What is Gestational Diabetes?
Gestational diabetes is a type of diabetes that only occurs in pregnant women and is either the result of changes in the production of hormones during pregnancy which cause insulin-resistance or a reveal of type 2 diabetes that exists before pregnancy. There is no test to differentiate between the two causes, but the difference between them is that gestational diabetes usually disappears after delivery, but type 2 diabetes does not. In addition, having gestational diabetes increases the women’s risk of developing type 2 diabetes in later life (after delivery).
Who is at risk for Gestational Diabetes?
The exact causes are still not known. There are some factors that increase the risk for having gestational diabetes. Risk factors include:
- Personal health history; women who are overweight, inactive, or if they had gestational diabetes are at higher risk for gestational diabetes.
- Family history: If a family member (mother or sister) have had gestational diabetes.
- Women who have had given a birth to a large or stillborn baby.
- Women over the age of 30.
How is Gestational Diabetes Diagnosed?
As gestational diabetes may produce no obvious symptoms, all pregnant women undergo a blood glucose test called Glucose Tolerance Test (GTT), around the 24th -28th week of gestation as a part of their pre-natal visits.
For those who have risk factors such as a history with gestational diabetes, blood glucose testing can be done at the first visit.
How to manage Gestational Diabetes?
To prevent complications of gestational diabetes, you need to start managing gestational diabetes as soon as you are diagnosed with it. Management for gestational diabetes aims to keep blood glucose levels equal to those of pregnant women who don’t have gestational diabetes.
Gestational diabetes management includes:
- Adopt a healthy diet.
- Exercise regularly.
- Test blood glucose frequently.
- Take insulin injections if needed.
- Follow up closely with your doctor, diabetic educator, and dietitian for better control of your gestational diabetes.
During the first trimester, a pregnant woman does not require any extra calories because the baby is still far too small to require extra energy from the mother. Caloric needs increase during the second trimester. At that time, a woman should add approximately 350 calories to her pre-pregnancy diet and about 450 calories a day more during the third trimester. Women who begin pregnancy overweight may need fewer calories and those who are underweight may need more. The added calories should come from healthy food rather than fatty and sugary food.
If you are concerned about how to add the extra calories to your diet, ask your dietitian to help you calculate the calories you need and how to distribute these calories in your meals and snacks throughout the day.
Exercise helps to control weight, keep blood pressure and glucose levels within the normal range, reduce stress that may lead to overeating and improve circulation and strength. Regular exercise allows the body to use glucose without extra insulin which helps combat insulin resistance.
Most women with uncomplicated pregnancies can do physical activity throughout their pregnancies, and they can start a program (most likely walking) while pregnant even if they have not worked out in the recent past. Check your blood glucose levels before you exercise. Do not exercise if your blood glucose is too low.
Signs and symptoms of low blood glucose:
Low blood glucose usually occurs gradually, so you need to pay attention to how you feel during exercise. You may feel:
- • Dizzy
- • Hungry
- • Shaky hands
- • Change in your heartbeat
- • Anxious
When you experience these signs and symptoms, stop exercising and follow your doctor and diabetic educator’s advice about how to treat low blood glucose. Sweat more than normal/
How to treat low blood glucose
Use the 15/15 Role;
- Eat a sugary food that has 15 grams of glucose such as 3 glucose tablets, a 1/2 cup of unsweetened fruit juice or regular, non-diet soda, 3 hard candies, 1 tablespoon sugar, plain or dissolved in water or 1 tablespoon honey or syrup.
- Check your blood glucose level after 15 minutes;
- If it is 70 mg/dl or higher take a snack or your meal if it is your meal time.
- If it is still under 70, repeat the above treatment (step 1 & 2).
- Frequent blood glucose testing:
Both fasting and two hours after meal blood tests are usually needed to be done on daily basis. Your doctor and diabetes educator will inform you about the required blood glucose levels. Home glucose monitoring record should be available with you each visit. New glucometers save all the results, so if you are using one of those; make sure you bring it with you to your appointment.
- Insulin injections, (if needed)
- Maintain a routine follow-up with the doctor, nurse/diabetic educator, dietitian and other members of the health care team. With close follow up, treatment can be monitored and modified as needed.
Watch your weight gain during pregnancy
Healthy weight gain during pregnancy decreases the risk of developing gestational diabetes and prevents complications for the mother and her child. Healthy weight gain during pregnancy also helps women return to a healthy weight after pregnancy.
The guidelines below show the recommended weight gain during pregnancy based on the weight status before pregnancy:
Weight Status Before Pregnancy Recommended Weight Gain
- Underweight 13-18 kg
- Healthy weight 11-16 kg
- Overweight 7-11.5 kg
- Multiple babies: Twins 16-20.5 kg
- Multiple babies: Three or more. Consult your doctor
What are the complications of gestational diabetes?
Possible complications for gestational diabetes include the following:
- • Having larger than normal babies, thus increasing the risk for post-partum hemorrhage because of the increased size of your uterus.
- • Babies are at risk for low blood glucose soon after they are born.
- • Babies may be at risk for developing obesity and type II diabetes when they grow older.
- Increased levels of glucose in the womb affects the baby’s lung growth and maturity, which could lead to breathing problems after delivery.
Maintain a healthy lifestyle after delivery
A woman who had gestational diabetes may continue to have high blood glucose after delivery and may deliver type 2 diabetes later in life. To decrease the chance of developing type 2 diabetes, it is important to maintain the diet, exercise and blood glucose testing (usually OGTT) plans for at least 6 months after delivery.
Studies show that women should try to lose the excess pregnancy pounds, in a safe manner, within one year of delivery. After that, they are likely to keep those pounds on, which increases the chance of developing diabetes, as overweight is a strong risk factor for diabetes.
Breast Feeding and risk for low blood glucose levels
Breastfeeding is good for women with diabetes, but the risk of low blood glucose is high because women who breastfeed burn more calories, in addition the abnormal sleep patterns increase the chance of sleeping through a snack or mealtime which can cause low blood glucose.
How to help prevent low blood glucose levels due to breastfeeding:
- lan to have a snack before or during breastfeeding.
- Drink enough fluids (plan to sip a glass of water or a caffeine-free drink while breastfeeding).
- Keep something to treat low blood glucose nearby when you breastfeed, so you don’t have to stop a feeding to treat low blood glucose.
- Check your blood glucose often and keep records of your results to help you track low blood glucose levels and also to help your physician adjust your insulin dose if you are using insulin.
How to decrease the risks of gestational diabetes in future pregnancies?
Before your next pregnancy:
To lower your risk for gestational diabetes in future pregnancies, we advise you to be fit for the pregnancy by losing any excess weight and starting a pregnancy at a healthy weight. Being fit also includes being physically active, inactive women have higher risk for developing gestational diabetes.
Watch your weight gain. Healthy weight gain during pregnancy is explained above. In addition, maintain physical activity such as walking if you don’t have any complications. Remember it is always advised to check with your physician before starting to exercise.
Compliance with your gestational diabetes management plan will give you a healthy pregnancy and birth, and help your baby to avoid future health problems.