Gestational Diabetes: Causes, Diagnosis & Treatments, Symptoms

Gestational diabetes, also known as diabetes in pregnancy, is a medical condition where women have high blood sugar levels during pregnancy. It typically occurs when the body can not produce enough insulin to regulate blood sugar levels during pregnancy.

In India, about 3-16% of women, with higher cases in urban areas, experience diabetes during pregnancy. A study conducted in Tamil Nadu stated a prevalence of 17.8% in urban areas and 9.9% in rural areas. Globally, the estimated gestational diabetes accounts for 15% of all pregnancies, but this can vary by region and population.

Gestational diabetes can increase the risk of complications during pregnancy, including preeclampsia, preterm birth, and the need for cesarean delivery. It can also increase the risk of developing type 2 diabetes for both the mother and baby. Therefore, it is crucial for pregnant women to be screened for gestational diabetes and to manage their blood sugar levels during pregnancy.

Gestational diabetes often doesn't cause any noticeable symptoms. Therefore, it becomes crucial for pregnant women to get screened for it. However, some women may experience symptoms similar to other types of diabetes, such as:

• Increased thirst and urination: High blood sugar levels can cause the body to pull fluid from its tissues, leading to dehydration. It can cause an increased urge to drink water (polydipsia) and more frequent urination as the body tries to remove excess sugar and fluids.
  
  
  
• Blurred vision: In gestational diabetes, high blood sugar levels can cause swelling of the eyes lens, which may lead to blurred vision. Usually, it resolves when blood sugar levels remain controlled.
  
  
  
• Fatigue or feeling tired all the time: in gestational diabetes, women feel fatigued. These occur due to high blood sugar levels causing the body to become less efficient at converting glucose into energy.
  
  
  
• Nausea and vomiting: High blood sugar levels can cause nausea and vomiting, particularly in the early stages of pregnancy.
  
  
  
• Frequent infections: Gestational diabetes makes pregnant women more susceptible to infections, such as bladder, vaginal, or skin infections, as high blood sugar levels can weaken the immune system in pregnant women.
  
  
  
• Increased hunger: High blood sugar levels stimulate your body to produce more insulin, which can lead to increased appetite.
  
  
  
• Dry mouth or a metallic taste in the mouth: In gestational diabetes, high blood sugar levels can cause dehydration, leading to a dry mouth or a metallic taste.

The exact cause of gestational diabetes is still under research, but the hormonal and metabolic changes during pregnancy play contributing factors.

• Hormonal and metabolic changes during pregnancy: During pregnancy, the placenta produces some hormones, which help in the growth and development of the baby, but these hormones can also make it difficult for the mother's body to use insulin effectively. It is known as insulin resistance. As a result, the mother may be unable to produce enough insulin to regulate their blood sugar levels during pregnancy, leading to gestational diabetes. According to a study published in the Journal of Diabetes and its Complications in 2018, insulin resistance during pregnancy was a vital contributor to the development of gestational diabetes. The researchers noted that the increase in insulin resistance during pregnancy is likely due to hormonal and metabolic changes.
  
  
  
• Obesity and pre-pregnancy weight: Women who are overweight or obese before pregnancy have a higher risk of developing gestational diabetes. It may be due to excess body fat, which makes it more difficult for the body to use insulin properly. A study published in the Journal of Obstetrics and Gynaecology Research in 2019 found that pre-pregnancy body mass index (BMI) was strongly associated with the development of gestational diabetes.
  
  
  
• Family history of diabetes: If a woman has a family history of diabetes, particularly in a first-degree relative (parent or sibling), she is more prone to developing gestational diabetes. According to a study published in the Journal of Obstetrics and Gynaecology Research in 2017, having a family history of diabetes was a significant risk factor for gestational diabetes development.
  
  
  
• Age: Women over 30 are at a higher risk of developing gestational diabetes.
  
  
  
• Previous high-birth weight babies: Women who have previously given birth to a baby weighing more than 9 pounds (4 kilograms) are at a higher risk of developing gestational diabetes. A study published in the Journal of Obstetrics and Gynaecology Research in 2017 found that a history of macrosomia (large babies) was a significant risk factor for gestational diabetes.
  
  
  
• Polycystic ovary syndrome (PCOS): Women with PCOS have a higher risk of gestational diabetes than women without PCOS. It may be because PCOS is associated with insulin resistance.

There are several steps women can take to reduce their risk of developing it. The following are some of the most effective prevention strategies:

• Maintain a healthy weight: Maintaining a healthy weight before and during pregnancy is one of the most effective ways to reduce the risk of gestational diabetes. A study published in Diabetes Care found that women who were overweight or obese before pregnancy were more likely to develop gestational diabetes than women with a normal BMI (body mass index).
  
  
  
• Exercise regularly: Regular physical activity improves insulin sensitivity and reduces the risk of gestational diabetes. According to a randomized controlled trial, women who participated in a supervised exercise program during pregnancy had a lower risk of gestational diabetes than pregnant women who did not exercise.
  
  
  
• Eat a healthy diet: A healthy diet high in fiber, protein, and antioxidants and low in sugar and refined carbohydrates can help regulate blood sugar levels and reduce the risk of gestational diabetes.
  
  
  
• Regular screening for diabetes: Women with one or more risk factors for gestational diabetes should get tests and screening for it during pregnancy. The American College of Obstetricians and Gynecologists recommends a woman should undergo gestational diabetes screening between 24 and 28 weeks of pregnancy. Early detection and prompt treatment can help prevent complications for both the mother and the baby.
  
  
  
• Manage stress: Chronic stress is the prime contributing factor to gestational diabetes. According to a study published in BMC Pregnancy and Childbirth, pregnant women who participated in a mindfulness-based stress reduction program had lower fasting blood sugar levels and a lower risk of gestational diabetes than women who did not practice stress-relieving exercises.
  
  
  
• Quit smoking: Smoking may increase the risk of gestational diabetes and other pregnancy-related complications.

Healthcare professionals recommend gestational diabetes screening between 24 and 28 weeks of pregnancy or earlier if they have risk factors for gestational diabetes. The following are the diagnostic tests for gestational diabetes:

• Glucose tolerance test (GTT): The glucose tolerance test is a diagnostic test in which women fast overnight and drink a sugary beverage. Healthcare professionals measure blood sugar levels during fasting and then at one, two, and three hours after drinking the sugary liquid. The limits for a positive test result are typically 95 mg/dL at fasting, 180 mg/dL at one hour, 155 mg/dL at two hours, or 140 mg/dL at three hours. If two or more blood sugar levels are higher than the limit, gestational diabetes is positive.
  
  
  
• Hemoglobin A1c (HbA1c) test: The HbA1c test is a blood test that measures average blood sugar levels over the past two to three months. It is not commonly used to diagnose gestational diabetes, but advisable in some cases. Positive test result is typically above 5.8%.

Gestational diabetes management involves controlling blood sugar levels during pregnancy. It reduces the risk of complications for both the mother and the baby. The following are some steps that may help to manage gestational diabetes:

• Consumption of a healthy diet: A healthy diet is crucial for the gestational diabetes management program. Women with gestational diabetes take help from a registered dietitian to create a meal plan that balances carbohydrates, proteins, and fats to control their blood sugar levels. Eating meals in small portions throughout the day rather than a few large meals can also help regulate blood sugar levels. A 2018 systematic review and meta-analysis of 20 randomized controlled trials found that dietary interventions like shifting to a reduced-carbohydrate diet or a low glycemic index diet effectively reduce blood glucose levels in women with gestational diabetes. According to another study, a Mediterranean diet improves glycemic control and reduces the risk of complications in women with gestational diabetes.
  
  
  
• Regular exercise: Daily physical activities can help regulate blood sugar levels by improving insulin sensitivity. Women with gestational diabetes should work with their healthcare providers to create an exercise plan that is safe and appropriate for their needs. The American College of Obstetricians and Gynecologists recommends regular exercise as part of the management of gestational diabetes.
  
  
  
• Monitoring blood sugar levels: Women with gestational diabetes should monitor their blood sugar levels regularly throughout the pregnancy, several times a day if needed. For this, women may use a glucose meter to check blood sugar levels at home or take periodic blood tests to check HbA1c levels. According to a randomized trial, self-monitoring blood glucose levels at home reduces the risk of complications in women with gestational diabetes. Another study published in 2020 found that frequent self-monitoring of blood glucose levels also improves glycemic control and reduces the risk of complications in women with gestational diabetes.
  
  
  
• Medications: Sometimes, diet and exercise alone may not be enough to control blood sugar levels in women with gestational diabetes. Therefore, healthcare professionals recommend medicines, such as insulin or oral hypoglycemic agents, to help manage blood sugar levels. According to a systematic review and meta-analysis, insulin therapy efficiently reduces the risk of complications of gestational diabetes. According to another study, metformin, an oral hypoglycemic agent, effectively reduces blood glucose levels and improves pregnancy outcomes in women with gestational diabetes.
  
  
  
• Regular prenatal care: Women with gestational diabetes will need to see their healthcare providers regularly throughout the pregnancy to monitor their blood sugar levels, check for signs of complications, and adjust treatment as needed. Regular prenatal care is crucial for managing gestational diabetes and reducing the risk of complications. A systematic review and meta-analysis published in 2019 found that intensive prenatal care, which included regular monitoring of blood glucose levels and individualized treatment plans, was associated with reduced risk of complications in women with gestational diabetes.
  
  
  
• Delivery planning: Women with gestational diabetes may be at increased risk for certain complications during delivery, such as shoulder dystocia. As a result, healthcare providers may recommend a planned delivery, such as induction or C-section, to reduce the risk of complications. A systematic review and meta-analysis published in 2020 found that planned-early delivery, such as induction or C-section, was associated with reduced risk of stillbirth and neonatal morbidity in women with gestational diabetes. However, the timing and mode of delivery should be individualized based on the woman's specific situation and the healthcare provider's recommendations.

After childbirth, women with gestational diabetes require extra precautions to manage their blood sugar levels to reduce the risk of developing type 2 diabetes. The following are some of the precautions steps:

• Monitor blood sugar levels: Regularly monitoring blood sugar levels can help you stay within the recommended range. Your healthcare provider can advise you on how often you should monitor your blood sugar levels and what your target levels should be.
  
  
  
• Maintain a healthy diet: Eating a diet low in sugar and refined carbohydrates can help you manage your blood sugar levels. A healthy diet includes fruits, vegetables, whole grains, lean proteins, and healthy fats. Avoid high sugar and refined carbohydrate products, such as sugary drinks, packaged snacks, and processed foods.
  
  
  
• Exercise regularly: Regular exercise can help improve your blood sugar control and reduce your risk of developing type 2 diabetes. Healthcare providers recommend at least 30 minutes of moderate exercise for a minimum of five days a week.
  
  
  
• Take medications or insulin as prescribed: If your healthcare provider has prescribed medicines or insulin to help manage your blood sugar levels, it is crucial to take them as directed.
  
  
  
• Attend follow-up appointments: Regular check-ups can help ensure that your blood sugar levels are well-controlled without causing complications. Your healthcare provider may also recommend regular screening for type 2 diabetes and other related conditions, such as high blood pressure and cholesterol levels.
  
  
  
• Breastfeed your baby: Breastfeeding help reduce the risk of developing type 2 diabetes after gestational diabetes. If you are facing difficulty or have any queries consult your healthcare provider.

What is gestational diabetes?

Gestational diabetes is a type of diabetes that develops during pregnancy. The main causative factor is hormonal changes that affect how your body uses insulin, leading to high blood sugar levels.

What are the symptoms of gestational diabetes?

Gestational diabetes often does not cause any noticeable symptoms. However, some women may experience increased thirst, frequent urination, fatigue, and blurred vision.

How is gestational diabetes diagnosed?

Gestational diabetes is typically diagnosed through a glucose tolerance test(GTT), which measures how your body processes sugar. The doctors perform this test between 24 and 28 weeks of pregnancy.

How is gestational diabetes treated?

A combination of diet and exercise regimen helps control blood sugar levels. In some cases, doctors may prescribe medications or insulin therapy.

What are the risks of gestational diabetes?

Gestational diabetes can increase the risk of certain complications during pregnancy, such as high blood pressure, preeclampsia, and preterm delivery. Women with gestational diabetes also have an increased risk of developing type 2 diabetes later in life.

Can gestational diabetes be prevented?

There are no definite preventive measures for gestational diabetes, but maintaining a healthy diet and regular exercise can help reduce the risk. Women with a higher risk of gestational diabetes, such as those with a family history of diabetes, may also be advised to undergo early screening.

What should I eat if I have gestational diabetes?

If you have gestational diabetes, it is crucial to eat a healthy and balanced diet, which is high in fiber, proteins, and minerals, as well as low in sugar and refined carbohydrates. The doctor may advise you to include lean proteins, fruits, vegetables, whole grains, and healthy fats in your daily food.

How can gestational diabetes affect my baby?

Gestational diabetes can increase the risk of certain complications in your baby, such as macrosomia (a large baby), respiratory distress syndrome, and low blood sugar levels. However, you can reduce the risk with proper management and care.

Will I still have gestational diabetes after I give birth?

Gestational diabetes typically resolves after delivery. However, women with gestational diabetes have an increased risk of developing type 2 diabetes later in life and should continue to monitor their blood sugar levels and make healthy lifestyle habits.

Who is at risk for gestational diabetes?

Women who are overweight or obese, have a family history of diabetes or have previously had gestational diabetes are at a higher risk for gestational diabetes.

Can gestational diabetes cause birth defects?

However, gestational diabetes does not typically cause congenital anomalies. But poorly controlled diabetes during pregnancy can increase the risk of congenital malformations.

How often will I need to check my blood sugar if I have gestational diabetes?

Your healthcare provider will recommend a monitoring schedule based on your individual needs. But most women with gestational diabetes should check their blood sugar levels multiple times a day.

Will I need to take insulin if I have gestational diabetes?

Not all women with gestational diabetes will need insulin therapy, but some may require it to manage their blood sugar levels.

Can I still have a vaginal delivery if I have gestational diabetes?

Yes. Women with gestational diabetes can still have a safe vaginal delivery with proper care and guidance.

Can exercise help manage gestational diabetes?

Yes. Regular exercise can help manage blood sugar levels and reduce the risk of gestational diabetes-related complications.

Can gestational diabetes cause high blood pressure?

Gestational diabetes can increase the risk of high blood pressure during pregnancy, leading to numerous pregnancy-related complications, such as preeclampsia.

How often will I need to see my healthcare provider if I have gestational diabetes?

Your healthcare provider will recommend a schedule based on your requirements, but most women with gestational diabetes need frequent check-ups and monitoring.

Can gestational diabetes cause stillbirth?

Poorly controlled gestational diabetes can increase the risk of stillbirth. But with proper management and care, you can reduce this risk.

Can gestational diabetes cause preterm labor?

Gestational diabetes can increase the risk of preterm labor and early delivery. But with proper management and care, you can overcome this hurdle.

Will I need to adjust my diet and exercise after I give birth if I have gestational diabetes?

If you have gestational diabetes, it becomes crucial to maintain a healthy diet and exercise routine after delivery to reduce the risk of developing type 2 diabetes later in life.

How will gestational diabetes affect breastfeeding?

Gestational diabetes typically does not affect breastfeeding. But you should continue monitoring blood sugar levels and following a healthy diet and exercise routine.

Can gestational diabetes cause my baby to develop diabetes later in life?

Babies born to women with gestational diabetes have an increased risk of type 2 diabetes later in life. But with proper guidance and care, you can decrease this risk.

Can gestational diabetes be cured?

Gestational diabetes typically resolves after childbirth, but women with gestational diabetes have an increased risk of developing type 2 diabetes later in life. Therefore, they should monitor their blood sugar levels and maintain their lifestyle.

What happens if gestational diabetes is left untreated?

Untreated or poorly controlled gestational diabetes can increase the risk of complications for both the mother and baby, including high blood pressure, preeclampsia, preterm labor and delivery, stillbirth, and an increased risk of developing type 2 diabetes after childbirth. Therefore, it becomes crucial to manage gestational diabetes and reduce these risks for a better quality of life.