Gestational Diabetes Mellitus (GDM) is defined as any degree of glucose intolerance that develops with the onset of or during the pregnancy. This state may subside or may continue post full term. GDM poses health risks to the fetus and to the mother and also leads to complications during and at the end of the term. If gestational diabetes is timely identified and managed during the full course of pregnancy, a lot of the complications can be avoided and a healthy baby is delivered post full term.
In the past few years, the incidence of GDM has increased multi-folds, especially for Asian origin women! Once GDM is diagnosed, one needs to be highly vigilant of their diet and physical activity to manage the blood sugar level within a safe range.
Symptoms of Gestational Diabetes
There are usually no symptoms of GDM. It is detected by the routine glucose tolerance test as described below. But when it is out of control, one may experience the following symptoms:
- Excessive hunger or thirst
- Excessive tiredness
- Frequent Urination
- Episodes of black-out or low blood sugar
Since these symptoms are very commonly associated even with healthy pregnancy during the last trimesters, it is quite hard to confirm GDM without actual tests.
Who is susceptible to gestational diabetes?
Glucose tolerance decreases with the progress of pregnancy due to various additional hormones secreted via placenta in the body. Hormones such as human placental lactogen, progesterone, prolactin, and cortisol lead to increased insulin resistance. As the level of the above hormones increase, it may subsequently lead to GDM in some cases. Hence, it is detected during the later stages of the 24-28th week in pregnancy.
Gestational Diabetes usually develops due to pre-existing hyperglycemia and insulin resistance, which gets aggravated during pregnancy.
Every year, around 2% and 10% of women are diagnosed with gestational diabetes. Over the past decades, both the incidence and ratio of pregnancy diabetes has increased. Here are some of the factors that can increase your susceptibility to develop gestational diabetes:
- Your age is more than 25
- Have a family history of diabetes
- You are overweight before your pregnancy
- Have high blood pressure
- Are having multiple babies
- During pregnancy, the weight becomes more than normal
- In the past, suffered from gestational diabetes
- Must have given birth to a baby weighing more than 9 pounds
- Have had a mysterious miscarriage or stillbirth
- Taking glucocorticoids
- Have conditions like polycystic ovary syndrome (PCOS), acanthosis nigricans, or shows insulin resistance
- Have undergone treatment of infertility
- Have suffered from recurrent Urinary Tract Infections (UTI)
Complications associated with gestational diabetes
If gestational diabetes is not properly managed, the blood sugar levels will stay in the elevated state throughout the pregnancy. This can cause many complications and possibly harm both the mother and fetus. With GDM, a mother has higher chances to face pregnancy-induced hypertension, preeclampsia, antepartum hemorrhage, preterm labor, and cesarean delivery. Some of them can be avoided by managing gestational diabetes well.
However, others such as higher susceptibility of the baby and the mother towards Diabetes at a later stage needs to be tightly controlled post delivery. GDM also poses following health risks and complications to the fetus/baby:
- high birth weight of the baby and hence higher possibility of cesarean section birth
- post birth unit care requirement
- high-intensity jaundice after delivery
- baby will have much higher chances of developing metabolic disorders, Diabetes, cardiovascular disorders
- congenital malformation
- difficulties during labor
- higher risk of diabetes in future
- a risk to the life of fetus and mother such as stillbirth, neonatal deaths, or perinatal mortality
Types of gestational diabetes
GDM is of two classified into 2 levels based on the required level of intervention for the management of the condition:
- Class A1 – It can be controlled by diet and physical activity
- Class A2 – It needs to be managed by insulin and/or oral medications.
How would gestational diabetes affect delivery?
As stated earlier, GDM poses multiple health risks to the fetus and to the mother. Should one be diagnosed with GDM, it is necessary to make required changes to diet and lifestyle and or take medications along with. While management is necessary, GDM could still affect baby delivery via:
- Making cesarean section necessary: One should be mentally prepared for the requirement of C-section in case of emergency due to sudden changes in blood pressure, blood sugar, heartbeat, or planned due to the size of the baby.
- A requirement of insulin during delivery: Blood sugar levels must be maintained during labor and delivery as hyperglycemia (high blood sugar) in mother leads to hypoglycemia (low blood sugar) in the newborn. When a mother has GDM, she may require insulin support either via a shot or via a plastic tube.
- Pre-term delivery: This may be required if pre-eclampsia (sudden high blood pressure) develops during the third trimester. Should this happen, then the only solution to save the life of mother and baby is via early delivery. Apart from this, early delivery may need to be planned for various other reasons including the size of the baby.
How is gestational diabetes diagnosed?
If you do not have any past history of diabetes or blood sugar a normal level at the beginning of pregnancy, your doctor may recommend you to do screening for gestational diabetes around 24-28 weeks. He will do the tests as below:
Glucose challenge test
There is no preparation required for the glucose challenge test. You will be given a glucose solution to drink and undergo a blood test after one hour. If the blood sugar level is high, your doctor may do a three-hour oral glucose tolerance test which is a two-step testing. Some doctors only do a two-hour glucose tolerance test and it is known as one-step testing.
- First, you undergo the test of fasting (overnight fasting for at least 8 hours) blood sugar
- You are given a solution containing 75 grams (g) of carbohydrates to drink.
- Then they will check your blood sugar levels repeatedly after one hour and two hours.
The doctor will confirm that you have gestational diabetes if your blood sugar level matches the following values:
- fasting blood sugar level – more than or equal to 92 milligrams per deciliter (mg/dL)
- one-hour blood sugar level – greater than or equal to 180 mg/dL
- two-hour blood sugar level – greater than or equal to 153 mg/dL
For the two-step test, you will not need to be fasting. They will give you a sugary solution containing 50 g of sugar and then after one hour, they will check your blood sugar. If your blood sugar level is greater than or equal to 130 mg/dL or 140 mg/dL, they’ll perform a second follow-up test on another day according to your doctor.
- In the second test, your doctor will test your fasting blood sugar level.
- The doctor will tell you to drink a sugar solution by adding 100 g of sugar.
- You will undergo the test of your blood sugar at one, two, and three hours later.
They will confirm you with gestational diabetes if you have no less than two of the following values:
- fasting blood sugar level greater than or equal to 95 mg/dL or 105 mg/dL
- one-hour blood sugar level greater than or equal to 180 mg/dL or 190 mg/dL
- two-hour blood sugar level greater than or equal to 155 mg/dL or 165 mg/dL
- three-hour blood sugar level greater than or equal to 140 mg/dL or 145 mg/dL
What should you eat if you have gestational diabetes?
Dietary intervention is absolutely essential to managing the blood sugar levels with or without additional treatment. One should be watchful of the quantity and quality of foods consumed to avoid large fluctuation in glucose level in the blood. In a majority of the cases, complications of GDM can be avoided and GDM managed well by switching one’s diet. Here are some of the points to consider:
- Stop the consumption of simple carbohydrates such as processed and packaged foods, white carbohydrates such as white flour, white sugar, and white rice. Instead, replace them with foods rich in complex carbohydrates such as brown, red, or black rice, millets, whole wheat flour, beans, lentils, and tubers.
- Reduce the number of carbohydrates and replace them with proteins and healthy fats. Go for plant-based proteins such as lentils and beans whenever possible. Proteins will keep you full for long, hence help avoid low blood sugar episodes.
- Include probiotics rich foods such as fermented foods in your diet. This supports gut flora and helps to mitigate the effect of placental hormones in the body.
- Avoid big meals that are far apart. Instead, consume multiple small to moderate sized meals with healthy snacks such as salads, nuts, and fruits in between.
After the birth of the baby!
Women with GDM have 40% higher chances of developing Diabetes Mellitus later in life. Once the baby is delivered, your doctor would recommend monitoring your blood sugar levels on regular basis. After 6 weeks of delivery, the blood test is conducted to check whether the glucose level has turned to normal! Based on this, one would fall into 3 possible categories:
- Normal: Blood glucose level has returned to normal after all the hormonal changes have balanced out.
- Impaired Glucose/Insulin Tolerance: This would require tight monitoring of blood glucose and also permanent changes to diet and lifestyle.
- Diabetic: May or may not require medication. Dietary and lifestyle changes are mandatory.