Gestational Diabetes: Causes and Treatment

Some women whose blood sugar was normal before pregnancy develop high blood sugar—gestational diabetes—in the later weeks of pregnancy, which can harm the health of both mother and baby. Although blood sugar usually returns to normal after birth, these mothers become more prone to type 2 diabetes in later years. The good news is that patients with gestational diabetes can have a healthy pregnancy and birth by keeping their blood sugar under control through healthy eating, exercise and, if needed, medical treatment.

Symptoms of Gestational Diabetes

It usually develops in the last 3 months of pregnancy. Blood sugar can be kept under control with the right diet and medical approach. However, even if blood sugar returns to normal on its own after birth, these mothers benefit from continuing regular checkups.

Causes of Gestational Diabetes

Although it is not fully understood, it is thought that in some pregnant women, placental hormones counteract insulin and pave the way for gestational diabetes.

Risk Factors for Gestational Diabetes

• Pregnant women over the age of 25
• Family or personal predisposition: type 2 diabetes in family members, or the mother having given birth to a large baby over 4,000 grams or had a stillbirth in a previous pregnancy
• Excess weight: a body mass index over 30

Complications of Gestational Diabetes

Although most patients with gestational diabetes give birth to healthy babies, problems for the health of mother and baby can occur when blood sugar is not regularly controlled.

Complications affecting the baby

• Large baby: higher risk of birth injuries and of complications with cesarean delivery.
• Preterm birth and breathing difficulties in the newborn,
• Low blood sugar in the newborn; severe hypoglycemia episodes can cause seizures in the baby.
• Predisposition to type 2 diabetes later in life
• Stillbirth or death shortly after birth,

Complications affecting the mother

• High blood pressure and preeclampsia (toxemia of pregnancy): an important risk factor that threatens the lives of mother and baby.
• Predisposition to type 2 diabetes in the mother

How Can Gestational Diabetes Be Prevented?

• Healthy eating: starting before pregnancy, eat a diet low in fat and calories and rich in fiber. Choose vegetables, fruit and whole grains in particular, and reduce your portions.
• Exercise regularly: walking, cycling, swimming and so on…
• Reach your ideal weight before pregnancy.

Diagnosing Gestational Diabetes

There is no single standard approach to diagnosing gestational diabetes accepted across the medical world. If your body mass index was 30 or higher before pregnancy, or if your mother, father, a sibling or one of your children has diabetes, your doctor will order the necessary diabetes tests at your first prenatal visit. If you do not have such a clear risk factor, gestational diabetes is screened for with glucose tolerance tests between weeks 24 and 28 of pregnancy. First, you drink a sugary syrup and your blood sugar is tested one hour later. If the result is above 130–140 mg/dL, a 3-hour glucose tolerance test is performed.

Once gestational diabetes is diagnosed, close monitoring is needed, especially in the last 3 months of pregnancy. Your diet and treatment are adjusted based on blood sugar readings taken at home and occasionally at a healthcare facility, along with general assessments of your baby's health.

After birth, your blood sugar is measured right after delivery and again at 6–12 weeks to assess whether you are at risk of diabetes.

Treatment of Gestational Diabetes

• Regular blood sugar monitoring: Fingerstick blood sugar checks you can do at home, along with occasional laboratory blood sugar tests and adjustments to diet and treatment based on the results, are very important for the baby's healthy development, for an easier birth and for managing the mother's risk of type 2 diabetes in later years.
• Healthy diet: A diet rich in fiber—mainly low-fat, low-calorie fruits, vegetables and legumes—in appropriate portions makes it easier to control your blood sugar, and appropriate weight gain is one of the most important factors for a healthy pregnancy.
• Exercise: Regular moderate-intensity exercise helps control blood sugar effectively and also helps relieve common complaints such as back pain, muscle cramps, swelling, constipation and sleeplessness.
• Medication: When lifestyle changes such as diet and exercise are not enough to regulate blood sugar—as is the case for about 15–20% of patients with gestational diabetes—insulin treatment may need to be started.
• Close monitoring of the baby: Closely following the baby's development with ultrasound and NST (non-stress test) devices and determining the right week and method of delivery are vitally important. After birth, babies of mothers with gestational diabetes also need close blood sugar monitoring. It should not be forgotten that these babies may have seizures caused by hypoglycemia.