Gestational Diabetes – Why does it occur?

What is gestational diabetes?

Gestational Diabetes is a type of diabetes that develops for the first time during pregnancy, in a woman who has previously not had diabetes. Gestational diabetes can occur at any stage during the pregnancy. For most women, however, it develops in the second or third trimester of pregnancy.

This pregnancy complication develops when the body is not able to produce enough insulin. Insulin is the hormone that helps regulate the amount of sugar in blood circulation. With insufficient insulin levels, a pregnant woman’s body cannot meet the increased demands of pregnancy. This often leads to medical challenges if gestational diabetes is not caught early and managed properly.

Note too, that this definition applies regardless of whether the condition persists even after pregnancy. Additionally, when women with pre-existing diabetes get pregnant, they are not said to have gestational diabetes. Instead, they are referred to as pregnant women with diabetes.

In this post, we look at the symptoms, risk factors and treatment options for gestational diabetes. We also highlight some of the complications that may arise for both baby and the mother, importance of blood sugar control as well as tips to help women with gestational diabetes.

Pregnancy and increased blood sugar levels

As mentioned above, gestational diabetes occurs when a pregnant woman’s body does not produce adequate amounts of insulin. But how exactly does this work? After having a meal, the body takes the carbohydrates from the food and breaks them down to a type of sugar called glucose. This glucose is absorbed into blood circulation from where it is taken up by the body’s cells for energy production.

One of the organs that is involved in this process is the pancreas. The pancreas is the organ that produces the hormone insulin. Insulin helps transfer this sugar into the cells where it is needed, this reducing the levels of sugar in blood circulation.

In pregnancy, the placenta, which is the organ that allows for the baby to access nutrition and oxygen, also produces hormones that aid in the baby’s growth and development. Some of these hormones interfere with insulin production, making it hard to manage blood sugar levels. When this happens, the pancreas has to work three times as hard to make enough insulin. If this extra insulin cannot be produced, pregnant women then get gestational diabetes.

Who is likely to get gestational diabetes?

Any pregnant woman can develop gestational diabetes, but there are those who are at a higher risk. Statistics provided by the World Diabetes Foundation show that Gestational Diabetes affects up to 3% of all pregnancies. That’s approximately every 3 out of 100 pregnant women (Source).

You are likely to get gestational diabetes if:

  • You have had gestational diabetes in a previous pregnancy.
  • Your BMI (Body Mass Index) is more than 30, which is classified as obese. Obesity has been linked to poor insulin production, and is therefore a risk factor for gestational diabetes. Read more on how to work out your body mass index and what is healthy here.
  • You have a family history of type 2 diabetes.
  • You gain weight rapidly during pregnancy.
  • You have delivered a baby who weighs 4.5kgs (10lbs) or more before.
  • You have polycystic ovarian syndrome (PCOS).

What are some of the symptoms of gestational diabetes?

Gestational diabetes typically does not cause any symptoms. In fact, most pregnant women learn that they have gestational diabetes at routine clinic tests. If, however, the blood sugar levels get too high, some pregnant women will experience the following symptoms:

  • Feeling hungrier than usual, and eating a lot more
  • Increased thirst
  • The need to pee more often
  • Exhaustion
  • A dry mouth

It is important to mention that these symptoms may overlap with changes during pregnancy, and do not mean automatically mean that one has gestational diabetes. For this reason, only routine screening and blood sugar tests can confirm the condition. Most doctors carry out blood sugar tests between the 24th and the 28th week of pregnancy.

How does gestational diabetes affect the baby?

Many women with gestational diabetes go on to get healthy babies, but there are instances where this form of diabetes can pose medical challenges. These challenges include:

  • The baby is likely to be bigger than usual, often causing difficulties during childbirth. This happens because when the mother’s blood sugar levels are high, and the baby gets its nutrients from the mother, there is a chance s/he gets excess nutrients. They then become ‘overfed’ and tend to grow very big. For this reason, sometimes labour induction or a Caesarean Section is required for the baby’s safe delivery. The baby may also be born with nerve damage as a result of the pressure exerted on the shoulders during labour and delivery.
Gestational diabetes and big baby
Image showing how gestational diabetes leads to a big baby. Source.
  • Gestational diabetes has also been linked to the presence of excessive amounts of amniotic fluid. Amniotic fluid is the fluid that surrounds the baby in-utero. This condition, known as polyhydramnios, can lead to a preterm birth.
  • Women with gestational diabetes are also more likely to have a premature birth where the baby is born before 37 weeks of pregnancy are over.
  • There is also an increased risk of preeclampsia, a pregnancy complication that is characterized by increased blood pressure. If untreated, preeclampsia leads to eclampsia – a potentially fatal condition.

Read More: Preeclampsia and eclampsia – Here’s what you need to know

  • After birth, there is a chance that the baby could develop jaundice. Jaundice is a condition where the baby has low blood sugar levels, often accompanied by the yellowing of the eyes and the skin.
  • While this is rare, gestational diabetes may lead to a still birth.

Treatment and Management of gestational diabetes

The treatment and management of gestational diabetes revolves around keeping the levels of blood sugar under control all through the pregnancy. Your doctor will typically test you between weeks 24 and 28 of the pregnancy. For women at risk, this test may be done earlier and then repeated. It helps to work alongside a health professional in order to lower the blood sugar levels for the duration of the pregnancy.

Depending on the results obtained after the tests, treatment and management may include either or all of the following: dietary changes, regular exercise and medication.

Dietary changes to manage gestational diabetes

Dietary changes have been shown to be effective in helping keep blood sugar levels in check during pregnancy. Below are some helpful tips for the management of gestational diabetes. It is recommended that you incorporate these changes with advice from a qualified nutritionist. These changes include:

  • Eating regularly helps to maintain stable glucose levels. It is also advisable to avoid skipping meals as this causes sudden surges in the amount of glucose in blood circulation.
  • Consume foods that have a low glycemic index (GI). Such foods are preferred because they release sugar gradually and this goes a long way in stabilizing blood sugar levels. Such foods include, but are not limited to beans, brown rice, wholewheat products and lentils among others. Read more about the low-glycemic diet on this
  • Avoid sugary drinks and foods. Note that fruit smoothies and juices are also rich in sugar, so it helps to reduce their intake. Go for healthy snacks such as nuts and seeds.

Exercise as a means of managing gestational diabetes

Exercise is recommended for the management of gestational diabetes, simply because it helps to reduce the amount of glucose in blood circulation. A general guide is to get at least 150 minutes of exercise a week. Options range from brisk walking, to jogging, rope skipping, swimming and aqua aerobics. Make sure you speak to your doctor if you have concerns about exercising while pregnant. This is also recommended before conceiving to allow for a healthy pregnancy.

Read More: Pregnancy Timeline and what to expect in the three trimesters

Medication for gestational diabetes

Medication is given to pregnant women with gestational diabetes if dietary changes and medication do not show any progress as far as blood sugar levels are concerned. This medication may be in tablet or injection form.

In addition to these, pregnant women with gestational diabetes may be required to attend extra prenatal clinics to monitor both mother and the unborn baby.

Resources

The Kenya National Diabetes Educators Manual

Centers for  Disease Control and Prevention (CDC)

 

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