Most of us know that there are two main types of diabetes called Type 1 and Type 2, and the differences between them. However, did you know other than those two types there is another one type can occur during pregnancy? It is called “Gestational Diabetes Mellitus (GDM)”.

Gestational Diabetes is a temporary condition due to a high blood sugar level in blood during pregnancy. It usually develops between 24th and 28th weeks of pregnancy and with no prior diagnosis or history of diabetes.

The overall prevalence of Gestational Diabetes among pregnant women is 13.2%. That means 13 of every 100 pregnant women can have Gestational Diabetes during the course of pregnancy.

Complications due to Gestational Diabetes may occur in 7 out of every 100 pregnancies. The risk for Gestational Diabetes-related complications increases with mothers age.

Also, the risk of developing Type 2 Diabetes Mellitus in later life is seven-fold high in Gestational Diabetes mothers than normal pregnant mothers.

The exact cause for Gestational Diabetes is still unknown, but there are some clues.

Insulin is a hormone that produces from the pancreas which helps to move glucose molecules from the blood to cells.

During pregnancy, placenta, which connects baby to mother, produces high hormone levels, for example, Progesterone, Estrogen and Human Chorionic Gonadotropin (hCG), most of which could impair the action of insulin and while supporting baby’s growth. Due to impaired insulin action, the pancreas produces more and more insulin. When the baby grows, the placenta also grows and produce more and more hormones that may further counter-attack insulin. The insulin resistance intensifies, the blood sugar level goes up and leads to Gestational Diabetes.

Did you know that there is a rarer version of Gestational Diabetes called ‘Gestational Diabetes Insipidus’?

We have priviously discussed similarities and differences between Gestational Diabetes Mellitus and Gestational Diabetes Insipidus.

Who are at risk of Gestational Diabetes?

Any women during pregnancy can get Gestational Diabetes. But the risk is higher in mothers who are;

• Overweight or obese
• Had larger babies (> 4.5kg) previously
• With a history of Gestational Diabetes in previous pregnancies
• Having a close relative with Diabetes Mellitus
• Older than 25 years
• Known to have conditions causes insulin resistance such as Acanthosis Nigerians, Polycystic Ovarian Syndrome
• Taking antipsychotics or steroid medications
• Nonwhite races such as Hispanic, American Indians, Asian, African Americans
• Pregnant with multiples like twins and triplets.

Symptoms of Gestational Diabetes

Gestational Diabetes has no specific symptoms. It is commonly diagnosed when the mother goes through pregnancy screening tests.

Nevertheless, there are some features which suggestive of high blood sugar level, the symptoms common to diabetes in general. These symptoms give a red flag indicating that the mother may be having a high sugar level.

• Increase thirst
• Frequent urination
• Dry mouth
• Tiredness
• Fatigability
• Blurred vision

How to Diagnose Gestational Diabetes

Once confirmed the pregnancy, the doctor will assess you for risk factors for Gestational Diabetes and other diseases. You may be advised to undergo a screening test if there are risk factors. The test for Gestational Diabetes is called Oral Glucose Tolerance test or “OGTT”.

Oral Glucose Tolerance Test or “OGTT”

This is the typical test of screening for Gestational Diabetes. Usually, it is done between 24th
and 28th weeks of gestation. The test requires 8 – 10hours of overnight fasting. Following a first blood sample, you will be asked to drink 75g of glucose dissolved water. Then, the blood samples are taken at 1 hour and 2 hours.

If the fasting blood glucose level is more than 92mmol/dL, the first-hour value is over 180mmol/dL, and second-hour value is over 153mmol/dL, doctors confirm that you have Gestational Diabetes.

How to Manage Gestational Diabetes

• Nutritional counselling and healthy eating

Take advice from a dietitian regarding the balanced, healthy low fat and low sugar diet. Also, you may need to restrict calorie intake and reduce plasma triglyceride level.

Eating regularly and two hourly is recommended. Do not take a high amount of carbohydrates in one go because that may cause a spike of blood sugar.

Consume healthy carbohydrates such as: whole grain, nuts, starchy vegetables, and red rice.

• Regular exercises

Exercises help to control the blood sugar level to a certain extent. The exercises safer in pregnancy are: walking, swimming, and Yoga.

Doing exercises moderately at least five times per week would reduce the risk of developing Gestational Diabetes. Exercises will help to relax the mind and throw away the stress too.

• Frequent blood sugar checkups

Blood sugar levels can be checked at home using a glucometer. The device is straightforward to use, and your doctor could guide you with instructions and the results’ interpretation.

• Medications

It could be challenging to control the high sugar level in pregnancy because the baby needs sugar to grow up inside mom’s tummy. Sometime your doctor may prescribe insulin injection to control the blood sugar level till childbirth. Usually, oral sugar controlling drugs are not recommended during pregnancy.

Managing type 2 Diabetes Mellitus during pregnancy

If you are diagnosed to have Type 2 Diabetes Mellitus before pregnancy, it is essential to discuss and take advice from your doctor ideally before getting pregnant or at least at the early stage of pregnancy. It is crucial to discuss diet, exercises and medications for the safety of you and your baby.

Challengers with babies born to Gestational Diabetes mothers

Most of the time babies of Gestational Diabetes mothers are healthy, but there is a chance for some problems due to Gestational Diabetes.

• Large babies

Babies of Gestational Diabetes mothers can grow large because extra glucose in the blood can cross the placenta to the baby. As a result, labor may be complicated. Difficult delivery may end up damaging the newborn’s shoulders.

• Hypoglycemia (low blood sugar level in blood) and seizures in newborn babies.

Because of extra glucose in the baby’s blood, the insulin production in the baby’s body goes up. So just after the delivery baby may not get enough maternal glucose but insulin action may persist. Due to the low blood sugar levels, newborn babies are prone to get hypoglycemia and seizures. Therefore, mothers with Gestational Diabetes are encouraged to feed their babies as soon as possible after the delivery.

• May need an early delivery plan

Gestational Diabetes itself not an indication for a caesarean section but it is important to assess the baby’s weight in the latter part of pregnancy and appropriateness for normal delivery. Mothers with Gestational Diabetes should ideally deliver around 38 weeks because gestation over 38 weeks increases the risk for complication (due to large babies) without c-section.

• Early birth and breathing difficulties

Gestational Diabetes mothers have a high risk of premature labour. The babies born early may get breathing problems easily and need help with breathing in the first few days of life.

• Jaundice

Babies of Gestational Diabetes mothers may have yellowish discolouration of the eyes and skin. Jaundice needs to be managed by a Pediatrician as a matter of emergency.

• high blood pressure and pre-eclampsia

Gestational Diabetes mothers have a high risk to get high blood pressure and pre-eclampsia. Pre-eclampsia is a severe condition of pregnancy which can be harmful to both mother and baby. Therefore continuous blood pressure monitoring is also important.

Do not mix-up pre-eclampsia with pre-diabetes because they sound similar. We have discussed the difference of pre-diabetes from diabetes before.

Recommendations for pregnant mothers after delivery and for future pregnancies

• Breastfeeding lowers the risk of having Type 2 Diabetes Mellitus in your babies later in life.
• Most of the time Gestational Diabetes treatment can stop after the delivery of your baby.
• You must check blood sugar levels before going home and at 6-8 weeks after the delivery because it is necessary to confirm that the mother had Diabetes only during pregnancy or whether it is persistent after the pregnancy too. If it is only Gestational Diabetes, no need for further treatments. However, if the blood sugar level is higher than normal months after delivery, you may need to start hypoglycemic medication.
• Gestational Diabetes mothers have a high risk of developing Type 2 Diabetes Mellitus later in life. So need to do regular blood sugar checkups, healthy eating and regular exercises.
• Remember, there is a risk of developing Gestational Diabetes in next pregnancies too. So, your next pregnancy has to be planned well in consultation with your healthcare provider.

Gestational Diabetes, can it be prevented?

The bad news is that Gestational Diabetes cannot be prevented. But you can reduce the risk of having Gestational Diabetes by maintaining healthy body weight, healthy eating habits and regular exercises.

The healthy lifestyle is the key to preventing, managing and reversing Gestational Diabetes and the chances of acquiring Type 2 Diabetes Mellitus later in life.