Gestational diabetes is a type of diabetes that occurs only during pregnancy. As with other diabetes conditions, gestational diabetes affects the body's use of sugar (glucose). Gestational diabetes can cause high blood sugar that is not a problem for the mother but affects the health of the unborn baby.
You can overcome gestational diabetes by eating a healthy diet, exercising regularly, and taking medication if necessary. You can have a healthy pregnancy period by taking care of yourself. Fortunately, gestational diabetes is a short-term condition. After delivery, the blood sugar level returns to normal.
For many women, gestational diabetes does not cause any symptoms. Rarely, they may have symptoms such as extreme thirst or frequent urination.
When to Go to the Doctor? If possible, go to the doctor while you are trying to get pregnant so that the possibility of gestational diabetes can be evaluated as soon as possible. Gestational diabetes will also be evaluated at your regular prenatal checkups after pregnancy. If gestational diabetes develops, your doctor visits may increase. These will be especially in the last 3 months of pregnancy, your doctor will carefully examine your blood sugar level. It will be measured again immediately after birth and within 6 weeks to make sure your blood sugar level has returned to normal after delivery. If you have gestational diabetes, it's a good idea to have your blood sugar checked frequently.
Causes: Researchers have yet to find a definitive cause as to what causes it. To understand how gestational diabetes occurs, it can be helpful to understand how glucose is processed in the body. Insulin is a substance produced by the pancreas. After eating, sugar molecules called glucose from the meal mix into the blood. Insulin helps glucose to be transported from the blood to the cells, where it is converted into energy. The placenta that surrounds the baby during pregnancy produces high levels of various hormones. Almost all of them damage insulin activity in tissues, so blood sugar rises.
As your baby grows, the placenta produces more of the hormones that interfere with insulin. In gestational diabetes, the hormones produced by the placenta raise the blood sugar level to such a level that it can affect the baby's growth and development. This discomfort usually occurs in the last half of pregnancy, although sometimes at 20 weeks.
Risk Factors: Although any woman can develop gestational diabetes, some women are at greater risk. Risk factors are as follows;
- Being over the age of 25: Women over the age of 25 are more prone to develop gestational diabetes during pregnancy.
- Personal or family health history: if you or a close family member has mild diabetes, you are at risk for gestational diabetes. If you have had gestational diabetes in a previous pregnancy, have given birth to a baby weighing more than 4 kg, or have had an unexplained stillbirth, you may also have gestational diabetes.
- Being overweight: if you have an overweight problem, you are more likely to develop gestational diabetes.
Race: Black, Hispanic and Asian races have a higher risk of gestational diabetes than others for reasons that cannot be explained.
Complications: Many pregnant women with gestational diabetes have healthy babies. However, gestational diabetes that is not well controlled can cause high blood sugar levels and problems for both mother and baby.
Complications That May Affect the Baby: If the mother has gestational diabetes, the following risks exist for her baby;
- Overgrowth: Extra glucose crosses the placenta, causing the pancreas to produce extra insulin. This can result in the baby getting too big. This can lead to the baby getting stuck in the birth canal, birth injuries and cesarean section.
- Low Blood Sugar (Hypoglycemia): Sometimes babies whose mothers have gestational diabetes may develop low blood sugar, ie hypoglycemia, because their own insulin production is high shortly after birth. Serious situations caused by this problem can cause crises in the baby. Emergency feeding or intravenous glucose can bring the baby's blood sugar level back to normal.
- Breathing Difficulty Syndrome: If your baby is born prematurely, he may experience respiratory distress syndrome that makes it difficult to breathe. Babies whose mothers have gestational diabetes are more likely to experience this condition than others. Babies with respiratory distress syndrome may need help with breathing until their lungs develop.
- Jaundice: The yellowing of the skin and whites of the eyes occurs when the baby's liver is not developed enough to break down the substance called bilirubin. Jaundice is not a cause for concern when carefully controlled.
- Type 2 Diabetes Later in Life: Babies whose mothers have gestational diabetes are likely to develop obesity and type 2 diabetes later in life.
- Developmental Problems: Children whose mothers have gestational diabetes may experience problems in walking, jumping, balance and other activations that require coordination. There may also be disturbances such as interest problems or hyperactivity.
Untreated gestational diabetes rarely results in the death of the baby before or shortly after birth.
Complications That May Affect You:
Preeclampsia: Gestational diabetes increases the risk of high blood pressure and preeclampsia, which is defined as excess protein in the urine after the 20th week of pregnancy. If left untreated, it can cause serious or even fatal complications.
- Urinary Bladder Infections: Pregnant women with gestational diabetes carry the risk of urinary bladder infections 2 times more than normal pregnant women. The reason for this is the excessive amount of glucose in the urine.
- Future Diabetes: If you have gestational diabetes, there is a risk that you will also have gestational diabetes in a future pregnancy. You can also develop type 2 diabetes as you age. However, a healthy lifestyle such as eating a healthy diet and exercising regularly reduces this risk.
Diagnosis and Treatment: Your doctor will evaluate you for gestational diabetes early in pregnancy. Many women have a screening test for gestational diabetes in the 2nd trimester.
Routine Screenings for Gestational Diabetes: Screening for gestational diabetes is recommended for most women. Many women at average risk for gestational diabetes have an OGTT (sugar load) between 24 and 28 weeks of pregnancy. If your risk of gestational diabetes is higher than normal, this test may also be done earlier.
- Initial Sugar Loading Test: You start this test by drinking a syrupy glucose solution. After 1 hour, a blood test is done to measure your blood sugar level. A blood sugar level of 130 - 140 mg/dl or 7.2 - 7.8 mmol/l is considered normal. If your blood sugar is higher than normal, it just means you're at risk for gestational diabetes. Diagnosis is made after the 2nd follow-up test.
- Follow-up Sugar Loading Test: In this test, you are asked to fast from the night and your fasting blood sugar is checked. You are then asked to drink another sugary solution and a blood test is done every hour over a 3-hour period. Gestational diabetes is diagnosed if at least 2 tests are higher than normal.
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Diagnosis of Gestational Diabetes: In this case, your doctor will examine you more frequently, especially in the last 3 months of pregnancy. In these examinations, your blood sugar level is carefully checked. If you're having trouble keeping your blood sugar under control, you need insulin, or if you have other pregnancy-related complications, extra checkups are needed for the baby's health. These tests are done to evaluate the function of the placenta. If your gestational diabetes is difficult to control, it can affect the placenta, compromising the baby's ability to exchange oxygen and nutrients. A single negative test result is not a problem. Your doctor may order some extra tests to evaluate the baby's condition.
- NST (Non Stress Test): The sensors placed on your belly are connected to a monitor. This test evaluates increases in fetal heart rate by correlating them with fetal mobility. If the baby's heart rate does not increase with movement, the fetus may not be getting enough oxygen.
- Biophysical Profile (BPP): This test combines NST with fetal ultrasound. The baby's movements, breathing, and whether the amniotic fluid is at a normal level are evaluated. The decreased fluid indicates that the baby is not urinating enough and the placenta is not functioning as it should.
- Fetal Movement Count: You can have this simple test done simultaneously with NST and BPP. You count the baby's kicks over a period of time. Little movement may indicate that the baby is not getting enough oxygen.
Postpartum Blood Sugar Test: After giving birth to your baby, a blood test is done again after birth and 6 weeks later to make sure your blood sugar returns to normal. If the results are normal, it is necessary to have a test at least every 3 years. If results show as a diagnosis of diabetes or pre-diabetes, treatment may be considered.
Treatment and Medicines: Keeping your blood sugar level under control is very important for the health of the baby and to prevent complications at birth. Your treatment plan may include:
- Blood glucose measurement: You may need to measure your blood sugar 4-5 times a day - in the morning on an empty stomach and after meals. There are special tools for this. With the help of a lancet (a small needle), you pierce your finger and put the incoming blood on the test strip, which you place on the glucose meter. Your doctor will also measure your blood sugar during delivery. If it rises, your baby will release large amounts of insulin, which can cause low blood sugar soon after birth.
- Diet : The best way to keep blood sugar under control is to eat the right food in the right amount. Eating healthy foods also prevents excessive weight gain during pregnancy. A healthy diet includes fruits, vegetables, and grains that are rich in nutrients and healthy in fat and calories. It is also necessary to limit the intake of carbohydrates, including sweets. However, not every diet is suitable for everyone. It is the healthiest way to consult a dietitian in this regard.
- Exercise: Exercising lowers the blood sugar level by sending the sugar to be used for energy to the cells. Exercise also increases sensitivity to insulin, meaning your body needs less insulin to deliver sugar to your cells. Regular exercise also reduces problems such as back pain, muscle pain, swelling, constipation and difficulty sleeping during pregnancy, and prepares you for birth. With your doctor's approval, you can exercise most days of the week. If you haven't been exercising for a long time, start slowly. Sports such as walking, cycling and swimming are the best alternatives during pregnancy.
- Medication: If diet and exercise are not enough, you need insulin injections to lower your blood sugar level. About 15% of pregnant women with gestational diabetes need insulin therapy to keep their blood sugar levels under control.
Your baby also needs close monitoring. The baby's growth and development is often followed by ultrasound and other tests. If delivery does not occur at the expected time, your doctor may initiate labor. Giving birth after the expected date can increase the risk of complications.
After having gestational diabetes, there is a risk of developing type 2 diabetes later in life. Healthy living habits, such as diet and exercise, can reduce this risk.
Coping and Support with Gestational Diabetes: Living with a condition that can affect your baby's health is not easy. Feeling sorry for your baby can make it difficult for you to take care of yourself. You may find yourself eating the wrong foods and forgetting to exercise. Stress can increase your blood sugar levels even more.
The more you learn about gestational diabetes, the better you will feel. Talk to your doctor, read books, review articles.
Precaution: There are no guarantees in preventing gestational diabetes, but the more healthy habits you have before pregnancy, the better.
- Eat healthy: Choose foods low in fat and calories. Choose fruits, vegetables and grain foods.
- Do physical activity: Exercising before and during pregnancy gives positive results in preventing gestational diabetes. Try to exercise for 30 minutes a day. Swimming, walking or cycling can be a good alternative.
- Lose their excess weight: Losing weight during pregnancy is generally not recommended. But if you're planning to become pregnant, losing weight can help you have a healthier pregnancy. Change your eating and exercise habits. Focus on the benefits of losing weight, such as a healthier heart, more energy, and more self-confidence.
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