Pregnancy Q&A

Gestational Diabetes

Being diagnosed with gestational diabetes can be a very distressing time for a woman during pregnancy, especially a first pregnancy.

Not only do you have to deal with the emotional, hormonal and physical changes of pregnancy which comes with a lot of questions already, but now you have to cope with managing your blood sugar levels as well. It can be frightening.Gestational Diabetes

The good news is that it is a manageable condition. With the help and support of a dietician, healthcare team and your doctor, you can have a healthy pregnancy.

What is Gestational Diabetes?

“Gestation” is defined as the time between conception and birth, which is “during pregnancy”. Diabetes is defined as a metabolic disorder in which a person has a high blood sugar level (glucose level). Therefore gestational diabetes (also called gestational diabetes mellitus) is a condition in which women, who have never had diabetes, develop high blood sugar (glucose) levels during pregnancy, usually in the third trimester.

What Causes Gestational Diabetes?

We do not know exactly what triggers gestational diabetes in some women and not everyone, but we do know that hormones produced by the placenta block the mother’s insulin, creating an insulin resistance. The role of insulin is to move the sugar from your blood into your cells for energy storage. When the insulin action is blocked, insulin can no longer move the sugar out of your blood and your blood sugar levels rise and stay high. This is dangerous for both you and your unborn baby.

Because it is the hormones from the placenta that creates this resistance to insulin, after birth these hormones disappear and the insulin can then act normally, allowing the blood sugar levels to revert to normal again. Hence the name “gestational diabetes” as it only occurs during pregnancy.

Risk Factors For Gestational Diabetes:

Any pregnant woman can develop gestational diabetes; however there are some risk factors that increase the chances of developing gestational diabetes such as:

  • Obesity – the higher your Body Mass Index (BMI), especially a BMI > 30, the more likely you are of developing gestational diabetes.
  • A family history of type 2 diabetes, especially a parent or sibling.
  • If you had a previous pregnancy with gestational diabetes.
  • If you have given birth to a baby weighing more than 9 lbs. or 4 kgs.
  •  If you have pre-diabetes – when your blood sugar (glucose) levels are slightly elevated prior to becoming pregnant.
  • Unexplained multiple miscarriages or stillbirths – excluding gestational diabetes would be one of the investigations done.
  • Age – gestational diabetes is rare in pregnant women under the age of 25, increasing over the age of 25 and particularly over the age of 30.
  • Polycystic Ovarian Syndrome (PCOS) – a common cause of infertility is also associated with insulin resistance and therefore early screening for gestational diabetes is recommended.
  • For reasons unknown, women who are African American, American Indian, Asian American, Hispanic/Latina, Pacific Islander American, Aboriginal, Torres Strait Islanders, Indian, Vietnamese, Chinese, Middle Eastern or Polynesian have a higher risk of developing gestational diabetes

The prevalence of gestational diabetes varies globally and it is estimated that it affects approximately 8% of pregnant women in Australia, 3.5% of pregnant women in the United Kingdom and up to 18% of pregnant women in America.

What Are The Symptoms Of Gestational Diabetes?

For most pregnant women, gestational diabetes does not present itself with any noticeable symptoms and therefore it is most commonly diagnosed through screening tests done between the 24th and 28th weeks of pregnancy. Symptoms such as tiredness, frequency of urination and thirst may be overlooked as “normal” pregnancy symptoms.

Once you become pregnant, as part of your prenatal care, your doctor will evaluate your risk of developing gestational diabetes and determine when you will need a screening test.

Gestational Diabetes Test:

Depending on your risk of developing gestational diabetes, you may have the test much earlier or as a routine screening test between the 24th and 28th weeks of your pregnancy.

The screening test is called a glucose challenge test and involves drinking a flavored syrupy drink, waiting an hour and then having a blood test done.

If the results are normal, no further testing is required. If the screening test shows a high blood sugar (glucose) level, a second test is then done.

This is called a glucose tolerance test (GTT) and for this you need to fast overnight (8 hours), have a fasting glucose blood test done, then drink another syrupy glucose solution and then have a blood test taken at 1 hour intervals over the next 3 hours (4 lots of blood taken).

The diagnosis of gestational diabetes is made if at least 2 of your blood glucose levels are higher than normal.

Why Is It So Important To Test For Diabetes During Pregnancy?

Uncontrolled gestational diabetes can have harmful effects on both your pregnancy and your unborn baby. As it is usually diagnosed late in pregnancy, around the third trimester, after your baby has developed, it does not cause birth defects.
However, uncontrolled high levels of blood glucose will increase the risk of:

  • A big baby weighing more than 4 kgs or 8.8 lbs. This is called macrosomia. Because of the high blood glucose levels passing to the fetus, your unborn baby’s insulin works overtime storing the excess glucose as fat. A possible complication of this is shoulder dystonia. This is when the baby’s shoulders get stuck during delivery, leading to breathing problems.
  • Requiring a caesarian section because of the size of the fetus.
  • Preterm baby – going into labor before 37 weeks gestation. This may result in your baby developing respiratory distress syndrome and needing assistance with breathing until his/her lungs are mature enough.
  •  Baby having a low blood sugar (glucose) level (called hypoglycaemia) after birth because baby’s insulin production is increased. If not treated promptly with feeding or intravenous glucose, the risk of seizures is high.
  • Baby developing jaundice – a yellowish discoloration of your baby’s skin and the white part of the eyes. This is caused by the inability of the liver to breakdown bilirubin and has to be monitored and treated under ultraviolet light if necessary.
  • Perinatal death – increased risk of your baby dying just before or just after birth.
  • Your baby developing obesity and/or type 2 diabetes later in life.
  • You developing gestational diabetes with subsequent pregnancies and a higher risk of developing type 2 diabetes later.
  • You developing hypertension during pregnancy which can lead to pre-eclampsia and eclampsia, which are life threatening disorders. Pre-eclampsia is characterized by a rapid rise in your blood pressure, fluid retention (edema) and protein in the urine (proteinuria) which, if left untreated, can lead to seizures, a stroke, multiple organ failure and death.

To prevent complications during pregnancy that can affect both you and your unborn baby, it is very important to have your gestational diabetes monitored and managed. This way you can reduce the risks and have a healthy pregnancy.

Managing Gestational Diabetes

After the diagnosis has been confirmed by the GTT, you will have a lot of questions you will want answers to.

Write down all the questions as they come to mind so that you do not forget any and have your list ready before your next appointment with your doctor.

Read as much as you can on gestational diabetes management, talk to your health care team and join a support group. The more knowledge you have about monitoring and managing your gestational diabetes, the more in control you will feel and the easier it will be to make the necessary changes to your lifestyle.

Part of the monitoring process may include more frequent check-ups with your doctor and monitoring of your baby’s health through fetal movement counting, ultrasounds and measuring your baby’s heart rate.

During pregnancy, managing your gestational diabetes may include:

  • Special meal plans (based on your height and weight) which will be individualized for you by the dietician in your health care team as no single diet is right for everyone. This will include not only what you eat, but how often and portion size to help keep your blood glucose levels within target levels.
  • Regular exercise as this stimulates your body to move glucose into your cells which helps to regulate your blood glucose levels.
  • Monitoring your blood glucose levels regularly during the day, starting just after waking (before having a meal), just before meals and again 1 to 2 hours after meals. This ensures that you stay within your recommended target levels and allows for adjustments to your diet plan if necessary. Monitoring your blood glucose levels involves using a glucometer, a test strip and a small drop of blood. If the thought of pricking your finger to get a drop of blood is scary, do not worry as you will be helped by your health care team until you are confident enough to do it yourself. It is a lot easier with the newer lancets – see the video below on how to use a glucometer.
  • Occasionally a diet plan may not be enough to achieve your target glucose levels and you may require insulin injections.

What Happens After The Birth Of Your Baby?

Normally the blood glucose levels return to normal but in approximately 5% to 10% of women it stays high and further testing usually confirms a diagnosis of diabetes, mostly type 2 diabetes.

Therefore it is very important to continue having your blood glucose levels monitored after your baby is born.

You will still have a 10-fold increase in the risk of developing type 2 diabetes later in life too. Your doctor will continue to monitor your glucose levels for at least 6 to 12 weeks after baby is born and you will probably have regular checks for diabetes every 2 to 3 years.

Regular exercise, maintaining a normal body mass index (BMI) and a healthy diet will reduce this risk. Do not use crash dieting to lose weight. This is a long term goal and adopting a healthy lifestyle for your family will be more beneficial for your health and your children’s in the future.

As the risk of developing gestational diabetes with future pregnancies is increased, it is important to plan ahead and discuss your next pregnancy with your doctor, so that your weight and blood glucose levels can be monitored prior to becoming pregnant and from an early stage during subsequent pregnancies.

There are no guarantees in trying to prevent gestational diabetes, but the more healthy habits you can develop before becoming pregnant, the better.

Diet for Gestational Diabetes

Each woman with gestational diabetes will have an individualized diet plan based her BMI, level of physical activity, size and growth of baby and her blood glucose levels.

The diet plan is generally based on:

  • Spreading your carbohydrate intake over 3 small meals and 2 to 3 snacks per day and choosing low glycemic index (GI) ones. (The GI is a measure of how quickly the carbohydrate in foods will affect the level of glucose in your blood). Avoiding carbohydrates with lots of added sugar.
  • Limiting the intake of saturated fats by choosing lean meats, low fat dairy products and staying away from take away and processed foods and using healthier fats such as canola or olive oil and avocado.Exercise during pregnancy
  • Eating plenty of non-starchy vegetables and proteins.
  • Meal planning centred on eating several small meals throughout the day.
  • Avoiding simple sugars such as white sugar, honey, jams, maple syrup, candy and soft drinks.
  • Combining foods so that you do not ingest carbohydrates on their own.
  • High fibre content.
  • Drinking lots of water.
  • Exercise.

Here are some resources for creating a gestational diabetes meal plan:

Healthy Eating For Gestational Diabetes
Gestational Diabetes 2000 Calorie Menu Plan
Healthy Eating Guide For Gestational Diabetes
Gestational Diabetes Meal Planner Guide
Gestational Diabetes Recipes
Healthy Eating Plan For Gestational Diabetes
Gestational Diabetes – caring for yourself and your baby
Food For Gestational Diabetes – do’s and don’ts

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