Gestational Diabetes

Gestational diabetes today accounts for the highest rate of common diseases in obstetrics in many countries with developing economies.  

What is gestational diabetes?  

Gestational diabetes is a condition in which hormones produced by the placenta prevent the body from effectively using insulin. Glucose builds up in the blood instead of being absorbed by cells.  

Unlike type 1 diabetes, gestational diabetes is not caused by a lack of insulin but is caused by other hormones produced during pregnancy that can make insulin less effective, a condition known as diabetes is insulin resistance. The symptoms of gestational diabetes may go away after delivery. 

Why are women more susceptible to diabetes during pregnancy?  

Although the cause of gestational diabetes is not known, there are several theories as to why the condition occurs.  

The placenta provides nutrients and water to the developing fetus, and also produces a variety of hormones to sustain the pregnancy. Some of these hormones (estrogen, cortisol, and placental lactogen) can have an insulin-blocking effect. This is called the anti-insulin effect, which usually begins around the 20th to 24th week of pregnancy.  

As the placenta grows, more of these hormones are produced, and the risk of insulin resistance becomes greater. Normally, the pancreas can make extra insulin to overcome insulin resistance, but when it doesn’t produce enough insulin to overcome the influence of placental hormones, gestational diabetes can result. 

 What are the risk factors associated with gestational diabetes?  

Although any woman can develop diabetes during pregnancy, certain factors can increase the risk including:  

• Being overweight or obese Family history of diabetes  
• Having given birth a newborn weighing more than 4kg before  
• Age (women over 25 have a higher risk of gestational diabetes than younger women) 
• Race (women who are African-American, American Indian, Asian-American, Hispanic or Latino, or Pacific Islander are at higher risk)
• Prediabetes, also called is impaired glucose tolerance  

 Although elevated urine glucose is often included in the list of risk factors, it is not thought to be a reliable indicator of gestational diabetes. 

How is gestational diabetes diagnosed? 

 The American Diabetes Association recommends screening for undiagnosed type 2 diabetes at the first prenatal visit in women with diabetes risk factors. In pregnant women not known to have diabetes, testing for gestational diabetes should be done at 24 to 28 weeks’ gestation.  

In addition, women diagnosed with gestational diabetes should be screened for persistent diabetes 6 to 12 weeks postpartum. Women with a history of gestational diabetes are also recommended to have lifelong screening for diabetes or prediabetes at least every three years.  

How is gestational diabetes treated? 

Specific treatment for gestational diabetes will be determined by your doctor based on: 

•  Your age, overall health, and medical history  
• Level of disease  
• Your tolerance to medications , specific procedure, or therapy  
• Expectations for the course of the disease  
• Your opinion or preferences

 Treatment for gestational diabetes focuses on keeping blood sugar levels in the normal range. Treatment may include:  

• Special diet  
• Exercise  
• Daily blood sugar monitoring  
• Insulin injections 

Possible complications for the baby after birth?  

Unlike type 1 diabetes, gestational diabetes often occurs too late to cause birth defects. Birth defects usually begin during the first trimester (before the 13th week) of pregnancy. Insulin resistance due to insulin-resistant hormones produced by the placenta usually doesn’t occur until about 24 weeks. Women with gestational diabetes usually have normal blood sugar levels during the crucial first trimester of pregnancy. 

 Complications of gestational diabetes are usually manageable and preventable. The key to prevention is careful control of blood sugar as soon as diabetes is diagnosed. 

Infants of mothers with gestational diabetes are prone to chemical imbalances, such as low serum calcium and low serum magnesium levels, but in general, there are two main problems of diabetes pregnancy: macrosomia and hypoglycemia 

• Macrosomia. Macrosomia refers to a baby that is significantly larger than normal. All the nutrients the fetus receives come directly from the mother’s blood. If the mother’s blood has too much glucose, the fetus’s pancreas senses the high amount of glucose and produces more insulin to try to use this glucose. The fetus converts excess glucose into fat. Even if the mother has gestational diabetes, the fetus can still produce all the insulin it needs. The combination of high blood sugar from the mother and high insulin levels in the fetus leads to a lot of fat accumulation that causes the fetus to overgrow. 
• Hypoglycemia . Hypoglycemia refers to a baby’s low blood sugar soon after birth. This problem occurs if the mother’s blood sugar is always high, causing the fetus to have high levels of insulin in the circulation. After birth, the baby continues to have high insulin levels, but it no longer has high sugar levels from the mother, resulting in the infant’s blood sugar becoming very low. The baby’s blood sugar is checked after birth, and if the level is too low, an intravenous line may be given to the baby.  

Blood glucose is monitored very closely during labor. Insulin may be given to keep the mother’s blood sugar in the normal range to prevent the baby’s blood sugar from dropping too much after birth. 

(Source: Johns Hopkins Medicine) 

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