
  • Overweight with a body mass index (BMI) of 30 or higher
  • Previously given birth to a baby weighing larger than 4kg
  • History of unexplained miscarriage or stillbirth
  • Woman who are American Indian, Asian, Black or Hispanic

How can gestational diabetes affect you and your baby?

Majority of the women with gestational diabetes will deliver healthy babies. However, if gestational diabetes is not carefully managed, it can affect both you and your baby in various ways.

Complications in mother

  • High blood pressure and preeclampsia
  • Risk of getting gestational diabetes in future pregnancies
  • Risk of developing type 2 diabetes in future
  • Risk of c-section delivery

Complications in baby

  • Excessive birth weight
  • Risk of early labor or preterm birth due to macrosomic (large) baby
  • Respiratory distress syndrome or breathing difficulty
  • Low blood sugar (hypoglycaemia)
  • Type 2 diabetes in future

How is gestational diabetes diagnosed?

The doctor will likely to screen the woman with the history of diabetes and after evaluating various risk factors. It would be done between 24 and 28 weeks of pregnancy. There are basically two methods to diagnose gestational diabetes. These include:

Initial glucose challenge test

The doctor will give a sugary glucose solution to drink. An hour later, you will undergo a blood test to check the blood sugar level. If it is below 130-140 mg/dl, it is considered as normal. Even if it shows higher than normal, it only indicates higher risk, not gestational diabetes. To confirm the condition, you will have to go through glucose tolerance test.

Glucose tolerance test

You will have to fast overnight for this test. After measuring the blood sugar, you will have to drink a higher concentration sweet solution. Then your blood sugar levels will be checked every hour for three hours consecutively. If at least two readings are higher than normal, then you will be diagnosed with gestational diabetes. This can be determined from following, although these numbers can vary from lab to lab.

  • Fasting blood sugar level greater than or equal to 95 mg/dL or 105 mg/dL
  • Blood sugar level after one-hour greater than or equals to 180 mg/dL or 190 mg/dL
  • Blood sugar level after two-hour greater than or equals to 155 mg/dL or 165 mg/dL
  • Blood sugar level after three-hour greater than or equals to 140 mg/dL or 145 mg/dL

Is gestational diabetes treatable?

If you are diagnosed with gestational diabetes (GDM), you would be recommended to go through regular check-ups.

  • The primary focus of the treatment would be on continuously monitoring your blood sugar levels. In majority of the cases, the doctor would suggest you test your blood sugar before and after meals. For this, they would recommend you a special glucose monitoring device. Apart from this, the blood glucose would also be monitored during labor and delivery.
  • Healthy diet would be another management technique that would help you sail through this phase. Though doctor won’t advice losing weight, they may help you set your weight gain goals, depending on your case. A healthy diet includes fruits, vegetables, and whole grains. The doctor may also recommend you to avoid or limit highly refined carbohydrates including sweets. The best and ideal diet will depend from case to case.
  • Exercise is also a great tool to manage gestational diabetes. It lowers blood sugar by triggering the body to move glucose into the cells. Exercise also raises the sensitivity of the cells to insulin. This means the body need not produce high insulin to transfer sugar.
  • If the diet and exercise are not enough to control the blood sugar, the doctor may also suggest insulin injections. About 10-20 percent of women with gestational diabetes will need insulin injections to achieve their blood sugar goals.
  • Last but not the least, the monitoring of the baby is also a crucial part of the overall treatment plan. The doctor would be conducting repeated ultrasound and other tests. If it is necessary, the doctor may induce labor as delivering after the due date may increase the chances of complications.

After you deliver the child, the blood sugar should return to normal. As mentioned, if you have developed gestational diabetes, you are at the risk of developing type 2 diabetes later in your life. So talk with your doctor about how you can prevent diabetes from developing later in life and related complications.

Sources

1. What is Gestational Diabetes?(2016, November 21). American Diabetes Association read more
2. Gestational Diabetes: A Guide for Pregnant Women.(2009, August 05). PubMed read more
3. American College of Nurse Midwives: "Gestational Diabetes."(2006). read more
4. Gestational diabetes(2017, April 26). MedlinePlus read more