Gestational Diabetes

Gestational diabetes is the transient state of insulin resistance during pregnancy which leads to increased blood sugar levels. It may start at any point during pregnancy and it usually resolves after birth. It starts most commonly during the second and third trimesters.

What are the signs of gestational diabetes?

Most of the time gestational diabetes is asymptomatic. Therefore screening tests are offered to all pregnant patients to diagnose gestational diabetes.

However when blood glucose increases, the following signs may be present:

• Increased frequency of urination and increased thirst
• Dry mouth
• Feeling excessively tired

Why do you get gestational diabetes?

Gestational diabetes develops when the body cannot produce enough insulin to cover the body’s need to normalize blood sugar level.

Who is at high risk for gestational diabetes?

The following patients are at high risk for gestational diabetes;

• Patients with BMI>30
• Patients with a history of macrosomic (>4500 gr) baby birth
• Patients with a history of gestational diabetes in a previous pregnancy
• Patients with family history of diabetes

What risks are associated with gestational diabetes?

When gestational diabetes is not diagnosed and treated, it is associated with certain risks for the mother and the fetus.

The risks to the fetus can be summarised as follows:

• Macrosomia (increased fetal weight) leading to difficult delivery (dystocia) and increased incidence of C-Section
• Polyhydramnios (increased amniotic fluid volume) increasing the risk of preterm delivery
• Increased risk of preeclampsia
• Increased risk of neonatal hypoglycemia and jaundice, thus increased risk of neonatal intensive care unit admission.
• Increased risk of intrauterine death

The risks to the mother can be summarised as:

• Increased risk of future type 2 diabetes in the mother
• Increased risk of gestational diabetes in future pregnancies

Can you prevent gestational diabetes?

You can decrease the risk of gestational diabetes by the help of the following measures:

• Trying to conceive at an ideal BMI by having a balanced diet and regular exercise programme throughout pregnancy
• Having a balanced diet and regular exercise programme throughout pregnancy

How should be the diet for gestational diebetes?

Ideally the diet programme should be planned and followed up by a dietician. The total daily calory intake is calculated according to prepregnacy weight of the patient. Daily intake of protein, carbohydrate, fat and vitamins should be balanced. The meals should be divided into 3 main meals and 2-3 snacks per day.

It is important to consume more complex carbohydrates to balance blood sugar levels. Complex carbohydrates are found in plant based nutrients such as whole wheat, beans,peas and corn

How do you diagnose gestational diabetes?

During the first anenatal visit, your history and body weight will determine if you are at high risk for gestational diabetes. For high risk patients, oral glucose tolerance test is indicated as early as possible during pregnancy. When the test result is normal, OGTT should be repeated during 24-28 weeks of gestation. For low risk pregnancies OGTT is recommended during 24-28 weeks of gestation.

How is the management of gestational diabetes?

Gestational diabetes necessitates a multidisciplinary approach. A team of perinatologist, endocrinologist,dietician, diabetes nurse and a personal trainer should ideally follow up the patient with gestational diabetes.

How is gestational diabetes treated?

Treatment of gestational diabetes starts by following a balanced diet and regular exercise programme. The aim is to maintain ideal blood sugar levels. Controlled blood sugar levels decrease maternal and fetal risks during pregnancy. To monitor blood sugar levels,patients can use home kits, they can record their blood sugar profile and report this profile to their doctors.

When the blood sugar profile is over normal limits despite regular diet and exercise programme, medical treatment may be necessary. Medical treatment may be by oral antidiabetic medications or iv insulin.