What Should You Know About Gestational Diabetes Mellitus?

Gestational diabetes mellitus (GDM) is a type of diabetes (high blood glucose levels) that develops in pregnant women. In India, Gestational diabetes mellitus affects as many as five million women annually. Let’s look into gestational diabetes symptoms, risk factors, complications and diagnosis.

Gestational diabetes usually occurs between 24 to 28 weeks of pregnancy. Insulin is a hormone that breaks down the glucose from food and facilitates its entry into all body cells. During pregnancy, the hormones made by the placenta can affect how insulin works, and it can lead to high blood sugar levels. 

After giving birth, the GDM usually goes away, and glucose levels typically return to normal. It is not generally as serious as having type 1 or type 2 diabetes before becoming pregnant.

What Are Gestational Diabetes Symptoms?

This condition usually doesn’t cause any symptoms. Some women may experience:

• Increased thirst
• Frequent urination
• Nausea & vomiting
• Tiredness
• Blurred vision
• Weight loss
• Yeast infections 
• Dry mouth

Some of these symptoms can occur commonly during pregnancy, and they are not necessarily gestational diabetes symptoms.

What Factors Raise The Risk Of Gestational Diabetes Mellitus In Pregnant Women?

Gestational diabetes mellitus can occur in any woman. Some of the risk factors of GDM are:

• Overweight or obesity – having a body mass index (BMI) of 30 or higher
• Family history of diabetes (parents or siblings)
• Previously had a baby who weighed 4.1 kilograms or more at birth
• Had a gestational diabetes mellitus in a previous pregnancy
• Being older than twenty-five 
• Heart disorders
• High blood pressure
• Polycystic ovarian syndrome (PCOS)
• Prediabetes (high blood sugar levels but not high enough to be called diabetes)
• Nativity and Race: Women who are of Asian, African, Native American, Hispanic, or Pacific Island descent are at higher risk

Why Is It Essential To Take Care Of Gestational Diabetes Mellitus?

Unmanaged gestational diabetes can pose health risks to both mother and the baby. It can cause problems such as:

Baby gets too big (Macrosomia): All the nutrients for the baby comes from the mother’s blood. When high glucose levels are present in the blood, the fetus produces more insulin and converts this excess glucose to fat. Large deposits of fat can cause the fetus to grow excessively large. This increases the likelihood of needing a caesarean section. 

Low blood sugar levels: Some babies born to GDM mothers have low blood sugar levels immediately after birth. This problem occurs when the mother’s sugar levels have been constantly high, causing the fetus to have high insulin levels in its circulation. After delivery, babies continue to have high insulin levels resulting in very low blood sugar levels. Severe low blood glucose levels can cause seizures.

Risk of diabetes: Usually, gestational diabetes disappears after the delivery. Women who have had GDM are more likely to develop it again in future pregnancies. Also, about 50% of them are at higher risk of developing type 2 diabetes in the future. Babies born to mothers with GDM also have a high risk of developing type 2 diabetes later in life. 

Preterm birth: Elevated blood sugar levels can raise the risk of premature birth (giving birth before the thirty-seventh week of pregnancy). The risk is higher if the mother develops diabetes before the twenty-fourth week of pregnancy. 

Breathing difficulties: Diabetes can decrease the production of surfactant that coats the sacs in the lungs and keep them inflated when the baby breathes. Lack of surfactants can cause breathing problems in babies. Breathing problems are very common when a baby is born early to a mother with GDM. Breathing problems and low blood sugar after birth cause difficulty in feeding the baby.

Jaundice: High bilirubin levels in the blood causes the eyes and skin to look yellow (jaundice). In the case of Gestational diabetes, babies may take longer to remove extra bilirubin from their body due to low blood sugar or being excessively large. This results in jaundice in babies and may require treatment in the hospital.

Preeclampsia: GDM can increase the risk of preeclampsia in a pregnant woman, a condition that causes elevated blood pressure during pregnancy and can lead to serious complications. 

How Is Gestational Diabetes Mellitus (GDM) Diagnosed?

Blood tests – glucose challenge test and oral glucose tolerance test are used to diagnose GDM. The hormones which interfere with insulin start getting produced around weeks 24 to 28 of the pregnancy. Health care providers test for GDM in pregnant women at this period. 

The physician may test for diabetes during the initial visit after you become pregnant if you have risk factors such as polycystic ovarian syndrome or obesity. 

Glucose challenge test (glucose screening test): This test is performed after having sweet liquid containing glucose. After about an hour, a health care professional will collect your blood sample to check your blood sugar levels. If the blood glucose is 140 mg/dL or more, you will need an oral glucose tolerance test to confirm the condition. 

Oral glucose tolerance test (OGTT): In this test, your blood sugar levels are measured after you fast for at least eight hours. Your health care provider will check your fasting blood sugar levels. Then you need to drink the sweet liquid containing glucose. Your blood sample will be collected and checked for glucose levels every hour for three hours. High blood sugar levels at any two or more readings- fasting, 1 hour, 2 hours, or 3 hours indicates that you have gestational diabetes.

Women with a history of GDM should get screened for diabetes at least every three years. 

Keep Diabetes Under Control & Have A Healthy Pregnancy:

If you are diagnosed with GDM, you can prevent or minimize the complications by controlling blood sugar levels. Follow healthy eating and exercise to keep the sugar down. 

Learn how to measure your blood sugar levels. The American diabetes association suggests the following target blood sugar levels during pregnancy (Before a meal– 95 mg/dl or less; One hour after a meal–140 mg/dl or less; Two hours after a meal–120 mg/dl or less). Your doctor may prescribe medications for gestational diabetes mellitus if it is not controlled by lifestyle modifications.