Diabetes In Pregnancy: What Is Gestational Diabetes?

Gestational diabetes is a kind of diabetes that develops exclusively during pregnancy, and typically spontaneously resolves after labor and delivery.

Generally, gestational diabetes presents when the pregnant woman is in her third trimester, between 24 and 28 weeks. Although gestational diabetes fortunately doesn't mean that the patient will be diabetic after her pregnancy too, expectant mothers who suffer from gestational diabetes, are indeed more likely to develop type 2 diabetes later on in life. Gestational diabetes is fairly common, as it affects three to five percent of all pregnancies.

Although gestational diabetes usually has no symptoms — and when they're there, they tend to be mild, like feeling slightly more thirsty — pregnant women are routinely tested for diabetes during pregnancy, and attending all your prenatal appointments will help your OBGYN catch this kind of diabetes should you develop it. 

What causes gestational diabetes?

The reason why some pregnant women develop gestational diabetes is because the placenta can create hormonal changes that cause the body to resist the effects of insulin. Insulin is the hormone that helps metabolize glucose, and when the body cannot process insulin well, blood glucose levels rise — in this case, resulting in gestational diabetes.

Along with the development of insulin resistance, the growth of the fetus in the second and third trimester of pregnancy significantly increases your body's need for insulin. This is because your cells need more energy to sustain the growth of the fetus. Some levelof insulin resistance is, because of this, normal during the later stages of a pregnancy. 

Therefore, the combination of increased demand for insulin and an inadequate response to insulin increases the blood sugar levels, leading to gestational diabetes.

Those are the causes of gestational diabetes, but some risk factors also increase a woman's odds of developing diabetes during pregnancy. They include:

• Overweight or obesity
• A family history of type 2 diabetes, or a personal history of gestational diabetes
• A large birth weight baby during a previous pregnancy — 4.5 kg/10 lb or more
• Being of south Asian, African, Caribbean, or Middle Eastern descent

Treatment: How can gestational diabetes be managed?

Treatment of gestational diabetes revolves around techniques that can help you lower your blood glucose levels.

First things first, you will need to actively monitor your glucose levels. You can keep an eye on your blood sugar levels by using an at-home glucose monitoring kit. This kit is a device that pricks your finger to allow you to bleed a little, and then tests that blood to check your blood sugar levels.

Talk to a professional — a doctor, a nurse, or a midwife — so they can show you how to check your blood glucose levels properly, tell you when and how often you should be testing your glucose, and let you know what the appropriate level of blood sugar are. By actively monitoring your blood glucose levels, you will be able to know when your blood glucose levels are too high and when you should seek medical help.

There are a number of other treatment methods that doctors can suggest to help you control your blood glucose levels when you have gestational diabetes, as well. These treatments are:

• Modifying your diet. Your diet is key when it comes to keeping your blood sugar levels low. Therefore, you will need to closely watch your diet if you develop pregnancy diabetes. You can talk to a nutritionist or another health professional that can help you plan your meals. Some suggestions for your diet will include eating regularly and not skipping meals, eating foods that are starchy and have a low glycemic index (which means they release sugar slowly), eat lots of fruits and vegetables (5 portions a day), avoid sugar-laden foods, avoid sugary drinks, and include lean sources of meat into your diet. Examples of foods to include in your diet are whole wheat pasta, brown rice, beans, lentils, all-bran cereal, fruits, nuts, seeds and fish. Also be sure to keep to up to date with what foods you should avoid during pregnancy, such as specific types of fish and cheese.
• Exercising more. Physical activity is known to help lower blood sugar levels by encouraging your muscles to take up the available blood glucose. Therefore, increasing your level of physical activity is a great way of lowering your blood glucose levels. Obviously, you will not be able to do just any exercise when you are pregnant, so it is best to talk to a physiotherapist or a fitness trainer on what exercises are best for pregnancy. Walking and swimming are great exercises and can help manage diabetes. You should aim for 150 minutes of physical activity a week.
• Medications. If you are not able to control your blood glucose levels within a week or two of changing your diet and exercise patterns, then the doctor will prescribe medication to help lower your blood glucose. Generally, this medicine is metformin, but treatment can also include insulin injections. Metformin is a tablet that is administered up to three times a day, usually around mealtime. Metformin use can lead to side effects including feeling sick (nausea), vomiting, stomach pain, diarrhea and loss of appetite. You can do your own insulin injections once you know how. It is important to keep in mind that insulin can cause your blood sugar levels to fall too low, which is associated with a range of side effects including feeling shaky, hungry, sweating more and cognitive problems. Even if you start off managing your condition adequately with a mixture of diet and exercise, you may need to start taking medication in case your disease is not well-controlled.

Outlook

Some complications can develop due to gestational diabetes. However, if you work with your doctor to closely monitor your diabetes, then you should be able to avoid them. This is why you will be offered an ultrasound scan at 18 to 20 weeks to check for abnormalities and at weeks 28, 32 and 36 to monitor your baby’s growth.

For patients with diabetes, the ideal time to give birth is 38 to 40 weeks. If your blood glucose levels are well-controlled then there are usually no concerns and you can give birth naturally. If you are overdue, you may be offered a caesarean section. If your baby’s health is compromised, doctors may offer you an early delivery. It is recommended that you give birth at a hospital. You should constantly be testing your blood sugar levels and taking your medication as prescribed until you are in labor.

Once you have given birth, your baby’s blood sugar levels will be tested and closely monitored. Any medication that you are on will be stopped once you have given birth and you will be advised to monitor your blood sugar levels for a few days after.

Even after your gestational diabetes is resolved, which is usually is after giving birth, you should continue to monitor for symptoms of diabetes because patients with gestational diabetes are more likely to develop type 2 diabetes later on in life.