Cravings, Kicks & Caution: Exploring Diabetes During Pregnancy

Pregnancy is a wonderful experience, but it can also be challenging, particularly for women who have diabetes. Gestational diabetes, which occurs during pregnancy, can create serious risks for both the mother and her baby. This condition may result in several complications, such as preeclampsia, premature labour, and congenital abnormalities. Nevertheless, with appropriate care and management, women dealing with gestational diabetes can enjoy healthy pregnancies and give birth to healthy babies.

Gestational diabetes mellitus (GDM) is increasingly recognised as a major public health issue both globally and in India, where it is anticipated that the number of diabetic women will reach 313.3 million by 2040. In India, over five million pregnant women are estimated to be impacted by GDM, representing 16.2% of the total live births (20.9 million) in 2015 that experienced some form of hyperglycaemia.

Diabetes, a long-term health condition, influences how your body transforms food into energy. Typically, when you consume food, your body breaks it down into glucose (sugar), which then enters your bloodstream. The pancreas produces insulin, a hormone that serves as a ‘key’ to help glucose enter cells for energy use. In individuals with diabetes, this process is impaired — either the body doesn’t produce sufficient insulin, isn’t able to use insulin properly, or a combination of both.

This results in increased blood sugar levels that, if not properly managed, may lead to significant health issues over time, such as harm to the heart, kidneys, nerves, and eyes. Each type of diabetes (type 1, type 2, and gestational diabetes) has different causes and treatment needs. 

Managing diabetes typically requires a balance of diet, exercise, and medications to maintain blood sugar levels in a healthy range.

Diabetes during pregnancy, known as gestational diabetes, occurs when hormonal changes interfere with the body’s ability to use insulin effectively. As the placenta produces hormones that support foetal growth, they can lead to insulin resistance, causing the pancreas to struggle to meet the increased insulin demands of the body. 

Women with insulin resistance, often influenced by factors such as obesity, a family history of diabetes, or conditions like polycystic ovary syndrome (PCOS), are at an increased risk. Although gestational diabetes typically goes away after giving birth, it can raise the likelihood of getting type 2 diabetes later in life, highlighting the significance of monitoring and management for the well-being of both the mother and the child.

Here’s a detailed overview of the elements that raise the likelihood of developing gestational diabetes during pregnancy:

1. Family history of diabetes

If diabetes runs in your family, particularly type 2 diabetes, your risk of developing gestational diabetes is higher. This is because genetics play a role in insulin function and glucose tolerance, so if close family members, such as parents or siblings, have diabetes, it may increase your susceptibility.

2. Obesity

Carrying excess weight or being obese prior to pregnancy can place extra stress on the body's ability to regulate insulin. Increased weight frequently correlates with insulin resistance, a condition in which the body's cells do not react properly to insulin. This situation complicates blood sugar management, particularly during pregnancy, when hormones influence insulin sensitivity further.

3. Previous history of gestational diabetes

If a woman was found to have had gestational diabetes in a prior pregnancy, the chance of her experiencing it again in future pregnancies is increased. This likelihood persists because certain metabolic changes associated with gestational diabetes may not fully resolve after the first occurrence, leaving the body more prone to insulin resistance during future pregnancies.

4. Age factor  

Women who are 25 years or older are more susceptible to developing gestational diabetes, with the risk increasing as they age. This occurs because of age-related changes in metabolism and insulin sensitivity, which can hinder the body's ability to regulate blood sugar levels effectively.

5. Ethnicity 

Certain ethnic groups, including Hispanic, African American, American Indian, and Asian American populations, are statistically more prone to gestational diabetes. Researchers suggest this may be due to genetic predispositions and differences in insulin sensitivity that vary among ethnic groups. Additionally, environmental and lifestyle factors that vary across communities could play a role.

6. Polycystic Ovary Syndrome (PCOS)

Women with PCOS — a hormonal disorder characterised by irregular menstrual cycles and insulin resistance — have a higher risk of gestational diabetes. PCOS affects how the body processes insulin, which can complicate blood sugar regulation during pregnancy.

7. High blood pressure or other health conditions 

Preexisting conditions like hypertension, prediabetes, or metabolic syndrome can increase the likelihood of gestational diabetes. These conditions affect the body’s metabolism and how insulin is processed, which can make it harder to maintain stable blood sugar levels.

8. Sedentary lifestyle  

Insufficient physical activity is linked to a higher likelihood of insulin resistance, making it more challenging for the body to properly manage blood sugar levels. Regular exercise helps improve insulin sensitivity, so a sedentary lifestyle before or during pregnancy can increase the risk of gestational diabetes.

9. Previous delivery of a large baby

If you’ve previously given birth to a baby weighing more than 9 pounds (4 kg), this can indicate a higher risk of gestational diabetes in future pregnancies. This is because large babies are often the result of elevated blood sugar levels in pregnancy, which may signal underlying insulin resistance.

Being mindful of these risks can help expectant mothers take preventive actions, like maintaining a healthy weight, carefully monitoring their blood sugar levels, and participating in regular physical activity.

Regular prenatal check-ups are also essential for early detection and management.

In many cases, gestational diabetes may not cause any noticeable symptoms. However, some women may experience:

• Increased thirst
• Frequent urination
• Blurred vision
• Fatigue
• Slow-healing wounds

Diabetes during pregnancy, particularly gestational diabetes, can have a range of effects on both the mother and the baby if not managed carefully. Here’s a look at some of the major impacts and risks:

1. Increased chance of high blood pressure and preeclampsia

Expecting mothers who have diabetes are more likely to experience high blood pressure and a pregnancy complication known as preeclampsia, which can pose risks to the mother and the baby if not properly managed. This condition may require early delivery or other medical interventions.

2. Macrosomia (large baby size)

When diabetes is poorly managed during pregnancy, it can lead to macrosomia, a condition in which the baby becomes larger than normal. This happens because the baby absorbs excess glucose from the mother, converting it into body fat. Macrosomia can cause complications during delivery and may require surgery to avoid birth injuries.

3. Higher likelihood of preterm birth

Unmanaged diabetes increases the risk of preterm birth, especially if preeclampsia or other complications arise. Preterm babies often have underdeveloped organs and may need neonatal intensive care, which can lead to further health challenges.

4. Hypoglycaemia in newborns

Infants born to mothers who have diabetes may face hypoglycaemia, or low blood sugar, soon after they are born. Since they’re used to high glucose levels in the womb, their bodies produce extra insulin. After birth, without the mother’s elevated blood sugar, the high insulin levels can cause a drop in the baby’s blood sugar, requiring close monitoring.

5. Breathing difficulties (respiratory distress syndrome)

Diabetes in pregnancy can lead to respiratory distress syndrome in newborns, a condition where the baby’s lungs aren’t fully developed, making it difficult for them to breathe. Babies born preterm or with high birth weights are particularly susceptible and may need specialised care.

6. Increased risk of jaundice in newborns

Infants delivered by mothers with diabetes have a higher risk of developing jaundice, a condition characterised by yellowing of the skin and eyes resulting from elevated bilirubin levels. This is more common in premature babies.

7. Risk of becoming type 2 diabetic later in life for both mother and baby

Women who have had gestational diabetes have a higher chance of becoming type 2 diabetic as they age. Furthermore, children born to these mothers are more likely to face obesity and type 2 diabetes as they grow up.

8. Possible future gestational diabetes

Once a woman has experienced gestational diabetes, her chances of developing it again in future pregnancies are higher, which makes regular monitoring and preventative lifestyle measures essential for long-term health.

To reduce these impacts, it is essential for pregnant women with diabetes to consistently check their blood sugar levels, participate in regular physical activity that is safe during pregnancy, and follow a balanced diet.

Frequent prenatal checkups and monitoring for blood pressure and other indicators are also essential to support a healthy pregnancy for both mother and baby.

Gestational diabetes is usually controlled through a combination of:

• Diet: A nutritious diet can help in controlling blood sugar levels.
• Exercise: Engaging in regular physical activity can enhance insulin sensitivity.
• Medication: In some cases, medication may be necessary to control blood sugar levels.
• Regular monitoring: Regularly monitoring one's blood sugar levels is important for tracking them and modifying one's treatment plan as necessary.

Although you may not be able to completely avoid gestational diabetes, keeping a healthy weight before and during pregnancy, following a balanced diet, and remaining physically active can help reduce your risk.

Key points about diabetes during pregnancy

• Gestational diabetes is a prevalent condition experienced by numerous pregnant women. 
• Prompt diagnosis and intervention are vital to avoid potential complications. 
• Maintaining a balanced diet, engaging in regular physical activity, and taking medication when necessary can aid in managing gestational diabetes. 
• Consistent prenatal care is vital to monitor both your health and that of your baby.

Both type 1 and type 2 diabetes can have an impact on pregnancy. Additionally, gestational diabetes can develop during pregnancy.

If gestational diabetes is not properly controlled, it can result in complications for both you and your baby, such as preeclampsia, premature labour, and congenital defects.

To manage gestational diabetes, it's important to adhere to a healthy diet, participate in regular exercise, and take prescribed medications from your doctor. Regular blood sugar monitoring is also essential.

The typical fasting blood sugar range for pregnant women is between 70 and 92 mg/dL.

Yes, with proper management, diabetic women can have healthy babies. By working with their healthcare provider, women with diabetes can reduce the risks linked to pregnancy.