Last updated on December 28, 2021
Content By: Dr. Nikita Toshi BDS, Assistant Manager (Medical Review)& Dr. Ritu Budania MBBS, MD (Pharmacology) Head, Medical Affairs
Last updated on December 28, 2021
Pregnancy is a beautiful journey in a woman’s life especially if she has been yearning to mother a child. A wonderful yet also powerful process where a woman goes through many changes, both physically and mentally. While the female body prepares itself to carry a child, it goes through a lot of changes. These changes result in the expecting mother experiencing common pregnancy symptoms like sore breasts, nausea, vomiting, changes in breast size and shape, abdominal cramps, spotting, fatigue and more which can be felt as early as 4 weeks after conception. While most of these symptoms occur due to normal hormonal changes that are supposed to follow post-conception, there are also a large number of women who undergo hormonal imbalances during pregnancy. While these imbalances are mostly temporary, they require to be diagnosed and treated at the right time, to eliminate any life-threatening risk to the mother or the baby. One such condition that is caused due to hormonal imbalances during pregnancy is gestational diabetes. In this article, we are going to be looking at what gestational diabetes is, its symptoms, causes and risk factors and ways to effectively manage gestational diabetes to prevent further harm to the mother or the baby.
Pregnancy is a beautiful journey in a woman’s life especially if she has been yearning to mother a child. A wonderful yet also powerful process where a woman goes through many changes, both physically and mentally. While the female body prepares itself to carry a child, it goes through a lot of changes. These changes result in the expecting mother experiencing common pregnancy symptoms like sore breasts, nausea, vomiting, changes in breast size and shape, abdominal cramps, spotting, fatigue and more which can be felt as early as 4 weeks after conception. While most of these symptoms occur due to normal hormonal changes that are supposed to follow post-conception, there are also a large number of women who undergo hormonal imbalances during pregnancy. While these imbalances are mostly temporary, they require to be diagnosed and treated at the right time, to eliminate any life-threatening risk to the mother or the baby. One such condition that is caused due to hormonal imbalances during pregnancy is gestational diabetes. In this article, we are going to be looking at what gestational diabetes is, its symptoms, causes and risk factors and ways to effectively manage gestational diabetes to prevent further harm to the mother or the baby.
Written by
BDS, Assistant Manager (Medical Review)
Reviewed by
MBBS, MD (Pharmacology) Head, Medical Affairs
Gestational Diabetes is a condition where diabetes is diagnosed for the very first time in a pregnant woman. It occurs when the hormone produced by the placenta (the organ that provides nutrition and oxygen to the growing baby) hinders the body’s natural ability to use insulin effectively. Insulin is a hormone produced by the pancreas that plays an important role in lowering blood sugar levels and converting them into energy. When the body is not able to produce or respond to insulin, the blood sugar levels can build up and become very high resulting in complications during pregnancy.
Today, it is estimated that around 4 million women in India have been affected by gestational diabetes.
Most of the time there may be no noticeable sign of gestational diabetes as few of the symptoms are very similar to the symptoms of pregnancy, so it may be difficult to identify it at first. However, if you do have a combination of the following gestational diabetes symptoms, it is better to consult a doctor at the earliest to determine this or any other condition.
Blurry vision
Infections in the vagina, bladder or skin.
Tiredness
Excessive thirst with dry mouth.
Excessive need to urinate/large volume of urination.
It is important to note that tiredness, nausea and frequent urination are also very common symptoms of pregnancy. However, one of the most evident and noticeable symptoms of diabetes is blurry vision (the inability to see fine and precise details including sharpness and the focus in your vision). Both long term and short term diabetes may cause blurry vision in patients. However, it is also possible to have a high sugar level with no noticeable symptoms initially.
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One of the main causes of Gestational Diabetes is hormonal changes. During pregnancy, a woman’s body develops the placenta, which is an organ that provides oxygen and nutrients to the baby and removes wastes from the baby’s blood.
The majority of the time, the pancreas can release enough insulin to handle this hormone overload. But in some cases, these placental hormones may block insulin from doing its job properly. This is known as insulin resistance. As the pregnancy advances, the placenta grows and produces more hormones making the risk of insulin resistance even greater. When the body is unable to produce enough insulin, there is an extra build-up of glucose in the body which then leads to Gestational Diabetes. GDM usually occurs in the second half of the term and can be diagnosed in about 20 – 24 weeks into the pregnancy – It can also be diagnosed earlier or later in pregnancy depending upon the individual’s case.
Gestational Diabetes is most likely to affect women with the following factors:
In addition to the above-mentioned factors, diet and nutrition are also equally important factors for Gestational Diabetes. If the usual diet of the expecting mother has been unhealthy or unbalanced even before pregnancy, it can lead to Gestational Diabetes in pregnancy. Pregnant or not, a well-balanced diet and a healthy lifestyle can prevent several medical conditions during pregnancy and also at the later stages of life.
Now that we have understood what gestational diabetes is, let’s move on to diagnosis and treatment of the condition.
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If you have the above-mentioned symptoms or if you have any of the above-mentioned factors that put you at risk of developing the condition, it is best to consult your doctor for immediate treatments and precautions to prevent any serious complications during childbirth. Most hormonal imbalances that occur during pregnancy usually resolve by themselves after the child is born and for most women, gestational diabetes too, goes away after childbirth. However, it is very important to understand that half of the women who had gestational diabetes in their pregnancies, may go on to develop type 2 diabetes later in their lives. Therefore, you will likely be advised to get tested more frequently for any possible changes in blood sugar levels.
How is Gestational Diabetes Diagnosed?
The following are important gestational diabetes tests that are done to diagnose the condition:
Oral Glucose Tolerance Test (OGTT) – This is the prime diagnostic test for gestational diabetes (also used to test Type 2 Diabetes) that shows how well your body can break down or handle sugar from foods. It can determine if you are at risk of developing the condition or/and if you already have it. OGTT is a simple blood test that is done after you fast for 8 – 12 hours. Blood will be drawn in the morning before your breakfast. This is done to test your starting blood sugar level. You will then be asked to consume a sugary drink which is a mixture of glucose and water. Your next glucose tolerance test will be taken two hours later (or up to four times at different time intervals, depending on your case) where the nurse will draw more blood to see how your body has handled the sugar.
Additionally, your doctor will diagnose Gestational diabetes by an elevated level of blood glucose found in a screening test like fasting blood sugar or random blood sugar which may be advised multiple times during pregnancy and an oral glucose tolerance test which is the most important test for gestational diabetes.
Fasting blood sugar test – A fasting blood sugar test is taken on an empty stomach. For the 8 hours leading up to the test, you won’t be permitted to eat or drink anything but water. A nurse will draw blood from a vein in the arm for further testing.
Random Blood Sugar Test – RBS is the blood sugar test that is done at any time of the day irrespective of the time lapsed after meals. This gives an overview of the blood sugar levels and is used as a screening tool for diabetes.
HbA1C Test– Glycated haemoglobin test can be advised by your doctor to understand the average sugar levels over the past 2-3 months.
Doctors usually depend on blood tests, either OGTT or Fasting Blood sugar, Random blood sugar or both, to determine diabetes. For gestational diabetes, you will most likely have one or more blood tests, to confirm the presence of the condition. Once confirmed, you will be given some treatment for Gestational Diabetes Mellitus.
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If you are diagnosed with Gestational Diabetes, you can rest assured that the condition can be effectively managed with ease. Most women with gestational diabetes go on to have healthy, active babies and there is no threat to their future babies and pregnancies. It is important to stay stress-free and relaxed during your pregnancy to keep your baby safe and healthy. Managing gestational diabetes includes simple lifestyle changes, a positive mindset and above all a good doctor or gynaecologist who would be able to advise you with the right management or treatment plan suited to your diagnosis.
Treatment for pregnancy diabetes requires timely medications, a few lifestyle changes and timely attention following which you will be able to have a healthy pregnancy and baby. Patients with gestational diabetes will be advised to maintain a healthy and balanced diet after pregnancy to keep diabetes at bay. Once you consult your doctor, you will be given a set of treatment options depending on your case.
How to treat gestational diabetes?
First things first, if you have been diagnosed with gestational diabetes, never think of venturing into any form of self-treatment, it is absolutely vital to consult your doctor to ensure the right treatment is administered that will protect you and your baby throughout the pregnancy term. The following are a few Gestational Diabetes treatment options that your doctor may suggest:
Monitoring blood sugar levels
Once you have been diagnosed with gestational diabetes, your physician will ask you to keep a close eye on your blood sugar levels, maybe four times or more in a day (i.e. First reading in the morning before food and then one hour after all meals in a day). You can easily do this in the comfort of your home with a glucometer. Ensuring this, you will be able to keep your blood sugar levels within the normal range which will help you and your baby stay healthy and happy.
Insulin treatment for gestational diabetes mellitus
Most of the time, simple diet changes are enough to keep your blood sugar levels in control. However, for about 30% of women who are diagnosed with gestational diabetes, these diet changes are not enough. These patients will then be advised to take insulin. If you have been diagnosed with gestational diabetes, it is normal to worry about insulin therapy fearing that it may affect you or the baby. However, the good news is insulin does not cross the placenta and is absolutely safe during pregnancy. In fact, insulin is necessary to keep you and your baby safe from pregnancy complications. It is a traditional, first choice Gestational Diabetes treatment option that is also considered most effective.
Insulin injections are usually given in the upper arm or in the thigh. It is important to educate yourself on insulin and take utmost care when administering it yourself. Make sure you have the right doses, practice taking your shot or have someone with a steady hand assist you in doing so and always store the insulin properly to ensure that each dose works to its maximum level.
Diet for gestational diabetes
The following are some guidelines for diet for gestational diabetes that your doctor or dietitian may ask you to follow to keep your blood sugar levels in control:
Eat smaller meals that are more frequent.
Include an adequate amount of healthy carbohydrates in your meals. Carbohydrates break down to glucose during digestion and are highly beneficial for you and your baby. But remember to consume carbohydrates in a controlled amount, not to overeat.
Refrain from eating high sugary and processed foods. This is a golden rule for any person, pregnant or not.
Consume less sugary fruits and plenty of vegetables. If you crave sweets during pregnancy, opt for fruit instead of sugary food.
Include a good amount of protein and fibre rich food in every meal.
Exercises
Exercise has proved to be beneficial for women with gestational diabetes. It helps the body to become sensitive to the insulin produced and helps regulate blood sugar levels. Most doctors recommend aerobic exercise like walking, dancing and swimming with moderate intensity for about 30 minutes to an hour, three to five days a week. It is important to consult your doctor and understand the right exercises for yourself depending upon your health conditions.
Joining a community of fellow moms-to-be
Last but not the least, it helps a lot to know that you are not alone in your battles, no matter how big or small. Join a few new moms clubs or communities to share insights and experiences of pregnancies. You will be pleased to learn about different pregnancy stories and how extraordinary the human body can be during the pregnancy process.
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While gestational diabetes is fairly easy to control, there are some complications that may occur during and after pregnancy if the condition is left undiagnosed or untreated. In this section, we are going to make you aware of the complications with gestational diabetes, so if you do have to face a situation like this, you can deal with the condition with a positive and relaxed mindset.
What are the possible complications of gestational diabetes?
Early birth – One of the biggest complications of Gestational diabetes is the risk of the child being born prematurely. When the mother’s blood sugar levels are not controlled, the unborn child tends to receive too much glucose through the placenta and can grow too big for the mother to carry throughout the 9-month term. This is why it is extremely important to keep your blood sugars under control.
Breathing difficulties – When babies are born early or before their due date, they are likely to experience breathing issues that are caused by an insufficiency of a certain substance produced in the baby’s lungs during gestation that plays an important role in helping the child inhale and exhale.
Getting Type 2 diabetes later in life – Mothers and children born with gestational diabetes are at a higher risk of developing Type 2 diabetes in their later stages of life. It is crucial to set and maintain a healthy diet after pregnancy for the mother and right from the start for the children.
Stillbirth – Women with gestational diabetes mellitus are 5 times more likely to give birth to stillborns and 3 times more likely to give birth to babies who might not survive after the first few months.
Low levels of Calcium in the Blood – This is a complication that occurs in infants and is mainly caused due to low levels of magnesium in the blood of the diabetic mother. Gestational Diabetes causes frequent urination which may result in excessive magnesium loss during pregnancy.
New Born Babies That are Larger than Usual – As mentioned above, women with gestational diabetes have high levels of glucose that are passed down to the baby through the placenta. This results in newborn babies being larger in size and heavier in weight than usual. Gestational diabetes affects 15% – 45% of newborns and these babies are at a higher risk of developing several health concerns in their adult life.
Obesity in Children – Children born to women with gestational diabetes are more likely to be overweight and obese as they grow up. This is caused due to high levels of blood glucose being converted and stored as fat during the gestation period.
It is important to note that there is no hard and fast rule that all the above complications of Gestational Diabetes Mellitus will develop in you or your child. If the condition is left undiagnosed or untreated, these complications are generally bound to arise. However, diabetes can be controlled and maintained, so rest assured, you and your child can live healthy, happy lives with a little extra determination and care.
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While gestational diabetes cannot always be prevented, here are some ways you can help lower your risk of developing the condition:
Monitoring your weight is most important
One of the simplest, yet more effective ways to keep your blood sugars under control is by monitoring it along with your weight. Make sure both metrics are within the normal range and pay extra care if you have diabetes in your immediate family history. While every woman’s body is different and may react differently to foods, it is advised to consult a good gynaecologist and a nutritionist for advice on meal plans and diabetes exercise that is suited specifically to your diagnosis. It is absolutely vital to eat healthy during pregnancy but the occasional sweet treat will not cause any harm especially if there is no threat of gestational diabetes.
Good meal planning and a healthy lifestyle
Include a lot of greens in your diet with a good amount of fruits and vegetables. It is said to include one portion of vegetables, one portion of carbohydrates and one portion of proteins and iron to have a full balanced meal. Refrain from alcohol, smoking and other substances to have a safe and happy pregnancy for both you and your baby.
Exercise and physical activity
If your doctor gives you the green signal, include exercise and physical activity with moderate intensity in your everyday routine. Walking, dancing, swimming and exercises with the giant exercise ball are great exercises that can be carried out after consulting your doctor.
Gestational Diabetes is fairly common and there is no need to lose sleep over it. Thanks to recent medical advances and medications, many women with Gestational Diabetes have delivered healthy babies and maintained their good health through proper meal plans and determination. It is very important to consult your doctor to ensure that you and your baby are not at risk during pregnancy.
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Should I be concerned about type 2 diabetes as well?
If you have been diagnosed with gestational diabetes, it is important that you keep an eye on your blood sugar levels, maintain an active lifestyle and eat healthily. There may be a chance of developing type 2 diabetes later in life especially if you have other risk factors like a family history of PCOS, diabetes and obesity.
Can you have a healthy pregnancy with gestational diabetes?
If you maintain your blood sugars, eat healthily and exercise in moderation, you can most definitely have a healthy pregnancy with Gestational diabetes and also have a perfectly healthy baby. It is important to consult a doctor throughout your pregnancy and follow the treatment as advised.
What are the warning signs of gestational diabetes?
Many symptoms of gestational diabetes are very similar to the symptoms of pregnancy. However, one of the most important gestational diabetes signs that stand out is blurred vision. Although it is possible to have no noticeable symptoms at all. Other warning signs of gestational diabetes can also be recurrent vaginal, bladder or skin infections.
Can eating too much sugar cause gestational diabetes?
Simply eating too much sugar does not cause Gestational Diabetes. It merely increases the risk of developing it. The risk is higher if you have diabetes in your family history or if you are obese/overweight and have other health complications like PCOS.
Do mothers with gestational diabetes deliver early?
Mothers with gestational diabetes are at risk of delivering babies before their due date because of the increased levels of glucose in their bloodstream. This is passed to the baby through the placenta and the baby grows too big which becomes difficult and dangerous for the mother to carry to full term. However, with timely diagnosis and management of gestational diabetes, you can avoid the risks of such complications.
How common is stillbirth with gestational diabetes?
Diabetes affects 1% – 2% of pregnant women and increases the chances of stillbirth to up to five times. Children born to mothers with gestational diabetes are also 3 times more likely to not survive after the first few months. However, with timely diagnosis and management of gestational diabetes, you can avoid the risks of such complications.
Can gestational diabetes cause autism?
Recent studies are trying to find if diabetes and high blood pressure in pregnant women can be a risk factor for autism in some babies. However, it has not been proven and the chances of this happening are also relatively slim.
Will taking Insulin affect my baby?
Taking insulin will not affect your baby. In some scenarios, taking insulin is vital to keep both you and your baby safe during pregnancy with gestational diabetes. Insulin does not cross the placenta and is safe during pregnancy.
GDM is more likely to affect you if you have an immediate family member with diabetes. You are also more likely to get gestational diabetes if you have other medical conditions like PCOS or prediabetes prior to pregnancy. Genetics play a significant role in your GDM diagnosis but eating unhealthy and high sugary food is also considered unsafe during pregnancy.
Can I replace normal sugars with sugar-free?
Most doctors advise against any nutritive sugars that include both normal sugar and artificial sweeteners aka sugar-free substitutes. These include substitutes such as sorbitol, xylitol, isomalt and mannitol. Try to limit any artificial sugars during pregnancy.
Why am I asked to check my sugars frequently in a day, I don’t like to prick myself?
If you don’t like to prick your finger for the glucometer, there are a couple of alternatives. You can try to use a Continuous Glucose Monitor (CGM) or a Freestyle Libre. However, in both these alternatives, you will still have to insert a small sensor underneath your skin. For CGM, while there will be a sensor underneath your skin, you will still need to prick your finger at least once a day, to regulate the monitor.
Ultimately, a finger prick is the most convenient method of testing for diabetes, even though it may be challenging for some women. Try to rely on family members for support and care and remember to have a positive approach to overcome this condition.
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