All you need to know about Gestational Diabetes
Gestational diabetes (GDM) is a form of diabetes that causes high blood glucose during pregnancy. As rates of type 2 diabetes increase worldwide, so do rates of gestational diabetes. About 1 in 10 pregnant women is diagnosed with gestational diabetes. GDM is commonly diagnosed as high blood glucose starting between 24 and 28 weeks of pregnancy. Occasionally it is diagnosed earlier in pregnancy, which may indicate high blood glucose prior to pregnancy.
A raised blood glucose level before, and during pregnancy can cause a higher risk of complications for the mother and the new born. In this post you will understand the importance of having good control of diabetes before and during pregnancy.
What Causes GDM?
In all pregnancies, hormones secreted by the placenta interfere with the body’s use of insulin creating a problem called insulin resistance. With insulin resistance, the cells cannot effectively use glucose from the bloodstream for energy. If insulin production is not high enough to counter the insulin resistance, blood glucose rises.
What Happens When Blood Glucose In High In Pregnancy?
High blood glucose is known to cause adverse outcomes in pregnancy.
At the beginning of a pregnancy, high blood glucose levels can affect the embryo´s development, causing congenital heart disease and affecting fetal lung maturation. In the third trimester, gestational diabetes can increase birth weight above the 90th percentile and cause neonatal hypoglycaemia, preterm delivery and neonatal intensive care admission.
What Are The Signs Of GDM?
Some women may experience thirst, frequent urination or exhaustion when they have high blood glucose levels. However all of these symptoms are common in pregnancy. Therefore symptoms are not used to diagnose or determine testing for GDM.
How Is GDM Diagnosed?
Gestational diabetes is diagnosed through either a “Glucose Challenge Test” or one of two “Glucose Tolerance Tests.” In addition, your doctor might also order an A1c test to determine how high blood glucose levels have been over the previous 3 months.
Who Should Be Tested For GDM?
All women should be tested for gestational diabetes no later than 24-28 weeks. Women who are at higher risk for gestational diabetes should be tested earlier in pregnancy.
What Makes A Woman Higher Risk For GDM?
- GDM in a previous pregnancy
- History of prediabetes (A1c 5.7-6.4)
- Elevated Body Mass Index (BMI)
- A previous baby larger than 4000 mg
- History of Polycystic Ovarian Syndrome (PCOS)
- History of hypertension or metabolic disease
- Advanced maternal age (>35)
- Lack of physical activity
- Family history of diabetes in a first-degree relative
Can I Get Pregnant if I already have Diabetes?
The best chance of having a healthy outcome is to have pre-pregnancy counselling. During this visit, your doctor will create a plan for you and evaluate medications and drugs that may need to be stopped before becoming pregnant. This includes medications for blood pressure or cholesterol.
Some complications related to diabetes such as retinopathy and kidney problems can become worse during the pregnancy period. The ocular scan must be realized at regular intervals by a trained and qualified eye care professional and kidney function will be checked by a blood and urine sample routinely.
Advice to Follow to Achieve and Maintain Good Diabetes Control
Having regular appointments with your doctor, nutritionist and diabetes educator
- Creating a plan with your dietitian to understand how different foods affect your glucose levels
- Exercise regularly
- Folic acid supplementation
- Adjust diabetes medication. This may include starting insulin or injecting more often
- Check your blood glucose levels to achieve the target range:
- 70 – 100 mg/dl before meals
- less than 140 mg/dl 1 hour after meal
- Be aware of how to treat hypoglycemia
For some women, achieving the goal of good blood sugar control is difficult, however with the support of nutrition therapy and medical counselling regarding weight and blood targets, the risk of complications can be minimized.
At GluCare, we encourage the use of a continuous glucose monitor (CGM)to ensure patient stay within their blood glucose range. Our care team will also monitor trends of a range of parameters including glucose, activity, sleep trends, blood pressure and weight as part of your care and share this information with your obstetrician. This information, which is not usually captured by traditional healthcare providers, is part of GluCare’s continuous model of care where patients are monitored and able to communicate with the entire care team via our app. Our diabetes care is not restricted to a few in-clinic visits a year, and GluCare is transforming the way all diabetes is being managed with the use of technology.
