Gestational Diabetes

Gestational diabetes is a metabolic disorder that occurs in pregnant women. Gestational diabetes is characterised by high blood sugar levels that may be harmful to the pregnancy. Gestational diabetes usually goes away after delivery; however, it increases the risk of developing type 2 diabetes mellitus.

Associated Anatomy:

Pancreas, Placenta

Causes

The exact cause of gestational diabetes remains unknown. However, researchers hypothesise the following reasons can cause gestational diabetes-

Insulin resistance: The placenta produces certain hormones that help the baby during pregnancy. Over time, these hormones build up in the body and counteract the effects of insulin. This results in insulin resistance.
Inadequate insulin production: Sometimes, the pancreas does not produce enough insulin. Without adequate insulin, glucose builds up in the blood, causing hyperglycemia.

Signs or Symptoms of Gestational diabetes

Gestational diabetes generally is not associated with any symptoms. However, certain individuals may experience the following symptoms-

Blurred vision
Fatigue or tiredness
Excessive thirst
Frequent urge to urinate
Nausea
Yeast infections

Possible Treatments

It is critical to initiate treatment as early as possible to protect the health of the mother and the baby. Possible treatments are as follows:

Lifestyle modifications: How you remain active plays an essential role in managing gestational diabetes.
Exercise: Staying physically active can control blood sugar levels. Physical activity can also help in certain discomforts experienced during pregnancy like swelling, back pain, cramps, constipation, etc.
Healthy diet: Having a healthy and balanced diet consisting of fruits, vegetables, lean proteins, whole grains, etc., is critical for positive outcomes. A dietician can help you create a personalised diet plan based on your requirements.
Medications: If exercise and diet are not adequate to control blood sugar levels, the doctor usually prescribes insulin or to control blood glucose levels.
Blood sugar monitoring: Pregnant women would be asked to monitor their blood sugar levels 3-4 times daily to maintain a healthy blood glucose level.

Risk Factors

Women over 25 years of age and a descendant of Asian, African, Native American, Hispanic, or Pacific Island lineage are at an increased risk of developing gestational diabetes. Additionally, the following are some factors that may increase the chances of developing the disease:

Prediabetes
Overweight
High blood pressure
Obesity
Lack of physical activity
Family or personal history of gestational diabetes
Medications (like steroids) that interfere with the actions of insulin
Previously delivery of a baby weighing more than 9 pounds.
Have disorders like acanthosis nigricans, polycystic ovary syndrome (PCOS), or other disorders that can cause insulin resistance

Typical Tests

The American Diabetes Association (ADA) recommends routine checks for gestational diabetes in pregnant women. However, if there is no history of diabetes mellitus or if the blood glucose levels were normal during the start of pregnancy, screening for gestational diabetes is performed when the pregnancy is about 24-28 weeks old. The glucose challenge test and oral glucose tolerance test are a couple of tests performed to diagnose gestational diabetes.

Primary Prevention

Gestational diabetes cannot be prevented completely. However, specific steps can reduce the risk of developing the disorder.

Maintaining a healthy body weight: If you are overweight and plan to have a baby soon, losing weight will significantly reduce the risk of gestational diabetes.
Exercise regularly: Mild exercise like walking can also help in reducing the risk of getting the disorder.
Ensuring a healthy diet: Consult with your dietician to curate a personalised diet to ensure you eat nutritious foods before and during pregnancy.

Secondary Prevention

Regular follow-up visits with your medical practitioner, eating a healthy diet, and exercising will significantly decrease the risk of developing gestational diabetes in your pregnancy.

Additional Type

There are two subclasses of gestational diabetes, class A1 and A2 gestational diabetes. Class A1 gestational diabetes can be managed with diet alone, while class A2 gestational diabetes will require medications to ensure adequate glycemic control.

Epidemiology

Every year about 2-10% of women are diagnosed with gestational diabetes in the United States of America. India accounts for almost 5 million cases each year.
Women diagnosed with gestational diabetes are at an increased risk (about 35- 60%) of developing type 2 diabetes mellitus soon (about 10-20 years after pregnancy).

Expected Prognosis

Gestational diabetes is a common diagnosis during pregnancy. It usually disappears following delivery. With adequate measures to maintain blood sugar levels, it is possible to have a healthy pregnancy and baby.

Natural Progression

Gestational diabetes requires immediate actions following diagnosis. If it is not taken care of, it can cause complications for both mother and the baby.

Possible Complications

Gestational diabetes can cause complications to the mother as well as the baby. Possible complications to the mother include high blood pressure (preeclampsia), type 2 diabetes mellitus, cesarian birth, etc. The fetal complications include obesity, hypoglycemia, breathing difficulties, type 2 diabetes, and premature birth.

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