Gestational Diabetes in Pregnancy: Your Top Questions Answered

One in five women develop gestational diabetes throughout Pregnancy. Here’s the lowdown on the condition…

What is Gestational Diabetes?
Diabetes is a condition where a person’s blood sugar is too high. When this occurs during pregnancy (usually during the second or third trimester), it is referred to as gestational diabetes. When we eat, food is digested and absorbed into the body.  Much of this food is broken down into glucose in the blood stream. Insulin is then produced by the body to help move this glucose into cells to be used as energy.

In diabetics, three things could occur. The body may not produce any insulin at all, it may produce too little insulin, or the insulin produced might not work. These lead to high glucose in the blood stream, yet low glucose within cells to make energy. Without energy, cells and organs don’t function to full capacity.

How will it affect my baby?
Too much sugar in a mama’s bloodstream ends up going to the baby. Her baby then produces more insulin to process this sugar.

All this sugar and insulin can cause the baby to gain weight, particularly in the head and upper body, leading to problems during childbirth, especially related to squeezing through a narrow birth canal. Therefore, a C-section may have to be planned for a minority of diabetic mums whose babies start to look too big on a scan. These big babies born to diabetic mums tend to have additional fat stores and may be at increased risk of diabetes and obesity later on in their lives.

Right after birth, the baby is no longer using its mother’s glucose-rich blood, but is still producing high amounts of insulin. This means they can end up having too little blood sugar – which can be life threatening – so extra care needs to be taken. This may be in the form of breastfeeding soon after birth, or, in severe cases, an intravenous infusion of glucose to keep blood sugars stable.

How common is it?
In 2010, one in five pregnant women in a Singapore tertiary hospital were found to have Gestational Diabetes. In the US, gestational diabetes is diagnosed in up to 14% of pregnancies annually.

Risk factors for gestational diabetes include:

• Higher number of pregnancies
• Advanced maternal age
• Family history of diabetes mellitus
• Non-caucasian race
• Obesity

Considering the above, it is not hard to see why rates are increasing due to reduced levels of physical activity and the trend of advancing maternal age.

How will I know if I have it?
Typically, women with gestational diabetes have no noticeable symptoms. Only a minority of mums may experience symptoms such as increased thirst, needing to pee more than usual, excessive tiredness or frequent conditions such as thrush or urine infections. Therefore, your obstetrician or family doctor will offer routine screening for gestational diabetes between 26 and 28 weeks of pregnancy. These can be in the form of an oral glucose challenge test or an oral glucose tolerance test.

With the Oral glucose challenge test (OGCT) 50mg of glucose is ingested, and a blood test is taken an hour after. If the serum glucose is above 130mg/dl this suggests the mum has gestational diabetes. The Oral glucose tolerance test (OGTT) is a fasting blood test followed by 100mg of glucose ingested, and blood tests are taken 1, 2 and 3 hours after. Abnormalities in the test results will suggest a diagnosis of Gestational Diabetes.

How is it treated?
If a mum has been shown to have Gestational Diabetes, most of the time a careful change of diet and moderate exercise is enough to keep blood sugars normal.

Only if this fails to produce a reduction of glucose in the blood stream, injectable insulin may be used.  A mum with severe gestational diabetes might be instructed to use an insulin pen once in the morning and again before dinner.

Will it mean I have diabetes for life?
Unfortunately, over 50% of women who have had gestational diabetes will get diabetes later on in life.  It is therefore routine to get screened shortly after delivery, and every year after delivery.

Will I get it again in my future pregnancies?
If you have had gestational diabetes in a previous pregnancy, the likelihood of having it during subsequent pregnancies is higher. Therefore you may be asked to monitor your own blood sugar levels during future pregnancies, and oral glucose tests may be offered to your earlier, at around 16-18 weeks, and again at 26-28 weeks’ gestation.

What can I do to prevent myself from developing Gestational Diabetes?
As it is more common in overweight women, it is a good idea to lose any excess weight prior to pregnancy. During pregnancy, work with your family doctor or obstetrician to keep your weight gain in check.

Make an effort in eating a wide variety of colourful and nutritious foods, in sensible portions. Home cooked is great to enjoy, as it provides more control over your salt, sugar and fat intake. Also get into the habit of doing something active every day that is safe for pregnancy such as Yoga, Pilates, walking and swimming.

In conclusion…
Whatever the journey might be, make time to enjoy and savour your pregnancy, a time of change and also a time for appreciating the miracles of life!

Do look for support and strength in other women who may be going through similar stages of pregnancy, and never feel like you have to brave it alone. If you’re feeling lost, consider booking in a chat with your friendly family doctor who can link you up to support groups, coaches, counsellors, and networks to help keep you social, mentally strong and healthy!

References:
www.cdc.gov
www.ncbi.nlm.nih.gov/pubmed/24936548