Even though you neither never had diabetes nor are at are at risk to developing one (obesity, the absence of physical activity, family history…), because you are pregnant, you may develop silent diabetes that compromises your health and that of your future baby.
What is gestational diabetes?
In the early stages of pregnancy, the secretion of pregnancy-related hormones such as estrogens and progestins steadily increases. On the medium term, the increase in the concentration of these gestation hormones tends to raise the levels of glucose in the blood and to decrease the sensitivity of the organism to insulin (glucose-regulating hormone produced within the pancreas).
To clarify, the needs of a pregnant woman in insulin are 3 to 4 times higher than in non-pregnant women.
If the future mother cannot produce enough insulin to compensate for this diminishing sensitivity, glucose levels keep on increasing and diabetes appears.
Gestational diabetes is also called pregnancy diabetes. It occurs in pregnant women at about the end of the sixth month of pregnancy. Gestational diabetes is generally temporary and last only for the last part of the pregnancy. It may also reveal an already existing diabetes or pre-diabetes. Today, smartphone apps are a great help as well.
WHO definition of gestational diabetes: “Gestational diabetes is hyperglycemia that is first recognized during pregnancy”.
What are the symptoms?
This is the major issue with gestational diabetes: in most cases, it remains unnoticed and pregnant women do not feel any symptoms.
In some occasion, the future mother will be more tired, be thirstier or urinate more often. Obviously, we can hardly say these are symptoms since they are a common picture in pregnant women.
What are the risks, for the mother and the fetus?
They are very serious for both the baby and the mother.
For the mother
If her diabetes remains untreated, the mother is likely to develop severe complications: edema, arterial hypertension, cardiovascular disorders or renal disease. Her baby’s birth may be premature and she may deliver through a cesarean section.
The mother may also develop a very dangerous eclampsia whose risk factors include hypertension and diabetes. Eclampsia is one of the main reasons for death in pregnancy.
For the child
Excessive glucose does not stop at the mother level. It is passed on from the mother to the fetus. This excess of calories is stocked in the child organs and causes overweight. Thus macrosomia is the most frequent complication for the child. He may weigh above 4 kg and cause a more complicated delivery.
Other possible complications include respiratory distress, neonatal hypoglycemia, increased risk to develop type-2 diabetes, and neurological and heart defects.
How is it diagnosed?
There is no single method for detecting gestational diabetes.
Some doctors will search for diabetes in pregnant women only if they have one or more of the risk factors:
- Overweight or obesity
- Personal or family medical history
- Age (over 35)
- Large baby at birth in a previous delivery
A large size fetus, seen at the echography, should also be taken into consideration by the practitioner.
Detection of glucose in the urine with a dedicated urine stick is simple and cost-effective but will signal only the most obvious cases of overt diabetes.
Nowadays, the state of the art is the Oral Glucose Tolerance Test.
This test is usually carried out somewhere between 24 and 28 weeks into the pregnancy.
It consists of measuring blood glucose in fasting pregnant women and then measuring the increase in glycemia at different time intervals after she has ingested a predefined amount of glucose usually in syrup form.
There are many variations of this test. Some will rule out diabetes if the first measurement is low enough (less than 90 mg/dL). The amount of sugar ingested (50 to 150 g), the time intervals between blood samplings and the overall duration of the test (up to 6 hours) may vary too. Blood insulin concentrations may also be measured in some circumstances.
The doctor will compare your results to a reference curve.
How to treat gestational diabetes?
Whatever the treatment, you will have to monitor regularly, several times a day, your blood glucose. When fasting, your glycemia should not be in excess of 95 mg/dL and not more than 120 mg/dL two hours after you had a meal.
The first step to the treatment is to modify your diet:
- Lower the content in carbohydrates of your meals and favor low glycemic index food
- Favor food with a lot of fibers (vegetables, fruits, some types of bread or cereals..) that helps lower postprandial hyperglycemia
- Split your meals
- Measure your calories and comply with your doctor prescription
You will also have to stick with a physical exercise program that should be adapted to your physical condition: exercise helps to reduce blood sugar.
If these hygienic measures are not enough to lower your glycemia back to normal, your doctor may also prescribe insulin injections that will replace the natural insulin which is missing in your body.
And what about the delivery?
If your diabetes is well under control, pregnancy monitoring will not be very different from that of a non-diabetic pregnant woman. An additional echography may be done at the end of the pregnancy period for measuring the baby’s size.
If your diabetes is not well controlled or if you have other risk factors, your doctor will follow the pregnancy much more closely and he/she will carry out additional medical examinations.
If the baby is too large, more than 4.25 to 4.50 kg, you will probably have a cesarean section to minimize obstetrical risks.
Once the baby is born, he may have temporary hypoglycemia. This risk increases if his mother used to have large doses of insulin. He will be checked for glycemia for the first days of his life and will be fed very early (2-3 hours) after he is born.
Your gestational diabetes has revealed that either you were diabetic (or pre-diabetic) or your pancreas is unable to produce large quantities of insulin.
This relative deficiency put you at risk to develop diabetes later in your life or if you have another baby. That is the reason why your doctor will probably advise you to check your glycemia from once a year to once every three years.