GESTATIONAL DIABETES                                                                                                                          

                                                                                                                                                                                      

 What is gestational diabetes?

 Gestational diabetes is a type of diabetes that occurs during 24^th to 28^th week of pregnancy. In most of the cases, it is temporary (that is, it resolves after delivery), but these women are at high risk of developing type 2 diabetes mellitus later in life.

Good news is that you can work with your endocrinologist, dietician and obstetrician and manage your diabetes to have a healthy pregnancy and give a healthy start to your baby.

What is the cause of gestational diabetes?

When we eat food, it gets converted into a sugar called glucose. Glucose enters the blood stream and is taken up by various cells to produce energy. Insulin is a hormone produced from pancreas ( a gland located in your abdomen). It helps in the transport of glucose from bloodstream to the cells, thus helps in utilizing glucose for energy.

During pregnancy, some hormones are produced from the placenta (part which connects your baby to you) like estrogen, human placental lactogen etc. These hormones impair the action of insulin and increase blood sugar levels in your blood. Normally, pancreas can make enough insulin to compensate for this rise in blood sugar. But in some cases it may fail to do so and diabetes develops.

Who is at risk of developing gestational diabetes? 

Risk factors for development of gestational diabetes are mentioned below. You have high chances of developing gestational diabetes if you have one of the following-

1. You are overweight or obese before starting your pregnancy.
2. You are a pre-diabetic.
3. You have previous history of gestational diabetes/ large birth weight baby ( >4kg) or unexplained stillbirth.
4. You have a family history of diabetes.
5. You are >30 years of age
6. You have sedentary lifestyle
7. Asians/ black people are more prone to develop gestational diabetes ( reason not known).

What are the symptoms of gestational diabetes? 

Generally, gestational diabetes does not produce any noticeable symptoms. Some women may complain of excessive urination, thirst, fatiguability, blurring of vision or frequent bladder, vaginal or skin infections.

Complications due to gestational diabetes-

Most cases of gestational diabetes have healthy babies. However, untreated or uncontrolled blood sugar can cause some problems for your you and your baby.

Complications in baby-

 Following complications can occur if gestational diabetes remains untreated or inadequately treated-

1. Overgrowth– Normally, glucose can cross across placenta freely, but insulin does not cross. So, excess glucose from mother passes to the baby and stimulates baby’s pancreas to make more insulin. Insulin is responsible for growth of the baby. Excess insulin can cause overgrowth, so that there is a increased risk of cesarean section delivery. If you go for normal vaginal delivery, there are increased chances of injury to mother as well as baby.

2. Hypoglycemia (low blood sugar)– Due to high insulin levels, immediately after birth ( when glucose transport from mother stops), baby can develop hypoglycemia that is very low blood sugar level. They require immediate feeding or intravenous dextrose.

3. Early birth (preterm)– You have a risk of preterm labour pain and delivery if your bood sugar levels are not controlled.

4. Breathing problem– Some babies may have breathing problem immediately after birth known as respiratory distress syndrome. This happens particularly in preterm babies because their lungs are not mature enough.

5. Obesity and type 2 diabetes –These babies are at higher risk of developing obesity and type 2 diabetes ater in their lives.

6. Death– Sometimes, even death can occur before or immediately after delivery.

 

Complications in the mother-

1. Cesarean section/ injuries– You have a higher chance of having a cesarean section or sustaining injuries during normal vaginal delivery because uncontrolled diabetes can produce fat baby.
2. Pre-eclampsia– This means high blood pressure developing during pregnancy. This can cause problems like swelling in the legs and feet and can even be life-threatening for both mother and the baby.
3. Diabetes– If you had gestational diabetes, you are at risk of developing gestational diabetes in subsequent pregnancy or type 2 diabetes later in life.

 

When should you see a doctor?

If you have any of the above mentioned risk factors, then ideally you should visit a doctor before you get pregnant. Your doctor will evaluate you for the presence of prediabetes/ diabetes.

If you are already pregnant and you have above mentioned risk factors, then you should be evaluated for diabetes during first clinic visit that is first trimester.

If you don’t have any of the above mentioned risk factors, then your doctor will evaluate you sometime between 24^th to 28^th week of pregnancy.

 

Diagnosis of gestational diabetes-

American diabetes association recommends doing a oral glucose tolerance test to diagnose gestational diabetes. It is done after an overnight fasting (at least 8 hours, but not more than 14 hours).

1. A sample is withdrawn in the fasting state.
2. You will be given glucose water (75 gram glucose) to drink. You can add a lemon if you have nausea/ vomiting.
3. Repeat blood samples will be drawn at 1 and 2 hours.
4. You should be sitting at one place and not moving about these 2 hours.

Gestational diabetes is diagnosed if any of the following is true-

1. Fasting sugar level is ≥ 92mg/dl
2. 1 hour post glucose , sugar level is ≥ 180mg/dl
3. 2 hour post glucose, sugar level is ≥ 153mg/dl

 

Treatment of gestational diabetes

 To avoid untoward effects on your baby, you should start treatment immediately if gestational diabetes is diagnosed.

Treatment includes-

1. Diabetic meal plan 
   Ideally you should consult a dietician for an individualized meal plan. Calorie restriction depends on your weight. If you are overweight/ obese your doctor or dietician may restrict calories also. But remember, we donot want you to lose weight during pregnancy. Depending upon your current weight and body mass index, your doctor can set a target weight gain for your pregnancy and suggest a diet accordingly. Some recommendations for diet-
   1. You need to avoid direct sugars and fried food.
   2. Take small and frequent meals
   3. Add fruits, vegetables and whole grain foods to your diet.
   4. Limit the intake of refined carbohydrates, sweets etc.
2. Physical activity/ exercise Physical activity is a tool to prevent both gestational diabetes (if you have risk factors and do prepregnancy physical activity) and type 2 diabetes mellitus (if you had gestational diabetes earlier). Exercise has many benefits, most important is improved insulin sensitivity,If you don’t have any medical or obstetrical complication (consult your doctor to know about this), then it is recommended to get moderate physical activity (walking, cycling, swimming) for 30 minutes during most days of the week (150minutes a week). If you were not exercising before pregnancy, then start slowly and build up gradually.
3. Regular blood glucose monitoringYou need to get a glucometer ( a device that measures and displays your blood sugar) and check your blood sugar frequently (usually 4-6 times a day). This seems difficult and inconvenient, but it is necessary for a healthy pregnancy outcome. Remember to keep a record of your sugar level. Following targets are suggested by American Diabetes Association-
   1. Before meal (premeal)- ≤95mg/dl
   2. 1 hour after meal (postprandial)- ≤140mg/dl
   3. 2 hour after meal (postprandial)- ≤120mg/dl

    

4. InsulinIf your blood sugar level is not controlled with above measures, then your doctor may start you on insulin. Insulin is the safest treatment for treating diabetes during pregnancy.
5. Monitoring babyYour doctor will monitor your baby’s growth regularly. You may need repeated ultrasounds or other tests.FUTURE…
   1. Gestational diabetes resolves completely in most of the cases. Some women may remain diabetic even after delivery.
   2. Even if your sugar levels have come down to normal, you have a higher risk of developing gestational diabetes during your next pregnancy or type 2 diabetes during subsequent years.
   3. You can lower your risk of developing diabetes in future by following these steps-
      1. Continue following a healthy and balanced diet.
      2. Include at least 30 minute moderate intensity exercise in your daily schedule.
      3. Lose weight- Even if you lose 5-7% of your excess weight, your risk of developing diabetes in future will reduce substantially.
      4. Keep a check on your sugar levels.
         1. Get a repeat OGTT test after 6 weeks of delivery
         2. Continue getting OGTT and glycosylated haemoglobin (HbA1c) tests at regular intervals (once a year or as specified by your doctor).

ALL THE BEST!!