What is Gestational Diabetes?
Gestational diabetes mellitus (GDM) is a condition that only affects pregnant women and is caused by high blood sugar. It’s not caused by low insulin. Instead, a hormone produced by the placenta makes your body more resistant to insulin so your body can’t use insulin properly. So glucose doesn’t get into your cells and instead accumulates in your blood. Knowing the impact of this is key to managing the risks and complications.
What causes Gestational Diabetes?
The exact cause of gestational diabetes is not known to medical professionals. But they do know what happens. For the developing baby, the placenta is a storage house of nutrients and water. It produces several hormones that support a healthy pregnancy.
Among these hormones are:
- Estrogen
- Progesterone
- Cortisol
- Human placenta lactogen
These hormones can cause the contra-insulin effect.
What is the Contra-Insulin Effect?
The placenta produces more hormones as it grows. Usually this starts around weeks 20-24 of your pregnancy. At this stage insulin resistance becomes a bigger risk. And the higher calorie intake and less activity during pregnancy can cause higher than normal blood sugar (glucose) levels.
A common way to check how the body is managing blood sugar is the oral glucose tolerance test, especially for high risk pregnant patients or blood tests.
Diets for Blood Sugar Management
Foods to avoid or substitute
Eat healthy foods to manage your blood sugar:
- Choose multigrain, wholegrain, wholemeal, rye, linseed or pumpernickel bread over white bread.
- Make chapati and roti with wholemeal flour.
- Choose wholemeal pittas over white pittas.
- Choose wholemeal pasta, baked plantain or sweet potato over regular chips or mash.
- If you like rice, stick to brown.
- Stop eating cereals like Cornflakes and Rice Krispies. Instead eat porridge with jumbo oats made with single cream and water.
- Have plenty of vegetables with pulses like chickpeas, beans and lentils.
- Eat unsweetened yoghurt and milk. If you use non-dairy milk, opt for the unsweetened version fortified with vitamins and minerals.
- Eat fruits between meals but avoid smoothies and fruit juices.
- Avoid sugary drinks. Opt for water or decaf tea and coffee instead.
- Use artificial sweeteners instead of sugar.
- Avoid all kinds of sugar like sucrose, glucose, dextrose, fructose, lactose, maltose, honey, inverted sugar, syrup, corn sweetener and molasses.
Remember to watch your portion sizes and your weight. Monitoring blood sugar levels closely during labor is important to prevent complications to the baby like hypoglycemia and to keep the mother’s blood sugar in normal range.
Blood Sugar Levels
Normal fasting blood sugar is 70-100 mg/dL (3.9-5.6 mmol/L). For 100-125 mg/dL (5.6-6.9 mmol/L) specific lifestyle changes are needed. Diabetes is diagnosed when fasting blood sugar is 126 mg/dL (7 mmol/L) or above on two separate occasions. Also keep an eye on the baby’s blood sugar during labor to prevent low blood sugar.
What is Hypoglycemia?
Low blood sugar or hypoglycemia is when your blood sugar level is below 70 mg/dL or 3.9 mmol/L. It causes dizziness and blurred vision. High blood sugar increases the risk of diabetes. Average fasting blood sugar is a key to healthy habits and diabetes management.
Gestational Diabetes Symptoms
- Excessive thirst and urination.
- Fatigue and weakness.
- Blurred vision.
- Nausea and vomiting.
- Frequent infections.
Some less common gestational diabetes symptoms are slow healing of wounds or sores, frequent yeast infections especially vaginal infections, tingling or numbness in hands and feet due to nerve damage over time (usually over the longer term) and weight loss despite increased appetite. See a doctor for proper evaluation of these symptoms, don’t ignore them.
Gestational Diabetes Effects
Pregnant women with gestational diabetes may face severe consequences for themselves and their baby. Preeclampsia and other high blood pressure conditions are among the risks the mother may encounter during pregnancy due to this condition. Also, the chance of cesarean delivery is higher. Uncontrolled gestational diabetes increases the risk of type 2 diabetes in the future.
For the baby, gestational diabetes can cause complications like macrosomia where the baby is larger than average at birth. This can cause delivery difficulties and birth injuries. After birth the baby may have low blood sugar and has higher risk of developing obesity and type 2 diabetes in the future.
Screening and management is key to minimizing these effects and having a healthy pregnancy for mother and baby. It’s especially important to check the newborn’s blood sugar level immediately after delivery to prevent and manage hypoglycemia.
Gestational Diabetes Treated
Treatment for gestational diabetes is usually lifestyle modifications, close monitoring and sometimes medication. Having a healthy diet with balanced meals that can control blood sugar is one of the most important. Frequent exercise is also important since it can improve insulin sensitivity.
Women who monitor their blood sugar levels can track their progress and make adjustments. Medication may be prescribed in some cases to help regulate blood sugar. This may be insulin therapy or oral medications.
Close coordination with medical professionals like endocrinologists and obstetricians ensures complete care during pregnancy. With proper management many women with gestational diabetes can have stable blood sugar and have a healthy pregnancy outcome.
Future Pregnancies and Gestational Diabetes
Gestational diabetes can affect the health and wellbeing of the expectant mother and her baby. Women who had gestational diabetes in a previous pregnancy may be at risk for recurrence in future pregnancies. That’s why screening and care is crucial since early detection and treatment can minimize the risks of the disease.
Birth defects
Birth defects in the unborn child is one of the biggest problem with gestational diabetes. High blood sugar during pregnancy has been linked to fetal development and can cause structural defects or congenital anomalies according to studies[1]. That’s why it’s important to keep your blood sugar under control throughout pregnancy to minimize these risks.
Premature birth
Hyperglycemia can cause premature labor or require medical interventions like induction of labor or cesarean delivery. After an early birth the baby may experience severe problems like respiratory distress and developmental delays.
Increased risk of diabetes
Gestational diabetes affects the baby’s body cells especially those that regulate blood sugar. In response to the mother’s high blood sugar the baby’s pancreas may produce excess insulin and cause fetal hyperinsulinemia. This can lead to macrosomia and other complications at birth and long term health problems for the child like obesity and type 2 diabetes later in life.
Prevention
Before and during pregnancy a healthy lifestyle is the key to preventing gestational diabetes. This means regular physical activity and a balanced diet with fruits, vegetables, whole grains and lean proteins. But for some women these steps may not be enough to prevent gestational diabetes.
In these cases medical interventions may be needed to control blood sugar and lower the mother and child’s risk of complications. To control blood sugar this may mean regular blood sugar monitoring, dietary changes and in some cases insulin therapy or other medications.
Sarah’s Story
Background
I recently saw a patient, Sarah, a 28-year-old woman who was experiencing her first pregnancy. She had started to notice some persistent symptoms: fatigue, weakness, nausea and thirst. She assumed these were normal pregnancy symptoms and carried on with her daily routine, trying to manage as best she can.
Presentation
At 24 weeks Sarah came to me for a routine check up. She mentioned her symptoms and I was a bit concerned by the severity and persistence of them so I decided to run a glucose tolerance test to check for gestational diabetes.
Diagnosis
The test results confirmed my suspicions: Sarah had gestational diabetes. Sarah was overwhelmed. She worried that her condition will mean a difficult pregnancy, complicated delivery or long term health issues for her child.
Management and Treatment Plan
I assured Sarah that gestational diabetes can be managed well with proper care. I gave her a comprehensive treatment plan which includes:
- Dietary Changes: I referred Sarah to a nutritionist who would help her create a balanced meal plan that controls her blood sugar levels.
- Monitoring: I taught Sarah how to monitor her blood sugar at home and scheduled more frequent check ups to keep an eye on her condition.
- Exercise: I advised Sarah to do moderate exercise daily, like walking or prenatal yoga to help control her blood sugar levels.
- Medication: I mentioned that, if necessary, doctors may recommend insulin therapy or prescribe other medications to control her blood sugar levels.
Follow Up
With the support of myself and the healthcare team, Sarah followed her treatment plan. She made big changes to her lifestyle, eating healthier and exercising regularly. Sarah’s hard work paid off, her blood sugar levels stabilized and she began to feel more energetic and less nauseous. Our regular check ups showed that her baby was growing well and that there were no complications from the gestational diabetes.
Outcome
Sarah had a healthy full term baby boy. She mentioned to me how thankful she was for the education she received. Sarah’s story shows the importance of regular prenatal care and open communication with your healthcare provider. Gestational diabetes may seem scary but it can be managed and result in a healthy outcome for both mom and baby.
Key Points
Gestational diabetes can have far reaching effects on fetal development, pregnancy and long term health for both mum and baby. As an expectant mum you can increase your chances of a safe pregnancy and birth and preserve the health of your unborn baby by being aware of the risks of gestational diabetes and taking action to manage it. To get the best outcomes for mum and baby effective management requires early detection, close monitoring and multi disciplinary care.
Blood sugar levels need to be kept in range, especially for expectant mums. Eat healthy foods like a balanced diet with fruits, vegetables and whole grains to manage gestational diabetes and a healthy baby.
Monitoring the baby’s blood sugar and understanding the risk factors are part of prenatal care. By eating a balanced diet and managing gestational diabetes expectant mums can have a healthy pregnancy and a healthy baby.
Summary
Remember gestational diabetes can be a serious illness. Taking care of your pregnancy is important. To ensure long term health for mum and baby routine post natal care is important. Insulin injections may be needed in some cases to manage gestational diabetes if diet and exercise alone can’t control blood sugar levels.
Watch my video on gestational diabetes below or here:
Disclaimer: The Blog/Video Content on this channel is for educational purposes and not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always get advice from your doctor if you are worried or have symptoms.
References
- MMHJ van Gelder, et al. (2014). Maternal hypertensive disorders, antihypertensive medication use, and the risk of birth defects: a case–control study.
- Gestational Diabetes. National Health Service (NHS). Available at: https://www.nhs.uk/conditions/gestational-diabetes/
- Diabetes in pregnancy (gestational diabetes). Guy’s and St Thomas’ NHS Foundation Trust. Available at: https://www.guysandstthomas.nhs.uk/health-information/diabetes-in-pregnancy-gestational-diabetes
