Gestational diabetes as the name suggests is the type of diabetes which is seen only during pregnancy. It develops during pregnancy and usually disappears after the birth. Like other forms of diabetes, it also affects the way the body cells use glucose. It is one of the major cause of concern during pregnancy as gestational diabetes is capable of causing several complications during pregnancy.
Gestational diabetes causes high blood sugar which can affect the pregnancy and health of both the mother and the baby. It is especially common in the last three months or last trimester of pregnancy.
Gestational diabetes or also known as gestational diabetes mellitus is a serious pregnancy complication in which pregnant women with no history of diabetes develop hyperglycemia during gestation. In most cases, the hyperglycemia or gestational diabetes is caused due to impaired glucose tolerance due to pancreatic beta-cell dysfunction. The exact pathophysiology is unknown. One main aspect of the underlying pathology is insulin resistance, where the cells do not respond to insulin in the normal way. Several pregnancy hormones may disrupt the usual action of insulin as it binds to its receptor, by interfering with cell signalling pathways.
Causes of Gestational Diabetes
Gestational diabetes is caused due to the hormonal and various other changes that the body goes through the pregnancy. In several cases the changes causes gestational diabetes.
During pregnancy the body produces high levels of a number of the following hormones:
- Human placental lactogen
- Human placental growth hormone
The large amount of these hormones in the body reduces the effectiveness of insulin. As the foetus grows a higher level of these hormones are needed. The risk of developing insulin resistance increases in the pregnant mothers during the later course of pregnancy.
Several conditions during pregnancy certain conditions raise alarm and are considered as major causes of gestational diabetes like:
- Patients with previous history of gestational diabetes in prior pregnancies
- Basal metabolic index higher than 3
- Family history of type2 diabetes or gestational diabetes
- Previous history of miscarriage or stillbirth
- Having had a large baby[more than 9 pounds or 4.5 kgs]
- Overweight individuals
- Older age[more than 35]
- History of polycystic ovarian syndrome
- Some ethnic groups have a predisposition for gestational diabetes
- High blood pressure
The Symptoms of Gestational Diabetes
Most women with gestational diabetes experience no symptoms but few may experience non-specific symptoms like:
- Unusual thirst
- Frequent urination in large amounts
Gestational diabetes produces symptoms and is diagnosed by laboratory tests.
Test for gestational diabetes is a part of prenatal care. The doctor evaluates the risk factors for gestational diabetes early in the pregnancy. In high risk pregnancies, a test may be performed at the first prenatal visit. In average risk patients, the test is performed during the second trimester-between 24 and 28 weeks. The tests are:
Glucose Challenge Test
This is the screening test in which the blood is drawn an hour after drinking the sweet liquid containing glucose. If the blood sugar level is higher than 140, then oral glucose tolerance test is done.
Glucose Challenge Test[OGTT]
It measures blood glucose after a fast of atleast eight hours. Blood is drawn out first and then the liquid containing glucose is given. Then the blood is drawn at regular intervals. High blood sugar at two or more blood test times -fasting, 1 hour, 2hours, 3hours -suggests gestational diabetes.
Gestational Diabetes poses several risk for both the child and the mother. The important risk factors are listed below:
Risk for The Baby
The risks associated with gestational diabetes are due to very high level of blood sugar. By keeping the blood sugar level ideal, these risks can be reduced. Managing the blood sugar level brings these risks down and most women with gestational diabetes have healthy pregnancies and healthy babies. They are:
- Macrosomia –It is the risk of having a large baby. If the mother’s blood glucose levels are high it can cause high blood glucose levels in the baby as well. It increases the production of insulin in the baby which can make the baby grow larger than normal size. If the weight of the baby at the time of the birth is more than 4kgs it i known as macrosomia. This condition poses several risk to the health of the baby and the mother and can also lead to several complications during pregnancy. It also increases the risk of birth trauma. Either mother or the baby can be affected and there is difficulty in birth like bone fractures and nerve damage to the baby and tearing and severe bleeding in the mother. It also causes psychological distress. It can cause shoulder dystocia wherein the shoulder of the baby gets stuck in the pelvis during birth. It requires immediate medical assistance.
- Risk of a premature birth- gestational diabetes is linked to preterm birth. It may be due to the damage to the placenta caused to gestational diabetes.
- Risk of stillbirth at the end of the pregnancy
- Risk of low blood sugar in the baby after birth.
Risks for the Mother
Treatment and Management for Gestational Diabetes
The treatment strategy should includes daily blood sugar monitoring, a healthy diet, exercise and monitoring of the baby. Some important management tips are listed below:
- Testing kits are used for daily monitoring of the blood sugar level. It is important to test for sugar levels daily for proper management of the condition
- Making changes in the diet which includes eating more fruits and vegetables and avoiding sugars and fats
- Daily exercise is recommended. It is important to discuss your exercise regime with your doctor as strenuous physical activity can cause harm during pregnancy
- Medication available in the form of tablets or injections’ helps in keeping the blood sugar level under check especially in the later part of the pregnancy
- Overall monitoring