Overview of gestational diabetes
Gestational diabetes is defined as intolerance to glucose or presence of high blood glucose levels during pregnancy or the gestational period. Gestational diabetes usually disappears after delivery.1 It affects about 2–4% of all pregnancies and is of much concern because of the risk factors associated with it. It can affect both mother and the new born. This condition can be prevented and managed by eating healthy food, exercising regularly and taking necessary medication.
Epidemiology (Occurrence of gestational diabetes in different groups)
Epidemiology of gestational diabetes has not been studied systematically. Differences in screening programs and diagnostic critera make it difficult to study about the prevalences of gestational diabetes in various population of the world. Ethnicity is an independent risk factor for this condition. There are several other risk factors and in the absence of the risk factors, the incidence of gestational diabetes is low. Women in their first half of their pregnancy pose a high-risk, which include increased incidence of obstetric problems and later development of type 2 diabetes. Studies suggest a link between increased risk prediabetic condition, gestational diabetes and type 2 diabetes. Recent studies have clarified that prevention strategies are useful in modifying the risk factors.2
Symptoms of gestational diabetes
Gestational diabetes does not show any symptoms and the pregnant woman may be living with the condition without knowing it. If a blood test confirms the presence of gestational diabetes, that is, presence of high blood glucose level, then the symptoms may include the following.
- Increased thirst
- Increased urination
- Increased hunger
- Blurred vision
- Excessive weight gain
- Repeated vaginal infections
Risk Factors for gestational diabetes
A wide variety of risk factors are associated with gestational diabetes mellitus which can affect both mother and the fetus. The risk factors associated with mother include:
- Cesarean delivery
- Future type 2 diabetes
- Delivering over the age of 30 years
- Family history of diabetes
- Previously given birth to a large child
- Previously given birth to a stillborn child
- Having too much amniotic fluid
- Having gestational diabetes in previous pregnancy
- Having high blood pressure
The risk factors associated with the fetus include:3,4
- Increased rates of perinatal mortality
- Birth trauma
- Neonatal hypoglycemia
Diagnosis of gestational diabetes
Diagnosis for gestational diabetes is usually done between 24–28 weeks of pregnancy. The major test involved in the detection of this condition is oral glucose tolerance test. Here, blood sugar level is tested after consuming a sweet liquid at 1 h, 3h and 8 h. After fasting, the blood sugar level is again tested. Now, a cup of sweet liquid is consumed and blood sugar level is again tested for at least 3 h. If the blood sugar level is high then, it confirms gestational diabetes.
Other tests conducted during pregnancy are:
- Fetal ultrasound
- Nonstress test
Tests during labor and delivery:
- Fetal heart monitoring
- Blood sugar tests done every hour
Tests done after delivery:
- Fasting and random oral glucose tolerence test after 3 days of delivery
- If the woman is at high-risk for type 2 diabetes mellitus, then the glucose tolerence test should be conducted after 6 weeks and fasting sugar test atleast once in a year.5
Treatment of gestational diabetes
Treatment of gestational diabeted include the following.6
- Consumption of a balanced diet: Consukting a dietician and following the diet plan as suggested is helpful. Making a note of the things that are consumable and having a track of weight is also helpful. Obese woman should restrict their calorie intake to reduce hyperglycemia and plasma triglycerides.7
- Exercise: Exercising regularly for atleast 3 days a week for 20 min is useful.
- Checking blood sugar levels: Blood sugar levels should be checked regularly.
- Monitoring fetal growth: Fetal growth is monitered through ultrasounds and nonstress tests.
- Medical checkups: Frequent visits to the physician, checking the blood pressure and discussing about diet, medications etc.
- Insulin shots: If the blood sugar level is too high inspite of exercising regularly and eating balanced diet then insulin helps to lower the blood sugar levels.
- Prolonged gestation increases the risk of fetal macrosomia hence delivery in the 38th week is recommended.
1. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabet Care. 2003; 26(Suppl 1): S5–S20.
2. Ben-Haroush A, Yogev Y, Hod M. Epidemiology of gestational diabetes mellitus and its association with type 2 diabetes. Diabet Med. 2004; 21(2): 103–113.
3. Casey BM, Lucas MJ, Mcintire DD, Leveno KJ. Pregnancy outcomes in women with gestational diabetes compared with the general obstetric population. Obstet Gynecol. 1997; 90: 869–873.
4. Dang K, Homko C, Reece EA. Factors associated with fetal macrosomia in offspring of gestational diabetic women. J Matern Fetal Med. 2000; 9: 114–117.
5. Brody SC, Seth C, Russell Harris. Screening for gestational diabetes: A summary of the evidence for the U.S. Preventive Services Task Force. Obstet Gynecol. 2003; 101(2): 380–392.
6. American Diabetes Association. Gestational diabetes mellitus. Clinical Practice Recommendations 2004. Diabet Care. 2004; 27(Suppl 1): S88–S90.
7. Franz MJ, Horton ES, Bantle JP, Beebe CA, Brunzell JD, Coulston AM, et al. Nutrition principles for the management of diabetes and related complications (Technical Review). Diabetes Care.1994; 17: 490–518.
Written by: healthplus24.com team
Date last updated: February 05, 2015