Gestational diabetes is a type of diabetes that develops only during pregnancy. Gestational diabetes causes high blood sugar that can affect a woman’s pregnancy and the baby’s health as well. Complications associated with gestational diabetes can be prevented by eating healthy foods, exercising and, if necessary, taking medication.
What is gestational diabetes?
Gestational diabetes is usually diagnosed after 20 weeks of pregnancy. Usually when blood sugars are elevated before this time it usually means the individual had diabetes prior to the pregnancy. Gestational diabetes only occurs in pregnancy – blood sugars are elevated due to impaired insulin function. For most women, gestational diabetes does not cause noticeable signs or symptoms. It is usually detected following screening tests carried out by the healthcare provider. Unfortunately, many providers do not routinely screen for gestational diabetes thus resulting in the diagnosis being missed or delayed in some pregnant women.
What causes gestational diabetes?
At this time, we do not know why some women develop gestational diabetes. Gestational diabetes usually develops during the last half of pregnancy — sometimes as early as the 20th week, but generally not until later.
Any pregnant woman can develop gestational diabetes, but some women are at greater risk. Risk factors for gestational diabetes include:
• Age greater than 25. Women older than age 25 are more likely to develop gestational diabetes.
• Family or personal health history. The risk of developing gestational diabetes increases if you have prediabetes — slightly elevated blood sugar that may be a precursor to type 2 diabetes — or if a close family member, such as a parent or sibling, has type 2 diabetes. You are also more likely to develop gestational diabetes if you had it during a previous pregnancy, if you delivered a baby who weighed more than 9 pounds (4.1 kilograms), or if you had an unexplained stillbirth.
• Excess weight. You are more likely to develop gestational diabetes if you are significantly overweight with a body mass index (BMI) of 30 or higher.
Complications of gestational diabetes
Most women who have gestational diabetes and who are properly managed deliver healthy babies. However, gestational diabetes that is not carefully managed can lead to uncontrolled blood sugar levels and cause problems for the pregnant woman and her baby, including an increased likelihood of needing a caesarean section to deliver.
Complications that may affect the baby
The complications for babies of women who had gestational diabetes can vary in severity and include the following:
• Extremely large babies. Extra glucose in your bloodstream crosses the placenta, which triggers your baby’s pancreas to make extra insulin. This can cause the baby to grow too large (macrosomia). Very large babies — those that weigh 9 pounds or more — are more likely to become wedged in the birth canal, sustain birth injuries or require a C-section birth.
• Early (preterm) birth and respiratory distress syndrome. A mother’s high blood sugar may increase her risk of early labour and delivering her baby before its due date. Or her doctor may recommend early delivery because the baby is large.
Babies born early may experience respiratory distress syndrome — a condition that makes breathing difficult. Babies with this syndrome may need help breathing until their lungs mature and become stronger. Babies of mothers with gestational diabetes may experience respiratory distress syndrome even if they’re not born early.
• Low blood sugar (hypoglycemia). Sometimes babies of mothers with gestational diabetes develop low blood sugar (hypoglycemia) shortly after birth because their own insulin production is high. Severe episodes of hypoglycemia may provoke seizures in the baby. Prompt feedings and sometimes an intravenous glucose solution can return the baby’s blood sugar level to normal.
• Type 2 diabetes later in life. Babies of mothers who have gestational diabetes have a higher risk of developing obesity and type 2 diabetes later in life.
Untreated gestational diabetes can result in a baby’s death either before or shortly after birth.
Complications to the pregnant woman
Gestational diabetes may also increase the mother’s risk of the following complications:
• High blood pressure and preeclampsia. Gestational diabetes raises the risk of high blood pressure, as well as preeclampsia — a serious complication of pregnancy that causes high blood pressure and other symptoms that can threaten the lives of both mother and baby.
• Future diabetes. If you have gestational diabetes, you are more likely to get it again during a future pregnancy. You are also more likely to develop type 2 diabetes as you get older. However, making healthy lifestyle choices such as eating healthy foods and exercising can help reduce the risk of future type 2 diabetes.
Of those women with a history of gestational diabetes who reach their ideal body weight after delivery, fewer than 1 in 4 eventually develops type 2 diabetes.
Management of gestational diabetes
All pregnant women should be monitored during the pregnancy, but individuals with gestational diabetes require closer monitoring and should be under the care of an experienced obstetrician.
It is essential to monitor and control the individual’s blood sugar to keep her baby healthy and avoid complications during pregnancy and delivery.
Close monitoring is required during labour and immediately following the delivery of the newborn.
Follow-up blood sugar checks are also important. Having gestational diabetes increases a woman’s risk of developing type 2 diabetes later in life. Maintaining health-promoting lifestyle habits, such as a healthy diet and regular exercise, can help reduce this risk.
Conclusion
Gestational diabetes is one type of diabetes that only occurs in pregnancy. There might be few or no symptoms to suggest diabetes mellitus and is often diagnosed following a screening test. If gestational diabetes is not managed properly, or goes undetected, it could cause a range of serious complications for both the pregnant woman and her offspring.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge MB BS DGO MRCOG, is an Obstetrician/Gynaecologist and Family Doctor who has over thirty-two years in clinical practice. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).
