Gestational Diabetes

 

Gestational diabetes is a temporary type of diabetes that can occur in females during pregnancy (gestation). The condition tends to be onset between week 24 and 28 of pregnancy. Unlike type 1 and 2 diabetes, gestational diabetes occurs when pregnant female, specifically those who have never had diabetes before, experience high blood glucose levels during pregnancy.1 This condition affects about 9.2% of all pregnant females and is one of the most common health problems that pregnant females face.2 Fortunately, this condition can be controlled by eating healthy, exercising, and potentially taking appropriate medications. After the female gives birth, their blood glucose levels usually return to normal.1

 

Understanding Diabetes

Diabetes is a disease that alters how the body uses blood sugar, or glucose. Glucose is essential because it is the main source of energy for the body and the only source of energy the brain can utilize.3 There are two main types of chronic diabetes, types 1 and 2, which differ based on how the body reacts to glucose levels. Temporary types of diabetes include prediabetes and gestational diabetes. Prediabetes is diagnosed when there are to high levels of glucose in the blood, but not high enough to be classified as type 1 or 2 diabetes. Fortunately, prediabetes can be resolved through strict dieting and healthy eating. Gestational diabetes, which this article focuses on, often resolves itself after the child is born. All types of diabetes involve excess sugar in the blood, which can lead to serious health complications.3

How the Body Normally Processes Glucose

Glucose is the main source of energy for cells. It can enter the body as food or it can be created in the liver. Once absorbed into the bloodstream, glucose enters cells with the help of a hormone called insulin. Insulin is produced in the pancreas, which sits near the stomach. Insulin is important not only because it allows glucose to enter our cells, but also because so it decreases the levels of glucose in the bloodstream. High glucose levels in the bloodstream can lead to health risks such as preeclampsia or subsequent gestational diabetes. Insulin’s ability to reduce these high glucose levels helps to reduce the associated risks.3

How the Body Processes Glucose during Gestational Diabetes

While the exact cause of gestational diabetes is not entirely known, researchers have some basic knowledge about the disease. During pregnancy, the placenta, which connects the female’s blood supply to their fetus, supplies certain hormones to the fetus to help it grow and develop. These hormones, while necessary, can have some negative side effects on the female’s body because they block insulin from allowing glucose to enter cells. As pregnancy continues and the fetus grows in size, the body must produce more of these hormones to accommodate the growing fetus. Over time, the rise in these hormones can negatively impact insulin’s ability to allow cells to absorb glucose, making the pregnant female’s body less receptive to insulin. This means that throughout the pregnancy, a female’s body will develop what is called “insulin resistance.” Once someone has developed insulin resistance, their body has to work even harder to get the glucose out of the bloodstream and into the cells. In order to do this, the body must produce around three times the normal amount of insulin in an attempt to compensate for rising hormone levels.2 Producing such high levels of insulin puts a major strain on the pregnant individual’s pancreas. After an extended period of time, this can cause damage to the pancreas and can even cause the pancreas to fail altogether. In the case of gestational diabetes, however, the pancreas is usually not under strain for a long enough period of time to cause such damage.1 Pancreatic failure is much more common in people with chronic type 2 diabetes who have had the disease for many years.3

 

Risk Factors and Prevention Methods

There are various risk factors tied to a female’s genetics which could increase their risk of developing gestational diabetes. Fortunately, there are techniques an individual can make to prevent potential future gestational diabetes.

Common Risk Factors

Gestational diabetes affects females who do not have diabetes before becoming pregnant. There are some common risk factors which can increase a female’s likelihood of developing the disease:

  • Gaining excessive weight during pregnancy
  • Being a person of color
  • Being older than 25 years old
  • Having a family history of developing type 2 diabetes
  • Having gestational diabetes during a previous pregnancy
  • Having a body mass index (BMI) greater than 30
  • Having prediabetes prior to pregnancy
  • Having polycystic ovarian syndrome (PCOS)

Similar risk factors for type 2 diabetes can be found in those who are at risk of gestational diabetes.1,4 While these risk factors can increase a female’s chance of developing gestational diabetes, they in no way assure development of the diease.

Ways to Prevent Gestational Diabetes

Fortunately, for those who are in high risk categories, there are methods to decrease the likelihood of developing gestational diabetes. These steps can be taken both either prior to becoming pregnant and during pregnancy.

Eating Healthy

Following a healthy diet of fruits, vegetables, and whole grains can help your body optimize its absorbance of glucose. Eating unhealthy foods can cause the body to use fat as energy rather than glucose. This can be tested by measuring the amounts of ketones in your urine. If your blood glucose is above 200, your doctor may recommend taking daily tests to monitor healthier values.5

Working Out

Maintaining a healthy weight is important during pregnancy. Prior to becoming pregnant, it is healthy to lose any excess weight. However, once you are pregnant, it is necessary to gain weight for the developing child. The best way to maintain a healthy weight is to complete 30 minutes of daily moderate exercise during pregnancy. The goal of those workouts should not be to lose weight, but to be the healthiest version of yourself. Being active can help maintain blood glucose and cholesterol levels as well as decrease the likelihood of developing type 2 diabetes later in life. If a female gains too much weight too fast during their pregnancy, it can result in insulin resistance.1.4

 

What to Expect at the Doctor’s Office

It is always best to visit a doctor throughout your pregnancy to ensure that you are providing the best prenatal care for your fetus. If you are at risk of developing gestational diabetes, it can be helpful to visit a doctor before conception (creating a fetus) to evaluate your risks and establish preventative care (such as a workout plan or appropriate diet). Once pregnant, it is customary for a doctor to test for gestational diabetes around week 24 to 28 of the pregnancy because that is when insulin resistance is established.1

Glucose Challenge Test

Before being tested for gestational diabetes, a doctor will have you drink a sugary drink an hour prior to testing your blood. They will then test your blood for insulin and glucose levels, which will determine whether or not you have developed gestational diabetes. There is no need to fast for this procedure. If blood glucose levels are around 140 or higher, an oral glucose tolerance test (OGTT) may need to be performed.6

Oral Glucose Tolerance Test (OGTT)

This test is performed after you have fasted for eight hours, meaning you have not consumed any food in eight hours. First, your blood will be drawn. You will then drink a sugary drink and have your blood drawn every hour for the next two to three hours. Generally, high glucose levels during any of these blood drawings will indicate gestational diabetes.6 If you do have the disease, you will require more doctor’s visits throughout your pregnancy to maintain your blood glucose levels.1

 

Effects on the Fetus

Most females with gestational diabetes will deliver healthy babies. This can be ensured through maintaining a healthy diet and working out. However, there can be complications when a fetus is born to a pregnant individual with mismanaged gestational diabetes.1

Developing Macrosomia

Macrosomia occurs when an infant is born larger than normal (such as heavier than nine pounds). This occurs because the placenta from the pregnant individual, provided the fetus with excess glucose. With exposure to high levels of glucose, the fetus’s pancreas will produce more insulin in order to transfer the glucose from the blood to the cells.1 The extra glucose is then stored as fat, because the baby simply does not need so much sugar for immediate energy. Because of the extra fat storage, the fetus becomes larger than normal, a condition called macrosomia (see picture). Carrying such a large baby often makes delivery more difficult for the pregnant individual and usually necessitates a Cesarean section. Babies born to females with gestational diabetes are likely to suffer damage to their shoulders if their pregnant individuals opts out ofa C-section and decides to birth them vaginally.1,2

Being Born Premature

Being born before the expected delivery date is known as being born premature. This is usually due to a pregnant individual’s high blood glucose levels. These higher than average levels will increase the chances of inducing early labor. Alternatively, a doctor may recommend premature delivery due to the fetus’ large size. Premature babies will sometimes develop respiratory distress syndrome due to undeveloped respiratory system as a result of being born too early. This can make breathing difficult for the baby, and they may need help breathing until their lungs grow stronger.1

Developing Hypoglycemia

Hypoglycemia is the condition of having low blood sugar. Because the baby has been exposed to so much glucose in the womb, it has learned to secrete a lot of insulin. This means that the baby is likely to have low blood glucose when it is born because it no longer has the high blood glucose from its pregnant individual but it still has the high insulin levels. This can be combatted with prompt breast-feeding sessions and in more extreme cases, intravenous glucose delivery. These can help the baby’s blood glucose return to normal levels.1

Developing Type 2 Diabetes Later in Life

Babies born to females with gestational diabetes will have excess insulin levels. This puts them at a greater risk for developing obesity and type 2 diabetes later in life because their bodies are trained early on to be insulin resistant and to store fat more readily.1

 

Effects on the Pregnant individual

High blood sugar levels during pregnancy not only affect the developing fetus, but can also negatively harm the pregnant individual. Short-term high blood sugar does not result in significant organ damage, but it can make you feel tired, weak, thirsty, and make you more susceptible to infections. It also can result in depression and blurry vision.7  The typical long term effects associated with diabetes usually do not apply to females with gestational diabetes because they do not have the condition long enough; long-term effects take years to develop and gestational diabetes only lasts for a couple of months.

Common Complications of Gestational Diabetes

Pregnant females with gestational diabetes are also more likely to develop preelampsia during their pregnancy, which is a potentially fatal condition marked by high blood pressure. Because the female becomes resistant to insulin, they are also at a slightly greater risk for developing type 2 diabetes later in life. Females are also at risk for developing gestational diabetes again in any subsequent pregnancies. Making healthier life choices, such as eating healthier foods and working out, post-pregnancy can help to reduce these risks.1

 

Treatment After the Baby is Born

Most females with this condition will have a healthy baby as long as they monitor their blood glucose levels regularly and maintain a healthy diet. Treatment for this condition includes a combination of special meal plans, scheduled physical activity, daily blood glucose monitoring, and insulin injections.8

The American Diabetes Association suggests the following numbers as a guidelines for blood glucose levels in females with gestational diabetes:

  • Before a meal: 95mg/dl or less
  • 1-hour after a meal: 140mg/dl or less
  • 2-hours after a meal: 120 mg/dl or less8

Following a healthy meal plan that is low in carbohydrates and sugars is key to maintaining ideal blood glucose levels. If you or your partner are pregnant, consult a medical professional for specific guidelines on staying healthy during pregnancy, including how much sugar to eat and how much exercise to engage in.

Testing for Type 2 Diabetes

Around 12 weeks after giving birth, it is important to get tested for type 2 diabetes. If blood glucose levels remain high, you most likely have developed type 2 diabetes. If levels have returned to normal, you are still at risk for developing type 2 diabetes later in life because of the prior gestational diabetes. Therefore, be sure to get tested every three years for diabetes. Breastfeeding your baby has also been found to help your child maintain healthy levels of nutrients and helps you burn calories, which may decrease your chances of developing type 2 diabetes.9

 

Concluding Remarks

Prenatal care is important during any pregnancy, but especially in pregnant individuals with gestational diabetes. Gestational diabetes is temporary and occurs in females who do not have diabetes prior to pregnancy. The high glucose levels can negatively affect both the pregnant individual and fetus, so it important to maintain a healthy diet, work out, and possibly take extra insulin. With good management of the condition, pregnant individuals can avoid any complications and deliver healthy, happy babies.

 

References

  1. “Gestational Diabetes.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 28 Apr. 2017.
  2. “What Is Gestational Diabetes?” American Diabetes Association.
  3.  “Diabetes.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 8 Aug 2018.
  4.  “Preventing Gestational Diabetes.” National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Department of Health and Human Services, 1 May 2017.
  5.  “Managing & Treating Gestational Diabetes.” National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Department of Health and Human Services, 1 May 2017.
  6. “Tests & Diagnosis for Gestational Diabetes.” National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Department of Health and Human Services, 1 May 2017.
  7.  “Gestational Diabetes: Testing and Treatment.” American Pregnancy Association, 24 Nov. 2018.
  8.  “How to Treat Gestational Diabetes.” American Diabetes Association.
  9.  “After Your Baby Is Born.” National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Department of Health and Human Services, 1 May 2017.

 Last Updated: March 6 2019.

 

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