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11 April, 2021

Gestational Diabetes (GDM)

Diabetes diagnosed for the first time during pregnancy (gestation) is known as Gestational Diabetes. Gestational diabetes causes high blood sugar that can affect both Mother and baby.

There are two classes of gestational diabetes. Women with class A1 will be able to manage it through diet and exercise, while class A2 need to take insulin or other medications.

Blood sugar often returns to normal soon after delivery. But if you’ve had gestational diabetes, you are at a higher risk of getting type 2 diabetes. You’ll need to be tested for changes in blood sugar levels more often.

Symptoms

Women with gestational diabetes usually don’t have symptoms or may confuse them up to pregnancy. Most find out that they have it during a routine screening at 24-28weeks of Gestation.
You may notice that:

  • You’re thirstier than usual
  • You’re hungrier and eat more than usual
  • You pee more than usual

Causes

Insulin hormone is produced in the pancreas and regulates the body’s metabolism of fats and carbs, and helps the body turn sugar into energy.

Gestational diabetes occurs when hormones from the placenta blocks insulin and prevents the body from regulating the increased blood sugar of pregnancy effectively.

This causes high levels of sugar in the blood(Hyperglycemia), which can damage the nerves, blood vessels and organs in your body.

Risk factors

Risk factors for gestational diabetes include the following:

  • Overweight and obesity.
  • A lack of physical activity.
  • Previous gestational diabetes or prediabetes.
  • Polycystic ovary syndrome.
  • Diabetes in an immediate family member.
  • Previously delivering a baby weighing more than 4kgs.
  • Family History
  • Multifetal Pregnancies
  • Teenage or Elderly Pregnancies

Complications

Complications that may affect your baby

  • Excessive birth weight. Higher levels of blood sugar in mothers can cause their babies to grow too large and have birth injuries or need a C-section birth.
  • Early (preterm) birth. High blood sugar may increase risk of early labor and delivery before the due date. Early delivery may be recommended if the baby is large.
  • Serious breathing difficulties. Preterm babies born to mothers with gestational diabetes may experience respiratory distress syndrome.
  • Low blood sugar (hypoglycemia).Babies of mothers with gestational diabetes have low blood sugar (hypoglycemia) soon after birth. Severe episodic hypoglycemia may cause seizures in the baby. Frequent feedings and sometimes an intravenous glucose solution can return the baby’s blood sugar level to normal.
  • Obesity and type 2 diabetes in future. Babies of mothers with gestational diabetes have a higher risk of developing obesity and type 2 diabetes later in life.
  • Stillbirth. Uncontolled gestational diabetes can result in a baby’s death either before or shortly after birth.

Complications that may affect you

Gestational diabetes may also increase your risk of:

  • High blood pressure and preeclampsia. Gestational diabetes raises risk of high blood pressure, as well as preeclampsia.
  • Having a surgical delivery (C-section).
  • Future diabetes. If you have gestational diabetes, you’re more likely to get it again during a future pregnancy and type 2 diabetes later in life.

Prevention

There are no absolute steps for preventing gestational diabetes — but the more healthy habits you can adopt before pregnancy, the better.

  • Eat healthy foods. Choose foods high in fiber and low in fat and calories.Watch portion sizes.
  • Keep active. Exercising regularly before and during pregnancy can help protect you from developing gestational diabetes. 
  • Start pregnancy at a healthy weight. If you’re planning pregnancy, losing extra weight beforehand may help you have a healthier pregnancy.
  • Don’t gain more weight than recommended. 

Diagnosis

Initial glucose challenge test. You’ll drink a glucose solution. One hour later,  a blood test will be done to measure your blood sugar level. A blood sugar level of 190mg/dL indicates gestational diabetes.

Follow-up glucose tolerance testing. This test is similar to the previous test — except the sweet solution will have even more sugar and your blood sugar will be checked every hour for three hours. If at least two of the blood sugar readings are abnormal, you’ll be diagnosed with gestational diabetes.

Treatment

Treatment for gestational diabetes includes:

  • Lifestyle changes
  • Blood sugar monitoring
  • Medication, if necessary

Close management will help us avoid complications during pregnancy and delivery.

Lifestyle changes

Eat a healthy, low-sugar diet. Be sure you’re getting the nutrition you need. Follow a meal plan made for diabetics:

  • Replace sugary snacks like cookies, candy, and ice cream for natural sugars like fruits, carrots, and raisins.Include vegetables and whole grains, and watch your portion sizes.
  • Have three small meals along with two or three snacks regularly every day.
  • 40% of your daily calories should come from carbs and 20% from protein. Fifty percent of the carbs should be complex, high-fiber carbs, with fat being between 25% and 30%.
  • Take 20-35 grams of fiber a day. Foods such as whole-grain breads, cereals, and pasta; brown or wild rice; oatmeal; and vegetables and fruits will be helpful.
  • Total fat intake should be less than 40% of your daily calories. Saturated fat should be less than 10% of all the fat you eat.
  • Eat a variety of foods to make sure you get all vitamins and minerals. You may need to take a supplement to cover for deficiets. Stay active-Regular physical activity plays a key role in every woman’s wellness plan before, during and after pregnancy. Exercise helps to lowers your blood sugar, and regular exercise can help relieve some common discomforts of pregnancy, including back pain, muscle cramps, swelling, constipation and trouble sleeping.

Monitor your blood sugar-to make sure your level stays within a healthy range.

Medication

If diet and exercise aren’t enough, you may need Oral medication s or insulin injections to lower your blood sugar. About 10% and 20% of women with gestational diabetes need insulin to reach their blood sugar goals. 

Close monitoring of your baby

Close observation of your baby is important part of the treatment plan. It’s needed to check your baby’s growth and development with repeated ultrasounds or other tests. If you don’t go into labor by due date — or sometimes earlier — your doctor may induce labor. Delivering after due date may increase the risk of complications.

Follow-up after delivery

Check blood sugar levels after delivery and again in six to 12 weeks to make sure that your level has returned to normal. If your tests results are normal — and most are — you’ll need to have your diabetes risk assessed at least every three years.

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