It’s not uncommon to see symptoms of diabetes appear during pregnancy, also known as Gestational Diabetes Mellitus (GDM). Gestational diabetes mellitus (GDM) is a type of diabetes that occurs at the time of pregnancy and is associated with high blood sugar or glucose levels.
It’s not really harmful but if not managed well during pregnancy, can lead to type II diabetes. Pregnant women with GDM and a baby have an increased risk of developing type II diabetes in the future.
Diabetes has two types: type I and type II. Type I is associated with a lack of insulin whereas in Type II, insulin is present but it isn’t able to act on cells. GDM is similar to type II but in the same, insulin isn’t able to act due to the presence of hormones produced by the placenta in pregnancy.
Glucose remains in the blood which increases the risk of complications for the patient and baby during & after pregnancy.
Usually, blood sugar levels get normal after giving birth. But still, it takes a healthy lifestyle and care to get better and avoid GDM developing into a type 2 in the future.
What causes Gestational Diabetes Mellitus?
To pass various nutrients and connect the mother to baby, a placenta is formed during pregnancy. This placenta produces various hormones needed for the growth and development of the baby.
Some of these hormones reduce the action of insulin which ultimately causes high blood sugar levels.
Diagnosing Gestational Diabetes Mellitus
Checking blood sugar levels is a routine examination in pregnancy. Diagnosis of GDM is generally done at 24–28 weeks of pregnancy. However, it can be checked earlier if you are at a high risk.
The standard test, HbA1c, is not very effective in diagnosing GDM. HbA1c gives an average of the last 3 months which may give false results here.
The best way to diagnose GDM involves Glucose Challenge Test and Oral Glucose Tolerance Test (OGTT).
Glucose Challenge Test
In this test, the patient is asked to quickly drink a solution (usually 50 g of glucose dissolved in water).
After 30 minutes, a blood sample is taken to determine blood sugar levels. If the blood sugar level is higher than a specific cut off (>130 mg/dl), then the patient is recommended a longer glucose test, known as OGTT.
Oral Glucose Tolerance Test (OGTT)
This test involves overnight fasting for over 8 hours. The patient is asked to drink sugar solution of specified concentration (usually 75 g of glucose dissolved in water).
Again blood samples are taken but at different time intervals usually at one, two, and three hours since the blood sample was taken to check blood sugar levels.
In OGTT, the patient is diagnosed with GDM if the glucose level exceeds or equals to
- Fasting serum glucose > 92 mg/dl (5.1 mmol/l)
- 1 Hour blood sugar level: > 180 mg/dl (10.0 mmol/l)
- 2 Hour blood sugar level: > 153 mg/dl (8.5 mmol/l)
Why Gestational Diabetes is diagnosed in mid-pregnancy?
At an early stage, when blood sugar levels start increasing, the body uses a different mechanism to compensate. However, since hormones keep producing and blood sugar levels don’t improve later, the effect of insulin is decreased further and GDM could only be diagnosed later.
Risk factors
The risk is usually high for a woman getting pregnant after the age of 40. But GDM can also be developed at an early age. There are other factors that put a woman at the risk
- Family history: If you have a family history of type 2 diabetes mellitus, which means either your parents, brothers, or sisters have impaired glucose tolerance, you may develop GDM.
- Overweight or Obese: If your weight is on the higher side, or you are overweight, or obese, you are more likely to develop GDM.
- Gestational diabetes in the previous pregnancy: If you had GDM in the previous pregnancies, you may develop it again.
- Previous babies weighing more than 4.1 kg at the time of delivery.
- Polycystic ovarian syndrome (PCOS): PCOS is very common among females. One female out of 5 has PCOS and is related to disturbed levels of female sex hormones and causes higher weight which puts you at a risk of GDM.
- Elevated blood sugar levels: Risk of GDM increases if you have increased blood sugar levels.
- Lifestyle: Your lifestyle include dietary intake, disturbed sleep pattern & stress which plays an important role in the development of GDM
Signs & Symptoms
Some women may experience the following if they have gestational diabetes mellitus. However, some of these are also a sign of pregnancy, so they should be assessed with evidence or tests before a proper diagnosis:
- Increased thirst
- Frequent urination
- Tiredness
- Dry mouth
- Nausea & vomiting
- Mood swings
- Bladder infection
Managing Gestational Diabetes
- Physical activity: Regular physical activity helps in keeping blood sugar levels in the normal range by moving glucose from the blood to cells and helps in preventing gestational diabetes-related complications. Physical activities also help in reducing your body weight & keeping your weight in the normal range & reduces the chances of developing high blood sugar in the future.
- Dietary modifications: Dietary modification should be done in such a manner so that it fulfills your requirements (as a demand of nutrients gets increased in pregnant women) & also manage your blood sugar level. Dietary modification depends on which type of insulin you are taking and your basic needs. Modification in carbohydrate & protein intake helps in managing your blood sugar levels as well as limited intake of sugar-containing food products helps in preventing further complications. To manage your health and daily requirements, download the Zyla app from Google Playstore.
- Medication: Insulin is the first-line treatment of GDM. The use of OHAs are limited in pregnancy due to their hypoglycemic effect (low blood sugar episodes) & effects on the baby. Insulin is generally used to control sugar in GDM. The usage of insulin should be under the supervision of your physician and don’t make any changes in insulin by self as it may lead to hypoglycemic episodes.
- Monitoring of blood sugar level: While pregnant, maintaining blood sugar levels normal to prevent any kind of complications is important. For that, continuous monitoring of blood sugar levels is important.
Prevention of Gestational Diabetes
- Stay healthy: Check your glucose level after regular time interval if you have any risk factor and before making a plan of pregnancy, check your health status.
- Regular exercise: It helps in controlling your body weight and manage overall health which prevents the development of GDM.
- Limit intake of carbohydrate & simple sugar in diet: It helps in controlling your blood sugar levels
Effect of GDM on you & your baby
Another reason why it’s crucial to manage gestational diabetes is that it can lead to complications to the baby.
- Hypoglycemia in newborn baby: Sometimes babies just after being born, develop hypoglycemia (low blood sugar episode) because their own insulin production starts and severe hypoglycemic episode may cause seizures/ fits in the baby.
- Jaundice in newborn baby: Sometimes, newborn babies can develop jaundice just after birth.
- Increases risk for development of Type II diabetes: If you have gestational diabetes, then chances of developing type 2 diabetes increase if lifestyle is not taken care of.
- Early birth: If the mother has high blood sugar levels, then chances of pre-labor and chances of delivering the baby before due date increases.
- Difficulty in breathing: Babies born early or prematurely may experience respiratory distress/ difficulty in breathing/ shortness of breath, and need breathing support until their lungs become mature and able to function properly. In some cases, babies may experience breathing difficulty even if they are born after the due date.
- Chances of C-section: If blood sugar levels are high, sugar crosses placenta and baby stores this extra sugar as fat which causes an increase in body weight and further increases the risk of complicated vaginal birth or requirement of C-section
- High blood pressure: It is a condition that can be developed in pregnancy along with gestational diabetes and may further lead to other health complications, if not treated.
- Birth defects in babies: It happens due to the intake of certain restricted medicines in pregnancy or due to certain diseases or infections during pregnancy. It may be induced in the first trimester. The chance of abnormality in your baby increases with high levels of blood sugar. In order to prevent these abnormalities, you should have to manage your blood sugar level & lifestyle. Along with anomalies, chances of stillbirth is higher in women with GDM as compared to women without diabetes.
Why Gestational Diabetes sometimes develop into Type II?
Gestational diabetes disappears after giving birth as placental hormones aren’t being produced, but in some women, it may again develop in the next pregnancy or converts to type 2 diabetes mellitus in the future.
After delivery, generally, we forget to take care of our health or monitoring of blood sugar levels over a defined period. Uncontrolled blood sugar levels & sedentary lifestyle act as a precursor for the development of type 2 diabetes. Increased body weight may also further leads to T2DM in the future by enhancing insulin resistance.
If you have a history of gestational diabetes and you are planning for the next pregnancy, you should have to consult your doctor and get your blood sugar levels checked regularly.
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