Understanding Gestational Diabetes: A Guide for Moms-to-Be

While pregnancy is a wonderful experience for many, it can sometimes also present certain challenges. One challenge that many expectant mothers encounter is gestational diabetes. However, there’s no need to be alarmed. With proper care, you and your baby can remain healthy. In this article, we will discuss what gestational diabetes is, its causes, signs, and symptoms, as well as how to manage it effectively.

Gestational diabetes is a type of diabetes that can happen during pregnancy for women who didn’t have diabetes before. It usually occurs between the 24th and 28th week (second or third trimester). This is when hormones from the placenta can make it tougher for your body to use insulin properly, causing blood sugar (glucose) levels to rise higher than usual.

While you do need to take care of your high blood sugar levels for your health and that of your baby, gestational diabetes can still be controlled. With a few simple changes to your diet and daily routine, you can keep your blood sugar levels under control. The majority of women with a gestational diabetes diagnosis have smooth pregnancies and deliver healthy babies. It’s all about looking after yourself and your little one!

Most pregnant women do not experience noticeable signs or symptoms of gestational diabetes, which is why screening blood sugar levels is essential. A pregnant woman's normal blood sugar level is between 70 and 90 mg/dL when fasting and can reach up to 120 mg/dL two hours after eating.

Dr Ciciliamma Thomas, a retired gynaecologist from the Health Services Department of Kerala, advises, “Gestational diabetes often has no noticeable symptoms, making early blood sugar screening essential — ideally at the beginning of pregnancy or even prior.” She adds, "This early screening helps confirm that the patient is not previously diabetic with type 1 or 2 diabetes. Identifying any existing diabetes is crucial, as it can prevent foetal and maternal complications. Since gestational diabetes typically appears between weeks 24 and 28, screening should be repeated even if the patient was previously non-diabetic. Early detection allows for timely interventions, reducing risks for both mother and baby while enabling better monitoring throughout the pregnancy.”

However, some women may notice subtle signs, including:

• Feeling extra thirsty: Do you find yourself reaching for more water than usual, even when you haven’t had salty foods or been out in the sun?
• Peeing more often: Are you running to the bathroom more frequently than expected?
• Feeling super tired: Is your tiredness more than just the usual pregnancy fatigue, leaving you wiped out even without doing much?
• Dry mouth: Do you have a constant dry, parched feeling, no matter how much water you drink?
• Blurry vision: Are things looking a little fuzzy or out of focus lately?
• More infections: Have you been dealing with more infections, like bladder or vaginal issues, than usual?

Gestational diabetes may develop during pregnancy as a result of the following changes in your body:

• Hormonal changes: As your baby develops, the placenta produces hormones that can increase your body's resistance to insulin, making it more difficult to utilise it effectively. 
• Increased insulin demand: Your body requires more insulin as your pregnancy progresses. Sometimes, it can’t produce enough, causing blood sugar levels to rise.

Wondering if you could be at risk for gestational diabetes? Here are some key factors:

• Overweight: Are you comfortable with your weight? Being overweight can increase your risk.
• Age: Are you over 25? Age can increase your risk.
• Sedentary lifestyle: How active have you been? Regular exercise helps regulate blood sugar levels.
• Family history: Do you have family members with diabetes or prediabetes? This could raise your risk.
• History of stillbirth or birth defects: Having a history of unexplained stillbirth or a baby with birth defects may increase your risk.
• Gestational diabetes in previous pregnancy: Have you experienced this in your past pregnancies? It can happen again.
• Big babies: Have you given birth to a baby weighing over 4 kg (about 9 pounds)? This may indicate higher risk.
• Obesity BMI: Your body mass index (BMI) is over 30.
• Polycystic Ovary Syndrome (PCOS): Are you familiar with PCOS? It can impact your insulin levels.
• High blood pressure: Having high blood pressure or a history of heart disease can also be contributing factors.
• Ethnic background: Do you belong to higher-risk ethnic groups, like Black, Hispanic, Asian, or Native American? These ethnic groups are more prone to gestational diabetes.

If gestational diabetes isn't managed, it can lead to several complications for mothers. One significant risk is the development of high blood pressure during pregnancy, known as preeclampsia. Additionally, untreated gestational diabetes can increase the likelihood of premature birth. Mothers may also face complications during delivery, such as the need for a caesarean section if the baby grows too large. Over the long term, women who have gestational diabetes face an increased risk of developing type 2 diabetes in the future.

If gestational diabetes isn't well managed, it can impact your baby in several ways:

• Large baby size: Higher blood sugar levels in pregnancy can lead to the baby developing larger than average, a condition referred to as macrosomia. This can create complications during delivery, potentially leading to the need for a C-section or shoulder dystocia, which is when the baby’s shoulder gets stuck during vaginal birth.
• Premature birth: Gestational diabetes can trigger early labour or require an early delivery due to concerns over the baby’s size or other issues.
• Low blood sugar after birth: Babies may experience low blood sugar (hypoglycemia) after birth because of high insulin levels during pregnancy.
• Breathing difficulties: Babies born prematurely or at a larger size may have trouble breathing (respiratory distress syndrome) and require medical care.
• Jaundice: Certain infants might experience jaundice, a condition characterised by a yellowish tint to the skin and eyes.
• Congenital anomalies: High risk of getting congenital anomalies 
• Type 2 diabetes and obesity risk: Those children born to gestational diabetic mothers are at an increased risk of not only becoming overweight but also getting type 2 diabetes later in life. We must aim to stop the passing on of these health issues between generations to ensure that future generations are not burdened by diabetes.

If you have gestational diabetes, a balanced diet is key to managing blood sugar levels. Here are some guidelines: 

Choose whole grains like whole-grain bread, brown rice, quinoa, and oats instead of refined grains. Fill half of your plate with vegetables that are non-starchy, like peppers, spinach, and broccoli. Assign a quarter of your plate to lean proteins, including chicken, fish, eggs, or beans, and the remaining quarter to healthy carbohydrates like whole grains, starchy vegetables, and moderate amounts of fruit and unsweetened dairy. Keep an eye out for hidden sugars in packaged foods.

Select healthy fats from avocados, nuts, seeds, and olive oil while restricting saturated and trans fats. Monitor your carbohydrate intake by paying attention to portion sizes and pairing carbs with protein and fats. Avoid sugary snacks and beverages; opt for natural sweeteners or fruits instead. Make sure to drink enough water and reduce your intake of sugary beverages. For snacks, opt for Greek yoghurt, nuts, or sliced vegetables.

Maintaining consistent meal times can aid in stabilising blood sugar levels, and seeking help from a dietitian for a tailored meal plan can be helpful. It is advisable to have small, frequent meals. One must also exercise regularly; the easiest way to do this is to walk for about 15 minutes after every meal. Lastly, monitor your blood sugar levels to understand how different foods affect them.

Dr Ciciliamma Thomas, a retired gynaecologist from the Health Services Department of Kerala, says, “Depending on the severity of the condition, daily or weekly monitoring of blood sugar levels is essential for managing gestational diabetes. Oral medications may be recommended based on the patient's blood sugar readings.”

She emphasises, “To effectively manage gestational diabetes, focusing on dietary control is crucial, which includes minimising or avoiding sugar intake and having regular, frequent meals. Incorporating exercise and, if necessary, medications can further support management. It is vital to speak to your doctor to reduce risks for both the mother and baby.”

Gestational diabetes can sound overwhelming, but with the right health plan, you and your baby can thrive. Stay connected with your healthcare provider, maintain a nutritious diet, and stay physically active. With some attention and care, you'll be on the right path to a healthy pregnancy!

Gestational diabetes can lead to several risks for both the mother and baby during pregnancy. One of the concerns is high blood pressure, known as preeclampsia, which can cause serious health issues if not treated. The baby may also grow larger than normal, leading to complications during delivery, such as needing surgery. Babies delivered by mothers with gestational diabetes might experience low blood sugar levels or jaundice. Following childbirth, both the mother and baby have a higher risk of developing diabetes, making careful monitoring and management of gestational diabetes essential.

Avoid sugary foods and drinks, refined carbohydrates, and high-glycemic-index foods that can cause rapid spikes in blood sugar levels.

Excessive weight gain, larger babies upon screening, and frequent vaginal infections can indicate the presence of gestational diabetes mellitus (GDM).

To control sugar levels, eat balanced meals with fibre, lean protein, and healthy fats, stay active, and monitor blood sugar regularly.

If you have gestational diabetes, avoid foods that can spike blood sugar levels. Limit sugary foods like cakes, cookies, soda, and fruit juices while including milk and whole fruits in moderation. Stay away from high-starch foods such as white bread, rice, and pasta; opt for whole grains instead. Check for hidden sugars in processed foods, sauces, and fast food options. It is important to completely steer clear of alcohol during pregnancy because it poses significant health risks to the baby.