Gestational diabetes is a type of diabetes that starts during pregnancy. When the pregnant woman has diabetes, her body is not able to consume the sugar (glucose) in her blood as well as it should. So the level of glucose in the blood becomes above normal. Gestational diabetes occurs in 4% of pregnant women. It is usually diagnosed in the fifth or sixth month of pregnancy (Between the 24th and 28th weeks).
Generally, Females are cured from gestational diabetes after delivery.
Almost all women have some degree of impaired glucose intolerance during pregnancy due to the hormonal changes that occur during pregnancy. In this case, the level of glucose in the blood may be higher than normal, but not high enough to cause diabetes. During the last phase of the pregnancy (the third trimester), these hormonal changes place pregnant women at risk for gestational diabetes.
During pregnancy, increased levels of certain hormones made in the placenta (the organ that connects the baby by the umbilical cord to the uterus) help shifting nutrients from the mother to the growing fetus. The placenta produces hormones to prevent developing low blood sugar. They stop the actions of insulin.
Over the course of the pregnancy, these hormones produce impaired glucose intolerance, which increase the level of glucose in the blood. In order to decrease this level, the body makes more insulin to shuttle glucose into cells.
Usually the mother's pancreas can produce more insulin (about three times the normal amount) to overcome the effect of the pregnancy hormones on glucose levels. When the pancreas cannot produce enough insulin to do it, the glucose levels will raise and cause gestational diabetes.
1. being overweight prior to becoming pregnant.
2. Having glucose in the urine.
3. Impaired glucose tolerance or impaired fasting glucose (blood-glucose glucose levels are high, but not high enough to be diabetic.)
4. Family history of diabetes. (If the parents or siblings have diabetes)
5. Previously giving birth to a baby over 9 pounds.
6. Previously giving birth to a stillborn baby.
7. Having gestational diabetes with a previous pregnancy.
8. Increased Amniotic fluid Volume (A condition called polyhydramnios)
-Many women may develop gestational diabetes without having any risk factors.
Usually, there are no symptoms, but the following may be occurred:
1. Increased thirst
2. Increased urination
3. Weight loss in spite of increased appetite
5. Nausea and vomiting
6. Frequent infections, including those of the bladder vagina and skin
7. Blurred vision
Note. Although these symptoms are also common later in pregnancy anyway.
High-risk females should be screened for gestational diabetes as early as possible during their pregnancies. All other women will be screened between the 24th and 28th week of pregnancy.
To screen for gestational diabetes, the pregnant female should take a test known as “Oral Glucose Tolerance Test”. It involves quickly drinking a sweetened liquid, containing 50 g of glucose. The body will absorb the glucose rapidly, causing elevation of blood glucose within 30 to 60 min. One hour after drinking the solution, a blood sample will be taken from the arm to be tested and measures the processing of the glucose in the body. Any level of blood glucose greater than or equal to 140 mg/dl is recognized as abnormal. In that case, another test will be given after fasting for eight hours.
High-risk female with a normal screening test result, need to undergo another screening test at weeks 24 and 42 for confirmation of the diagnosis.
The aims of treatments are to maintain the blood-glucose level within the normal limits during the pregnancy, and ensure the well-being of the fetus.
1- Close monitoring of the mother and fetus should continue throughout the pregnancy.
2- Following specific dietary guidelines as instructed by the dietician. The pregnant will be asked to distribute the calories evenly throughout the day. Following these eating tips:
3- Regular exercise during pregnancy can improve the posture and decrease some common discomforts such as backache and fatigue. Being fitted during pregnancy is important, mild to moderate exercise at least three times a week. However, every pregnant woman should consult with her doctor before beginning an exercise program.
Since both insulin and exercise lower blood glucose, the mother should follow additional exercise to avoid a low blood-glucose reaction:
4- Monitoring weight gain: The recommend amount of weight gained during pregnancy depends on the pre-pregnancy weight. Typically, gain weight more during the second and third trimester and recommended intakes of calories should increase at that time.
5- If you gain the proper amount of weight during pregnancy by eating a healthy, balanced diet, then it is a good sign that the baby is getting all the nutriments he or she needs and is growing at a healthy rate.
6- It is not necessary to "eat for two" during pregnancy. It's true that pregnant woman needs extra calories from nutrient-rich food to help her baby grow, but she generally needs to consume 200 to 300 more calories than she did before she became pregnant to meet the needs of her growing baby. She must ask the doctor how much weight she should gain during pregnancy. A female of average weight before pregnancy can expect to gain 25 to 35 pounds during pregnancy. She may need to gain more or less weight, depending on what her doctor recommends.
7- In general, the pregnant woman should gain about 24 pounds during first three months of pregnancy and 1 pound a week for the remainder of the pregnancy.
The weight will be distributed as follows:
8- Medical Treatment:
- Symptoms of hypoglycemia include:
- feeling shaky
- Head aches
- Sudden hunger
Hypoglycemia is a serious problem that needs to be treated right away. If the pregnant woman thinks that she has a low blood-glucose reaction, she should check her blood glucose. If the blood glucose is less than 60 mg/dl, eat food containing sugar, such as 1/2 cup of orange or apple juice, 1 cup of skim milk, 4-6 pieces of a hard candy (not sugar – free), 1/2 cup regular soft drink; or 1 tbsp of honey, brown sugar or corn syrup. 15 min after eating one of the food listed above, check your blood sugar again. If it is less than 60 mg/db, eat another one of the food choices above. If it is more than 45 min until the next meal, eat a bread and protein source to prevent another reaction. Record all low blood-glucose reactions in the logbook, including the date, time of day the reaction occurred and how she treated it.
Diabetes in pregnancy affects the developing baby throughout the pregnancy:
1- In early pregnancy, maternal diabetes can result in:
2- During the 2nd and 3rd trimester:
3- After Birth:
4- Effects on the mother