Thanks to modern medicine, health outcomes for pregnant women and their babies are incomparably better in much of the world today, as compared to only a century or two ago. Even still, pregnancy remains a risky business rife with the potential for complications. One such complication is known as gestational diabetes (“GD”), and it can manifest in women who have never had any reason to worry about diabetes previously. Luckily, much is known about this condition and how to treat it effectively. With effective treatment, a good portion of the risk associated with GD can be mitigated.
What is Gestational Diabetes?
“Gestational Diabetes” may sound like a complex medical term, but it’s actually quite straightforward: “gestation” is a medical term for pregnancy, meaning that gestational diabetes is simply diabetes that manifests during pregnancy. The term excludes women with pre-existing diabetes who then become pregnant, and specifically applies to those women in whom diabetes is first diagnosed during their pregnancy. The condition may cease after birth, or it may develop into a persistent insulin resistance (otherwise known as type 2 diabetes).
As with more common varieties of diabetes, gestational diabetes disrupts the body’s normal ability to regulate blood glucose levels through the release of a hormone called insulin. This disruption causes glucose levels in the blood to rise beyond the limits of a healthy range, potentially putting the pregnant woman and the developing baby at risk of serious complications.
Throughout the roughly nine months of a pregnancy, a woman’s body will undergo many staggering changes to its physiology to create suitable conditions for the development of a new human being. Many of these changes involve the endocrine system, which is the complex system of chemical messages called hormones that communicate between various tissues and organs.
Unfortunately, such changes decrease sensitivity to the effects of insulin, a decrease in the production of insulin in the pancreas, or a combination of both. In fact, some decrease of insulin sensitivity is common in the later stages of most pregnancies, although this does not necessarily equate to full-blown gestational diabetes. It remains unclear why some women develop this condition and others don’t, which means that pregnant women and their healthcare providers should stay vigilant about monitoring their blood sugar levels before, during, and after their pregnancy.
Certain factors can indicate the relative probability that a particular woman will develop the condition during her pregnancy. This can be helpful in determining which patients should be most vigilant about their blood sugar levels during pregnancy.
Women with a pre-existing insulin resistance or prediabetes are more likely to suffer from gestational diabetes. Prediabetes is a condition defined by a chronically elevated blood sugar level that falls short of a full diabetes diagnosis, but which may suggest a higher likelihood of a future diagnosis of type 2 diabetes. Due to the greater risk of gestational diabetes associated with pre-diabetes, prediabetic women will likely be subjected to greater screening before and during their pregnancy.
In addition to monitoring your blood sugar levels, your doctor may also inquire about your personal and family history. This is because previous bouts of gestational diabetes in a prior pregnancy can strongly predict your odds of a recurrence, as can having an immediate family member who is diabetic.
Other risk factors can include having polycystic ovary syndrome, having previously given birth to a child heavier than 9 lbs, and being from certain ethnic backgrounds. While these factors fall outside of your control, others can be managed to optimize your odds of avoiding diabetes in pregnancy. For example, staying active and maintaining a healthy weight can reduce your odds of GD. Speak to your doctor for advice on how to reduce your risk during pregnancy.
Because GD can develop at any time during pregnancy, pregnant women are often screened for the condition, regardless of their circumstances. However, the timing of GD screening may vary depending on your personal level of risk. Generally, the more your doctor feels you are at risk of GD, the earlier in your pregnancy they will conduct a GD screening evaluation.
Different healthcare providers may employ their own versions of screening tests, but the procedures are often similar. Typically, you will be asked to drink a solution with a high glucose concentration. After some time has passed, a blood sample will be taken to assess your blood sugar levels. If your levels fall above a normal range, it may suggest that your body was unable to respond to the glucose solution effectively, possibly indicating GD. Follow-up evaluations may be conducted with similar protocols to solidify a suspected diagnosis of GD.
GD is a serious condition that will require medical attention and supervision throughout your pregnancy to minimize complications. Unfortunately, this condition can pose risks to the health of both you and your child. Detailed below are some of the more common complications that may arise because of GD. Note that these lists are not exhaustive, and you should consult with your doctor about potential complications with your pregnancy.
Complications Affecting the Baby
In many ways, a baby’s biology will mirror their mother’s during pregnancy. This is true to an extent regarding blood sugar levels – if a pregnant woman is experiencing hyperglycemia because of GD, her baby is likely to also experience elevated blood sugar levels. This can lead to several complications for the child’s delivery, as well as later in their life.
Having high blood sugar can cause a gestating baby to grow larger at an abnormal rate. This can lead to problems when it comes time to deliver the baby; babies above a certain size can have trouble exiting the birth canal which can lead to injury for both the mother and child. Doctors are therefore more likely to recommend a caesarian section to avoid such injuries if a baby’s birth weight is likely to be excessive.
Possible difficulties in pregnancy don’t end there, unfortunately. High blood sugar in developing babies can increase the odds of experiencing an early birth, either naturally or at the recommendation of a doctor (to avoid delivering at an excessive birth weight). More severe still is the increased likelihood for stillbirth just before or after delivery, especially where the gestational diabetes is untreated.
Later in life, people born from mothers with gestational diabetes can experience higher-than-average risks for obesity and type 2 diabetes.
Complications Affecting the Mother
GD poses various risks to women during and after pregnancy. Perhaps the most severe complication for pregnant women is the risk of high blood pressure and preeclampsia. Preeclampsia is a very severe medical condition that requires urgent medical attention to avoid harm to you and your baby. It can lead to a variety of effects, including high blood pressure, that can cause lasting injury.
Other complications of GD can include an increased likelihood of persistent post-partum insulin resistance or type 2 diabetes, as well as recurring bouts of GD in future pregnancies. Individuals who have suffered from GD in the past also remain at a higher likelihood of developing type 2 diabetes later in life.
If you do have GD, your healthcare providers will likely wish to develop a treatment plan to optimize health outcomes for you and your baby. The treatment plan may involve some combination of lifestyle changes, blood sugar monitoring, and antidiabetic medications – similar to a plan for treating type 1 or type 2 diabetes.
Blood sugar is directly and immediately impacted by our daily activities, including what we eat, how much we exercise, and how much stress we experience. Adopting a healthy diet – one that is high in fibrous fruits and vegetables and low in simple carbohydrates – can help keep your blood sugar in check and your body weight under control. Being regularly physically active can also help burn off some of the excess blood sugar circulating in your system, as physical activity increases the body’s overall demand for energy.
Keep in mind that not all activities or foods may be suitable for you, especially given your pregnancy, and it is important to seek and follow the advice of trusted healthcare professionals to develop diet and exercise routines to fight GD.
Keeping tabs on your blood sugar is relatively quick and painless and provides important about how your body is responding to whatever treatments you are undergoing. Ask your doctor when and how often you should be checking your blood sugar and be sure to report any unusual readings to them a soon as possible.
For some people, lifestyle changes and careful blood sugar tracking may not be sufficient to keep GD under wraps. Thankfully, a whole suite of anti-diabetic medications has been developed that may give you a boost in keeping your blood sugar in its normal range. Talk to your doctor about whether medications might be helpful for you.
GD will often subside after birth, but this is not always the case. Your healthcare providers will likely co-ordinate blood sugar sampling to be conducted regularly for a period of time after delivery to make sure your blood sugar has stabilized and returned to pre-pregnancy levels. Even if everything looks normal, you will likely need to return for regular assessments every few years, indefinitely, as a precautionary measure for emergent type 2 diabetes.
Becoming aware that you have GD can be alarming. Pregnant women already have enough to worry about when it comes to their health and the healthy development of their unborn baby. Thankfully, there are plenty of resources available to deal with this complication, and if treated effectively, you might one day look back at GD as only a small hiccup in an otherwise happy journey of getting to know your newborn baby. Be sure to start a discussion with your healthcare provider about GD as early as possible.