Managing Gestational Diabetes for A Healthy Pregnancy

Gestational Diabetes Mellitus has become a health concern for pregnant women worldwide. The increasing prevalence in India makes it a growing and critical public health challenge. This blog breaks down in detail about gestational diabetes and management techniques that every expecting mother should be aware of.

What is Gestational Diabetes Mellitus?
Gestational diabetes mellitus (GDM) is a type of diabetes that is identified during pregnancy. It is characterised by high blood sugar levels that may impact the mother and the growing fetus. GDM, similar to other types of diabetes, influences the usage of glucose by the cells in the body. 

Despite the diagnosis, there’s some good news to know- Gestational diabetes during pregnancy can be managed with diet, exercise, and insulin (if required). And for some people, the blood sugar levels may drop back to normal after giving birth. 

GDM in India: What does Statistics Say?
The intolerance to carbohydrates results in high blood sugar during pregnancy. India has been stated as the world’s largest diabetes population. The burden of gestational diabetes mellitus in India is estimated to range from 7.2% to about 21.4%, with regional variations. Globally, the Centers for Disease Control and Prevention (CDC) stated a GDM prevalence of 8% to 10%.  

Fact Drop:

The urban population of India seems to have a high prevalence of GDM when compared to the rural population. 

What Causes Hyperglycemia in Pregnancy?

Changes in hormones are an important event in the course of pregnancy. The hormonal changes, coupled with insulin inefficacy or insufficiency, can lead to gestational diabetes mellitus during pregnancy. Insulin is a growth hormone that influences the usage of glucose by cells for energy. The hormones produced by the placenta during pregnancy may disturb insulin’s mechanism, leading to insulin resistance.  The increasing demand for insulin to manage blood glucose levels can lead to hyperglycemia (high blood sugar) and, thereby, GDM. 

Risk Factors for Gestational Diabetes

Screening for GDM is usually done between 24 and 28 weeks of pregnancy. All pregnant women may be at risk for gestational diabetes and, hence, must be screened. There are also certain factors that may increase the risk for GDM, like

• Physical inactivity
• Overweight or obesity
• Being diagnosed with prediabetes
• History of GDM in the previous pregnancy
• Previous instances of delivering a macrosomic infant (weighing more than 4 kg)
• PCOS
• High blood pressure and cardiovascular disease
• Family history of diabetes
• Belonging to a certain race or ethnicity, like Hispanic, Black, American Indian, or Asian. 
• Later maternal age

A study has shown that undergoing IVF (In Vitro Fertilisation) treatment may increase the risk for GDM compared to spontaneous pregnancy. However, more studies are needed to understand this. Consult an IVF specialist to understand your risks and management strategies for GDM. 

Signs and Symptoms of Gestational Diabetes

Identifying the signs and symptoms of GDM is mandatory for prompt diagnosis and treatment planning. Most pregnant women may not know they’ve been experiencing these signs and symptoms until a blood test is performed. The signs and symptoms of GDM that should be observed by pregnant women include

• Fatigue
• Excessive thirst
• Frequent urination
• Nausea
• Dry mouth

Diagnostic Tests for Gestational Diabetes 
During the second trimester, the gynecologist will schedule glucose tests to check for gestational diabetes. The ACOG (American College of Obstetricians & Gynecologists) recommends the 2-step screening approach for the diagnosis of GDM. 

• The glucose challenge test is also referred to as the glucose screening test or the one-hour glucose tolerance test. This test requires drinking a glucose solution (50g glucose) and testing after one hour.  
• Blood sugar levels above normal in the first test indicate the need for an Oral Glucose Tolerance Test (OGTT) to confirm the diagnosis. This test requires 8 hours of fasting prior to testing and drinking a glucose solution that contains 100g of glucose. Blood samples are tested once an hour over the three hours. Two or more abnormal levels of blood glucose confirm gestational diabetes mellitus in the woman. 

Effects of Gestational Diabetes on Pregnancy and the Fetus

The first question that may arise for an expectant mom with GDM is often, “How does GDM affect my baby?” 

Well, uncontrolled gestational diabetes can impart negative effects on the mother and the fetus. Being aware of the complications helps in proper management of the condition. 

The complications of gestational diabetes for the mother may include,

• C-section delivery: There is an increased chance of having a Caesarean section due to uncontrolled blood sugar levels during pregnancy. 
• Preeclampsia: Severe complications like high blood pressure or preeclampsia may also occur. These conditions can be threatening to the well-being of the mother and the fetus. 
• Type 2 diabetes: The woman is also at a high risk of developing type 2 diabetes later in life, when gestational diabetes is not managed and treated during pregnancy.  
• Diabetes in future pregnancy: Having gestational diabetes increases the chance of being diagnosed with it in future pregnancies as well. 

Poor control of gestational diabetes during pregnancy can put the fetus at risk for,

• Premature birth
• Increased birth weight or macrosomia
• Breathing trouble
• Low blood sugar that may cause seizures in infants
• Obesity while growing up
• Type 2 diabetes in later years
• Stillbirth, when GDM is not treated

The increasing prevalence of gestational diabetes among expecting mothers underlines the power of early identification and management of blood sugar levels to sideline short- and long-term complications. 

Management and Treatment Plan for GDM

Being diagnosed with gestational diabetes during pregnancy requires being extra mindful about eating habits, physical activity, and monitoring blood sugar levels. The ultimate goal is to control blood sugar levels and prevent complications. Tracking the blood sugar levels in pregnancy using a glucose meter will be helpful for your healthcare provider to curate treatment plans. Adapting a well-balanced, healthy meal plan and being active are important pillars in the management of gestational diabetes. Let’s dive deeper into managing gestational diabetes for a happier pregnancy journey.

• A healthy eating plan: Eating the right type of foods at the right time and in the right quantity is critical in reducing sugar levels in pregnancy. To avoid glucose fluctuations during pregnancy, it is recommended to consume small meals often (3 meals and 2 snacks in a day). The gestational diabetes diet plan should focus on complex carbohydrates, lean or plant-based proteins, and healthy fats like olive oil, legumes, avocados, nuts, and seeds. A diet containing simple sugars, saturated fats, and processed foods must be avoided. Staying well-hydrated by drinking adequate fluids throughout the day is highly recommended. Consult a healthcare professional to understand specific dietary needs for your pregnancy.
• Move more: With the approval of your gynecologist, staying active and engaging in moderate-intensity exercises is encouraged. At least 30 minutes of exercise on most days of the week can impart benefits in controlling gestational diabetes. Exercising during pregnancy has shown several benefits for maternal and fetal health. 
• Tracking blood sugar levels: Regularly checking blood sugar levels during pregnancy helps you keep track of your health and take necessary actions. According to the American Diabetes Association (ADA) guidelines, the target blood sugar levels for gestational diabetes are: fasting or before meal <95mg/dL, one hour postprandial <140mg/dL, and two hours postprandial <120 mg/dL. However, variations may occur depending on the individual’s health and treatment strategy. 
• Medications: For some women, the use of medications may be suggested to achieve optimal control of blood sugar levels during pregnancy. A gynecologist knows what’s best for the mother and the fetus. At Nakshatra IVF & Women’s Centre, our specialists plan effective and practical treatment plans to prevent and control gestational diabetes among expectant mothers. 

• Sweet Takeaways

Gestational diabetes mellitus can be controlled and managed with an appropriate treatment plan. Maintaining the blood sugar levels within an optimal range is the central goal in gestational diabetes mellitus. Eating small meals frequently, regular exercise, and medications, if suggested, can help pregnant mothers with GDM achieve the goal and dodge complications.