Gestational Diabetes: Causes, Symptoms, Diagnosis, Treatment Risks, and Management for a Healthy Pregnancy

The nine-month duration of pregnancy can bring many health issues and worries along the way; regular check-ups and awareness is the only way to sail through it with good health. After all, a healthy pregnancy is a happy pregnancy. 

Gestational diabetes is diabetes mellitus of pregnancy. It is a condition characterized by high blood sugar levels that develop specifically during pregnancy in women who did not have diabetes before. It typically develops during the second or third trimester and poses potential risks to both mother and baby. With timely diagnosis and effective management, most women with gestational diabetes can have a healthy pregnancy and childbirth.

What Causes Gestational Diabetes?

During pregnancy, the placenta produces many hormones like estrogen, progesterone, prolactin cortisol, etc, that can interfere with the body’s ability to use insulin efficiently. This leads to insulin resistance, causing blood sugar levels to rise. Gestational diabetes does not develop in all pregnant women, certain risk factors increase the likelihood of developing it during pregnancy. The risk factors include: 

• A family history of diabetes mellitus- Women with a parent or sibling diagnosed with diabetes have a higher chance of developing gestational diabetes due to genetic predisposition.
• Being overweight before pregnancy- Excess body weight can lead to insulin resistance, making it harder for the body to regulate blood sugar levels during pregnancy. A body mass index (BMI) of over 30 increases the risk. 
• Previous pregnancy with gestational diabetes- If a woman had gestational diabetes in an earlier pregnancy, she is at a greater risk of experiencing it again in future pregnancies.
• Polycystic ovary syndrome (PCOS)- PCOS is linked to insulin resistance, which can increase the likelihood of developing gestational diabetes during pregnancy.
• Maternal age above 40 years- Older pregnant women are more prone to insulin resistance, making gestational diabetes more common in pregnancies after the age of 40.
• A previous child who weighed 4.5kgs or more at birth- A previous pregnancy with a child weighing more can increase the risk of gestational diabetes.

Symptoms of Gestational Diabetes

During pregnancy, women may experience many different kinds of symptoms. From nausea during the initial months, to tingling sensation in hands and legs, the list is endless. The specific symptoms of gestational diabetes may thus be missed many a time. Thus, routine screening for this condition during pregnancy is essential and is a part of the regular checkup which helps identify it. However, women should be aware of the symptoms of gestational diabetes and report them to their gynaecologist if they experience any of them- 

• Increased thirst
• Frequent urination
• Fatigue
• Blurred vision
• Dry mouth 
• Genital itching 

It should be noted that many of these symptoms can also be commonly experienced during pregnancy. Thus, consultation and discussion with gynaecologist must be sought. 

Diagnosis of Gestational Diabetes

Routine screening for gestational diabetes typically occurs between 24 and 28 weeks of pregnancy. Tests may include:

Glucose Challenge Test (GCT): This is a screening procedure used during pregnancy to identify potential gestational diabetes. Typically conducted between the 24th and 28th weeks of gestation, the test involves drinking a glucose-rich solution (usually containing 50 grams of glucose) followed by a blood test after one hour to measure blood sugar levels. Unlike fasting glucose tests, the GCT does not require fasting beforehand, making it convenient for pregnant women. If the blood sugar level is above the normal range, further testing, such as the Oral Glucose Tolerance Test (OGTT), is recommended to confirm the diagnosis of gestational diabetes.

Oral Glucose Tolerance Test (OGTT): This test assesses how well the body processes glucose. It helps determine if the body is producing enough insulin to regulate blood sugar levels effectively and remains a gold-standard test in diagnosing gestational diabetes and ensuring a healthy pregnancy outcome.

How is OGTT done?

• Fasting Blood Sugar Test: The test begins with a fasting blood sample taken after an overnight fast.
• Glucose Intake: After collecting the fasting sample, you will be made to sit comfortably and you will be given a measured dose of a glucose solution (this is up to 75g for pregnant women). The woman drinks the sample and waits at the hospital for further testing. 
• Blood Sugar Monitoring: Blood samples are collected at specific intervals while you sit and wait, (typically at 1-hour, 2-hour, and sometimes 3-hour marks) and the glucose in the samples is measured. This helps assess how the body metabolizes glucose over time. 

Interpreting OGTT Test Results

• If blood sugar levels remain higher than normal at specific time intervals, it may indicate impaired glucose tolerance or gestational diabetes.
• The standard diagnostic values differ for pregnant and non-pregnant individuals, with higher cut-off levels applied during pregnancy.

     Importance of OGTT 

OGTT is prescribed by the obstetrician and gynaecologist as a standard screening test during pregnancy. It helps in the early detection of gestational diabetes and allows for timely interventions, including dietary modifications, exercise, and blood sugar monitoring. Gestational diabetes if undetected and unmanaged can lead to many unwanted complications including preterm birth. 

Impact of Gestational Diabetes on Mother and Child

If left unmanaged, gestational diabetes can lead to complications in both, the mother and the baby. These complications include: 

• Excessive birth weight (macrosomia)- In case gestational diabetes is uncontrolled, the baby can grow larger than usual. This can lead to complications during delivery, while also increasing the need for induced labour and caesarean section. 
• Preterm birth and respiratory distress syndrome- Chances of birthing before 37 weeks increase in case of gestational diabetes. Since the lungs develop rapidly during the last few weeks, preterm birth babies have immature lungs making them more prone to respiratory distress syndrome.  
• Polyhydramnios- This is the presence of excessive amniotic fluid in the womb which can be the reason for premature birth and other complications during delivery. 
• Preeclampsia- This is the development of high blood pressure during pregnancy and can be accompanied by unmanaged gestational diabetes. 
• Low blood sugar levels after birth and increased chances of jaundice in the newborn. 
• Increased risk of developing type 2 diabetes later in life for both, the mother and the baby. 
• Very rarely, there may also be chances of stillbirth in case of uncontrolled gestational diabetes. 

How is Gestational Diabetes Managed? 

If a woman is diagnosed with gestational diabetes, then they shouldn’t worry about it, instead, follow some additional health guidelines to keep the diabetes under control. Effective management is key to ensuring a healthy pregnancy and minimizing complications. Timely detection and timely management of gestational diabetes can help women have a healthy and complication-free pregnancy and even normal delivery. Some management strategies include: 

Blood Sugar Monitoring in Pregnancy

Regular monitoring of blood sugar levels is crucial. This helps identify any fluctuations and allows healthcare providers to adjust the treatment plan accordingly. Women can discuss and get trained in monitoring their blood sugar levels at home through simple glucose monitoring devices. 

Healthy Diet Choices

Eating a balanced diet is essential in the management of diabetes mellitus, this applies to gestational diabetes too. Since many women are overfed lovingly during pregnancy, one must remember that a balanced diet is recommended for overall health in pregnancy and specifically in this condition as well. Some specific tips for maintaining healthy blood sugar levels include:

• Focus on complex carbohydrates like whole grains and oats.
• Include lean proteins such as chicken, tofu, and legumes in your diet. 
• Eat plenty of fresh fruits and non-starchy vegetables.
• Limit sugary and processed foods.
• Opt for small, frequent meals instead of large meals to avoid blood sugar spikes.

Regular Physical Activity

Staying active helps the body use insulin more effectively. Pregnant women can benefit from low-impact exercises such as:

• Walking
• Prenatal yoga
• Swimming
• Stationary cycling

Always consult a healthcare provider before starting any exercise regimen during pregnancy.

Medication Management

In some cases, lifestyle changes may not be sufficient to control blood sugar levels. Depending on the extent of the disease and individual requirements, your healthcare provider may prescribe oral medications or insulin therapy to control blood sugar levels. Any medication prescribed is based on scientific evidence and is safe during pregnancy. 

Regular Prenatal Check-ups

Frequent check-ups help monitor the mother’s health and the baby’s growth. Healthcare providers can track blood sugar levels, blood pressure, and fetal development to ensure that any complications are addressed early. Thus, pregnant women diagnosed with gestational diabetes and their families should ensure that they do not miss any prenatal appointments with the gynaecologist. 

Health Tips for Pregnant Women with Gestational Diabetes

• Stay Hydrated: Drink plenty of water to help regulate blood sugar levels.
• Plan Your Meals: Keep a food journal and plan meals to maintain stable blood sugar levels.
• Listen to Your Body: Pay attention to any unusual symptoms and report them to your healthcare provider.
• Prenatal Supplements: Take prescribed vitamins and supplements, such as folic acid, for overall health.
• Seek Support: Join gestational diabetes support groups or seek counseling to manage the stress and anxiety associated with the condition.

Post-Pregnancy Care

Gestational diabetes typically resolves after childbirth. However, women who have had it are at an increased risk of developing type 2 diabetes later in life. Post-delivery care recommendations include:

• Blood sugar testing 6-12 weeks after delivery and periodically thereafter
• Maintaining a healthy diet and regular physical activity
• Scheduling routine check-ups for long-term health management

The term Gestational diabetes can seem worrisome, but remember this condition can be easily managed with proper care. With controlled blood sugar levels most women can enjoy a healthy pregnancy and delivery. By monitoring blood sugar levels, adopting a balanced diet, staying active, and following medical advice, mothers can ensure the well-being of themselves and their babies. Raising awareness about diabetes during pregnancy and promoting regular screening can help more women receive the care they need for a smooth and joyful pregnancy journey.

Ankura Hospital for Women and Children wishes you a Happy and Healthy Pregnancy!