Gestational Diabetes – Symptoms, Causes, Treatments and Prevention

What is gestational diabetes?

Gestational diabetes or gestational diabetes mellitus (GDM) is the first time occurrence of diabetes during the pregnancy period. It is the onset or first recognition of elevated glucose levels during pregnancy.

Gestational diabetes can be controlled with two methods. It can be managed with diet control and nutrition therapy called diet-controlled gestational diabetes or A1GDM.

Gestational diabetes controlled with medication to attain adequate glycemic control is A2GDM.

In earlier days, only families with type 2 diabetes history and medical obstetric outcomes were assessed. It was useful but still not appropriate.  

The hormone related to gestational diabetes is human placental lactogen. Other hormones related to the increase in insulin resistance during the gestation period are growth hormone, prolactin, corticotropin-releasing hormone and progesterone. These are the hormones that cause hyperglycemia during the pregnancy period.

Gestational diabetes can affect your health and your baby. If gestational diabetes is not treated it can cause your baby to have problems during the birth.

The baby can be overweight or under-weight. Your baby can have jaundice or low blood glucose levels.

Gestational diabetes was uncertain and it can affect any woman during their pregnancy. So, in 2014 the U.S preventive service task force recommended screening every pregnant woman for diabetes mellitus.

Symptoms of gestational diabetes

Frequent urination

Gestational diabetes can cause fluid imbalance. The kidney lets out an excessive amount of liquid passed as urine. As a result, you get the urge to urinate frequently.

These frequent urination may make you dehydrate faster than usual. Always be watchful, about your hydration.

Nausea

During the pregnancy period, you go through a roller-coaster of physical and emotional changes. Nausea is common during the pregnancy period.

For some women, nausea and vomiting sensation stops during the first trimester. But for some, it persists during the pregnancy period.

Gestational diabetes may aggravate nausea and sometimes, you might have the urge to vomit.

Thirst

During pregnancy, the water intake may change, and women drink water a little extra than usual. Nevertheless, pregnant women with diabetes have a feeling of thirst very often.

Thirst is one of the prominent symptoms when you have gestational diabetes. You feel very thirsty even if you have not done any intense work or exercise.

Apart from the thirst sensation, your mouth becomes dry often. This also increases the urge to drink water frequently.

These are some of the symptoms of gestational diabetes. Consider discussing with your doctor.

Tiredness

You feel tired most of the day. Yet, some of the symptoms may be common during the pregnancy period. These may also indicate that you might be affected by gestational diabetes.

The weariness may continue even after your meal. You might have the feeling of drowsiness most often and always want to sleep.

Types of gestational diabetes test

When you experience the above-mentioned symptoms, your doctor will suggest a diabetes test. Diagnosis is done by two methods.

The glucose challenge test, oral glucose tolerance test or sometimes both.

Glucose challenge test

A glucose screening test or glucose challenge test will be the first test recommended by your doctor. The test is done by providing you with a sweet liquid that contains glucose. Fasting is not required during this test.

The blood is drawn after one hour you have taken the glucose liquid. If the blood glucose is more than 140 then you will have to test for an oral glucose tolerance test.

Glucose tolerance test

The oral glucose tolerance test or glucose tolerance test is done after the glucose challenge test. The glucose tolerance is done after your fast for 8 hours.

The blood is drawn after your fasting period. Then you will have to drink the liquid that contains glucose.

Again, the blood is drawn every 2-3 hours. The blood glucose level is calculated for the fasting period, 1 hour after fasting, 2 hours and then 3 hours.

High blood glucose levels during any of the tests indicate you have gestational diabetes. The mean is calculated and the doctor will explain to you the results.

According to the American College of Obstetricians and Gynecologists (ACOG), the recommended levels of blood glucose level during the fasting period should be below 95  mg/dL, for 1 hour it should be below 130-140  mg/dL and for 2 hours it should be below 120  mg/dL.

Causes of gestational diabetes

The cause of gestational diabetes is still unknown. The uncertainty of some women getting affected and others not is unknown to researchers.

Weight gain during the pregnancy period may be a reason. Hormonal changes can also trigger gestational diabetes.

The marked insulin resistance secondary to placental hormonal release can be another reason for gestational diabetes.

The other reasons as listed by PMID 31424780 are

• increase in body weight
• inadequate physical activity
• first degree relative with diabetes mellitus
• history of gestational diabetes
• triglyceride level above 250
• polycystic ovarian syndrome
• significant marker of insulin resistance.

Treatment of gestational diabetes

The treatment for gestational diabetes starts with diet modification, simple exercise and glucose monitoring more than medications.

Check your blood sugar levels four or more times a day

When you are diagnosed with gestational diabetes, it is important to test your blood sugar levels often.

Your doctor will advise you to get tested four times a day. First thing in the morning and then after meals.This is done to make sure the blood glucose level is within the healthy range.

Check your urine for ketones

• A ketone test is important as excess ketone may affect your baby. Research has revealed that pregnant women with excess ketone may affect the developing brain cells of the baby and may result in low IQ. There may be unforeseen disabilities too.
• The recommended time to test the ketone level is in the morning to see if the baby is receiving enough nutrition.
• The ketone test is simple. The ketone strip is available in the pharmacy. The strip is dipped in the urine sample, and if the colour changes, ketone presence is indicated.

Eat a healthy diet

During your pregnancy period, it is important to take foods that nourish your baby. And when you are tested with gestational diabetes always be watchful about the food you eat.

According to the National Library of Medicine, women with gestational diabetes are recommended to take a healthy balanced diet.

Consume whole fruits instead of fruit juices. Whole fruits have more fibre than fruit juices and fruit juices tend to spike your blood sugar level.

Consume lean protein and healthy fats in moderate quantities. Whole grains like cereals, rice and starchy vegetables like corn and peas can also be taken in moderate quantity.

It is better to choose high-fibre and whole-grain carbohydrates, they are healthier and do not spike your blood glucose level. These carbohydrates keep you full for a long time.

Low-fat dairy food or no-fat milk is a better choice. You can also consume yoghurt without added sugar and artificial sweeteners. Do not fully avoid dairy as they are a rich source of phosphorous, calcium and protein.

Healthy protein choices like fish and chicken can be included in your diet. Try to cut out all visible fat before consuming and choose the boiled ones over grilled and fried meat.

Sweets can be limited and always have a portion size. Sugar-free sweets are a better choice. A trick to reduce your dessert and sweets intake. Split your sweets with others so you don’t add extra sugars.

This diet plan is recommended for women who do not take insulin.

Make exercise a habit

Make exercise your daily routine. Move around to drink water or do your chores. Walking is one of the safest and simplest exercises.

You can also try other low-impact exercises like swimming. Before starting any exercise always consult your doctor. They might guide you better.

According to an article published in the National Library of Medicine (PMC4515443), it is recommended that pregnant women with gestational diabetes can do aerobic and resistance exercise three times a day at moderate intensity.

Risk factors of gestational diabetes

An epidemiological study (n = 11205) in London revealed that women of ethnic minority groups had a higher prevalence of gestational diabetes.

For South Asian women the risk factor was 7.6 and 11.3 for Indian women. This data was published in the National Library of Medicine (PMC4515443).

It also revealed that Indian women living in urban areas have a greater risk factor than those living in rural areas of India.

These risk factors also depend on age.

Heart disease

A study with 1000 women revealed that gestational diabetes doubled the risk of cardiovascular disease.

Another series study conducted revealed that gestational diabetes increased the incidence of cardiovascular diseases.

A pooled analysis of nine studies with 5,390,591  reported in the National Library of Medicine (PMID 30843102) revealed that women who were affected with gestational diabetes a had two-fold higher risk of cardiovascular diseases.

High blood pressure

Women with gestational diabetes have increased risk factors than women who were not affected by gestational diabetes.

Gestational diabetes and high blood pressure can affect women and their babies. According to the data published in PMC2584196, women with hypertension had an increased risk of gestational diabetes.

Gestational diabetes and hypertension can lead to metabolic syndrome, and they commonly appear together in an individual.

Inactivity

Being inactive is one of the common reasons that cause gestational diabetes. According to Frontiers in Pediatrics journal titled, “Gestational Diabetes: Physical Activity Before Pregnancy and Its Influence on the Cardiovascular System” a study was conducted to find the link between physical activity in the year before pregnancy and the onset of gestational diabetes.

Women who were physically inactive before pregnancy had a 3-times higher risk of developing gestational diabetes compared to active women.  

Almost half of the women were diagnosed with gestational diabetes in an earlier pregnancy. These negative influences of gestational diabetes could indicate impaired vascular health.

Obesity

Obesity during the maternity period is common. According to PMC4392761, one in five women is obese entering their pregnancy period.

Obesity during the pregnancy period is one of the prominent risk factors for gestational diabetes. Women who are obese and before pregnancy are four to eight times more likely to have gestational diabetes when compared to women with normal weight.

Family history of gestational diabetes

Pregnant women with a family history of diabetes are prone to gestational diabetes. Gestational diabetes is a potential risk factor that can pose complications for mothers and their babies.

A cross-sectional study was conducted with 1300 pregnant women. Among them, women who had a family history of diabetes had more chances of getting gestational diabetes, according to data published in BMC Pregnancy and Childbirth “Prevalence and risk factors of gestational diabetes mellitus: findings from a universal screening feasibility program in Lima, Peru”

Polycystic ovary syndrome

PCOS or polycystic ovary syndrome is common among women. It is also a common cause of infertility in women. They can also make your pregnancy period painful since they are commonly insulin resistant.

For women with PCOS, their bodies can make insulin but they cannot use it efficiently. This increases the risk of type 2 diabetes and gestational diabetes.

PCOS can cause gestational diabetes that puts the mother and baby at risk of type 2 diabetes after the pregnancy period.

Previous birth of a baby weighing nine pounds

• Macrosomia is a medical condition where the baby weighs considerably larger than the average weight. The nutrients from the mother’s blood are directly absorbed by the fetus.
• If the mother’s blood contains too much glucose, the pancreas of the fetus senses a high glucose level and, in turn, produces more insulin to use this glucose. As a result, the excess glucose is converted to fat.
• When a woman is a gestational diabetic, the fetus can produce a high glucose level which results in fat deposition, and the baby is overweight.

Risk factors of mother & baby gestational diabetes

Breathing problems

Premature babies may have breathing problems. They may experience respiratory distress syndrome.

Hypoglycemia

Babies may have a drop in blood glucose levels shortly after birth. There may be many occurrences of hypoglycemia.

These can also cause seizures in the baby and sometimes may cause jaundice. Intravenous glucose can help with the situation. These conditions can be avoided with prompt feeding.

Obesity

The risk of obesity increases for babies of the mothers who had gestational diabetes. They also have the risk of developing type 2 diabetes later in life.

Premature birth

High blood glucose levels may increase the risk of premature birth. The other reason for premature birth is the baby may be overweight.

Type 2 diabetes

Women who had gestational diabetes have an increased risk of type 2 diabetes. However, it can be uncertain.

Keep your weight in check and follow a healthy balanced diet. Avoid sugary foods and consume whole grains, fruits and vegetables.

Make exercise a habit for you and your child.

Diet and exercise for gestational diabetes

Physical activity is important during any phase of work. Women during their pregnancy period can experience hormonal changes.

These changes are inevitable. A healthy balanced diet and exercise can keep pregnant women and their babies healthy during and after the gestation period.

Eat healthy

Cravings are common but during pregnancy, they might hit a different level. You need not follow a strict diet. Instead, eat healthy food in large portions and limit the intake of junk foods.

This technique may help to bring a balance to your diet and you eventually eat healthy food. They will also make your baby healthy and happy.

Low sugar Diet

Some drinks may not be an evident source of sugar. However, they may contain artificial sweeteners and other added ingredients.

There is no safe amount of alcohol for pregnant women and they should strictly avoid alcohol.

The best source of hydration is water. They do not contain any artificial flavour or sugar. If you want something to relish your cravings you can go for some fruit and vegetable juices.

Prefer vegetables that give you various types of nutrients like broccoli, mushrooms, salad greens, fish, beans and eggs.

Brown rice, quinoa, oats, corn and eggs are rich in good fats and carbohydrates. These foods are low in calories and sugar content.

Pregnant women and women with gestational diabetes can consume these foods.

Exercise throughout your pregnancy

You can go for some leisure walk after your meals. Walking helps to relax your mind and body. Consult your doctor before taking up any exercise program.

If you have morning sickness, eat small snacks

Morning sickness is common during the pregnancy period. Try to have some fluids like water and lemonade (without sugar). These fluids should be kept in place for you to grab easily.

Try to eat small meals or some healthy snacks like fruits and vegetable salads. Avoid foods that have a strong flavour.

Ginger tea can be useful for morning sickness. They work better with nausea and vomiting.

Low Blood sugar

Women with gestational diabetes will not have problem with low sugar levels. However, always check your blood sugar level.

Women who take insulin may experience a drop in blood glucose levels. This may be due to not consuming enough food, too much exercise and an overdose of insulin.

Check your blood glucose level often, so that you need not keep guessing about your glucose levels.

Try to have some knowledge on low blood sugar level symptoms like sweating, hunger, shakiness, dizziness and blurred vision.

Always have some candy, raisins and some sugary foods. These handy foods can help you during a drop in blood glucose level.

Prevention of gestational diabetes

Maintaining a healthy weight before and after conception

Always maintain a healthy weight before and after pregnancy. Eat healthy food and avoid sugary foods.

Make physical activity a routine. These precautionary steps may help to prevent diabetes.

Eating well

Eat right and eat well. Do not skip your meals. Late-night cravings are common when you are awake for long. So always have an early bedtime and stick to it.

Exercise regularly during pregnancy

Exercise is important for a healthy baby to develop. It also keeps the mother healthy. You can consult your doctor if you have any complications.

Conclusion

Motherhood is an important phase for women. Enjoy your motherhood safely and always be thoughtful about the foods you take.

The foods you consume can make you healthy or only add empty calories. Cravings and mood swings are common during the pregnancy period.

Always try to share your sugary foods. In that case, you will not add any extra calories at the same time you can cut down your sugar intake.

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