What Is Gestational Diabetes?
When diabetes develops during pregnancy, it is known as gestational diabetes. Excessive glucose in the blood (hyperglycemia) in a pregnant woman who has gestational diabetes increases the risk of pregnancy complications and health risks to her and her baby. Having gestational diabetes also increases the risk that the woman will develop type 2 diabetes later in life [1,2].
Symptoms may be experienced by both the mother and the infant. Mothers may experience high blood pressure, frequent urination, difficulty breathing, and complications during labor and delivery. Infants will be more likely to be premature, have other birth defects, and are also at a greater risk of developing diabetes later in life.
Treatments will include glucose monitoring, lifestyle adjustments, medications, and a likely Cesarean delivery.
You should visit your primary care physician or obstetrician within 24 hours. Here a test for gestational diabetes, along with additional preventative tests, will be given. This will give you more knowledge on how to manage your pregnancy.
How common is Gestational Diabetes?
Gestational Diabetes is also known as
- Diabetes mellitus in pregnancy
- Overt diabetes
- Gestational diabetes mellitus
Gestational Diabetes Symptoms
Gestational diabetes may not cause any symptoms until complications develop. Therefore, most pregnant women are screened for gestational diabetes between 24 and 28 weeks of gestation, although some women may be screened earlier if they are at a high risk of developing gestational diabetes . Symptoms can be categorized by those experienced by mothers as well as those that will likely be present in infants.
Symptoms experienced by mothers
Symptoms that a mother with gestational diabetes may experience include:
- High blood pressure (hypertension): During pregnancy also called preeclampsia, this condition involves high blood pressure and possible damage to organs such as the kidneys or liver. This may cause symptoms such as a headache, vision changes, frothy urine, or decreased urine.
- Urinating more frequently than usual: Diabetes increases levels of sugar in the urine, which increases the frequency of urination, as the body tries to eliminate the excess sugar.
- Difficulty breathing: Having gestational diabetes is associated with polyhydramnios in which there is excessive amniotic fluid in the amniotic sac. This can cause the mother to have difficulty breathing and is also associated with complications for the baby during labor and delivery.
- Complications during labor and delivery: Infants of mothers with diabetes are likely to have larger bodies and head sizes, which may make vaginal delivery difficulty. Vaginal delivery may require the use of instruments such as forceps, or the mother may have to undergo Cesarean delivery (C-section).
Symptoms present in infants
Symptoms in the baby of a mother with gestational diabetes include:
- Preterm birth: This is defined as less than 37 weeks gestational age.
- Large head and body size: This occurs because they are exposed to higher-than-normal levels of nutrients during pregnancy. This may make delivery difficult and increases the risk that the infant may be injured during the delivery.
- Low blood sugar: Some infants of mothers with gestational diabetes may develop low blood sugar (hypoglycemia) shortly after birth, which may cause irritability, tremors, paleness, sweating, and/or changes in consciousness. This is because the baby had been temporarily exposed to high insulin levels from the mother. This usually lasts for two to four days and resolves when the infant's insulin levels normalize.
- Difficulty breathing: This is because their lungs are more likely to be underdeveloped.
- Birth defects: These may include defects of the heart, brain, spine, gut, and limbs, among others.
- Diabetes later in life: In addition to the symptoms above, infants of mothers with gestational diabetes are more likely to develop diabetes as a teenager or adult.
Gestational Diabetes Causes
Diabetes is a condition in which the level of glucose, a sugar in the blood, is abnormally high. Type 1 diabetes tends to develop early in life and requires lifelong insulin injections to survive. Type 2 diabetes tends to occur later in life but may be controlled through healthy food choices, daily exercise, and medications. As discussed prior, gestational diabetes is diabetes that develops during pregnancy.
Possible causes of gestational diabetes include increased insulin resistance, having a history of diabetes of any kind, related medical conditions, as well as a few other risk factors.
Increased insulin resistance during pregnancy
Gestational diabetes typically develops due to increased resistance to insulin during pregnancy . Insulin is a hormone in the body that normally helps the body metabolize glucose, maintaining normal glucose levels. During pregnancy, the placenta releases hormones that increase resistance to insulin, making it less effective. Usually, the body can produce more insulin to compensate for the increased insulin resistance. However, if the body cannot make enough insulin, then blood sugar levels increase and gestational diabetes results.
History of diabetes or gestational diabetes
Women who have a history of diabetes, either while pregnant or not while pregnant, have an increased risk of developing gestational diabetes. In addition, women who have a family member with diabetes also have an increased risk of developing gestational diabetes.
Related medical conditions
Related medical conditions that increase the risk of developing gestational diabetes include:
- Being overweight, obese, or gaining excessive pregnancy weight
- High blood pressure
- Polycystic ovary syndrome
- Taking steroids
Other risk factors
Other risk factors that increase the risk of developing gestational diabetes include:
- Older maternal age: This includes women who are older than 25 years of age.
- Certain ethnic groups: These include women who are Hispanic American, African American, Native American, South or East Asian, and Pacific Islander.
- Having a multiple gestation pregnancy: Being pregnant with twins or triplets increases the risk of developing gestational diabetes.
Treatment Options and Prevention for Gestational Diabetes
Methods of treating or relieving effects of gestational diabetes include glucose monitoring, nutritional therapy, exercise, medications, and induced labor or C-sections .
Most women with gestational diabetes are asked to monitor their blood glucose levels on a regular basis, usually multiple times per day. This will help the physician determine how well the blood glucose is being controlled and decide what treatments to recommend.
Most women with gestational diabetes will benefit from nutritional therapy, which involves receiving nutritional counseling from a registered dietician and following a special diet that ensures adequate nutrition for the developing baby while avoiding high blood sugar levels [1,5].
Most women with gestational diabetes will also benefit from regular exercise, especially exercise that builds muscle mass. Muscle is beneficial in gestational diabetes because it increases the body's sensitivity to insulin, helping to normalize blood sugar levels.
Women with gestational diabetes whose blood sugar is not well controlled with diet and exercise will need medications to lower blood glucose levels. These include medications taken by mouth or insulin injections described below.
- Metformin: Such as Glucophage or Glumetza
- Glyburide: Such as Diabeta or Glynase
- Insulin injections: Such as lispro (Humalog), aspart (Novolog), NPH (Novolin), glargine (Lantus), and detemir (Levemir)
Induction of labor or scheduled Cesarean delivery
Some physicians may recommend that women with gestational diabetes undergo induction of labor at a certain gestational age, typically 39 weeks. This can reduce the risk of labor and delivery complications compared to waiting for a later date. Some physicians may also offer the option of a scheduled Cesarean delivery to avoid some of the complications associated with vaginal delivery.
When to Seek Further Consultation for Gestational Diabetes
If you believe or know you are pregnant, you should establish regular prenatal care with a physician. As part of regular prenatal care, screening should be done for gestational diabetes so that it can be diagnosed early and treated.
If you develop any symptoms of gestational diabetes
You should let your physician know if you experience frequent urination, headaches, or vision changes. He or she can perform testing for gestational diabetes if it has not already been done.
Questions Your Doctor May Ask to Determine Gestational Diabetes
To diagnose this condition, your doctor would likely ask about the following symptoms and risk factors.
- How fatigued are you?
- Is your fatigue getting any better or worse?
- How long has your fatigue been going on?
- Is your fatigue constant or come-and-go?
- Any fever today or during the last week?
The above questions are also covered by our A.I. Health Assistant.
- Gestational diabetes. The American College of Obstetricians and Gynecologists. Published November 2017. ACOG Link
- Kampmann U, Madsen LR, Skajaa GO, Iversen DS, Moeller N, Ovesen P. Gestational diabetes: A clinical update. World Journal of Diabetes. 2015;6(8):1065-1072. NCBI Link
- Symptoms & causes of gestational diabetes. National Institute of Diabetes and Digestive and Kidney Diseases. Published May 2017. NIDDK Link
- How to treat gestational diabetes. American Diabetes Association. Published April 29, 2014. American Diabetes Association Link
- Diabetic diet. U.S. National Library of Medicine: MedlinePlus. Published May 30, 2018. MedlinePlus Link