What is Gestational Diabetes Mellitus (GDM)?
Gestational Diabetes also commonly known as GDM is a disorder of glucose intolerance leading to hyperglycemia (excess sugar) of variable severity, beginning or first diagnosed during pregnancy. Gestational diabetes is usually detected in the 2nd trimester of pregnancy (between 24 and 28 weeks of abnormal or absence of menstruation). This is a period when insulin resistance is at its highest in pregnant women.
In women with gestational diabetes, the insulin produced loses its sensitivity and hence does not do its actual function of getting the blood sugar levels under control, as an adaptation the pancreas tries to create more insulin and there is a resulting high in blood glucose levels.
Under the term gestational diabetes, there are two different groups:
- women who have undiagnosed diabetes that is discovered during pregnancy
- women who develop diabetes only during pregnancy, a condition that usually disappears after pregnancy
Understanding insulin resistance
Insulin resistance is in the backstage action that is responsible for this condition. It is an important piece of the puzzle in decoding what is diabetes and by extension GDM.
Insulin resistance is a condition in which cells become less sensitive to insulin. When liver, muscle, and fat cells become resistant to insulin, less glucose enters these cells and remains in the blood.
In response to insulin resistance, the insulin-secreting pancreatic cells tend to produce more insulin, and blood glucose levels become too high.
PCOS and gestational diabetes
The underlying causal link between PCOS and GDM is the fact that many women with PCOS are insulin resistant, and being pregnant increases glucose intolerance in the body. Therefore, women with PCOS who are pregnant are at increased risk for gestational diabetes, gestational hypertension, preeclampsia, and preterm delivery. Having a healthy body mass index before pregnancy and limiting weight gain during pregnancy can help avoid these complications.
If you have PCOS and trying to have a baby, GDM is something to look out for. However, there is a bright side: in most cases, GDM is manageable through lifestyle management. Early diagnosis and management of GDM will increase the chances of a healthy pregnancy and a healthy baby. Most measures that work effectively for keeping your PCOS in check are also some of the best ways to better manage gestational diabetes.
What are the causes?
There is an increased risk of diabetes during pregnancy because by nature pregnancy is diabetogenic. When you are pregnant, hormonal changes make your body less efficient at using insulin. If your pancreas is unable to adapt and produce more insulin to control your blood sugar, you have high blood sugar levels.
Some factors that may increase the risk of developing gestational diabetes include:
- be over 35 years of age
- being overweight
- Being pre-diabetic
- having a family history of diabetes
- having had gestational diabetes before
- Polycystic ovary syndrome (PCOS)
Symptoms of GDM
Gestational diabetes is asymptomatic in the vast majority of cases. Exceptionally, the patient may present symptoms of:
- intense thirst
- frequent urination
- increased hunger
- significant fatigue in case of very high blood sugar levels
- in some cases, headaches
When and how to screen for gestational diabetes?
Recommend testing for gestational diabetes in all pregnant women is between 24 and 28 weeks of pregnancy. For women at higher risk of developing gestational diabetes, the test should be done earlier. If you have one or more risk factors for gestational diabetes, a blood glucose test is recommended.
Risk factors for the mother:
- Excess amniotic fluid, increasing the risk of preterm delivery
- Cesarean section or vaginal birth is more difficult (due to the weight of the baby, among other things)
- Pregnancy hypertension or pre-eclampsia (high blood pressure and swelling)
- Remaining diabetic after delivery or developing long-term type 2 diabetes
For the baby:
If GDM is not treated timely or left undiagnosed your baby may become more prone to:
- have a high birth weight (more than 9 pounds or 4 kg)
- have low blood sugar at birth
- have jaundice
- have breathing problems such as respiratory distress syndrome
- have an increased risk of developing diabetes, obesity or heart disease during adulthood
The keys to successful treatment are based on a system that includes:
- patient motivation
- self-monitoring of blood sugar
- dietary measures
- a multidisciplinary approach to that relies on the guidance of your gynecologist, nutritionist, and endocrinologist
How to better manage gestational diabetes?
Self-monitoring your blood glucose regularly, usually before breakfast and one hour after meals is significantly helpful. Blood sugar levels are measured with a blood glucose meter, which is a small, portable device. You can measure your own blood sugar by pricking your fingertip with a lancing pen to collect a drop of blood, which you place on a small strip that is inserted into the device. The meter analyzes the sugar level in the drop of blood.
Here's where your blood sugar should be:
- Before a meal: 95 mg/dL or less
- An hour after a meal: 140 mg/dL or less
- Two hours after a meal: 120 mg/dL or less
To manage gestational diabetes, you could also:
- Choose a healthy diet: aim for low sugar, high fiber foods, and plenty of greens
- Be physically active: try to include an everyday workout
- Check your urine for ketones
- Get good sleep and follow-up regularly with your doctor
- Take medication (if diet and regular physical activity are not enough to normalize your blood sugar)
A pregnant woman with gestational diabetes is at risk of having diabetes post-pregnancy. After delivery, continue with your dietary measures, monitor blood sugar levels, and consult with an endocrinologist. For subsequent pregnancies, periodic testing is recommended, especially at the beginning of your pregnancy for careful medical management.
Monitoring your diabetes is important for your well-being and that of your baby. If you have any questions or concerns, don't hesitate to talk to a health care professional and seek the support you need to make sure your pregnancy goes smoothly.