Gestational diabetes: causes, symptoms, values ​​and risks

Gestational diabetes

Gestational diabetes is a type of diabetes that develops exclusively during pregnancy. The term “diabetes” means that the level of glucose in the blood, blood sugar, is too high. It is known that the body uses glucose for energy. However, too much glucose in your blood will be a problem for you and your baby. Gestational diabetes is usually diagnosed during the later stages of pregnancy. If you were diagnosed in the early stages of pregnancy, then it could have developed before you became pregnant.

Treating gestational diabetes can help both you and your baby stay healthy. Keeping your blood sugar levels in check can help protect you both. If you have gestational diabetes, a team of doctors will take care of you. In addition to your gynecologist – the doctor who will deliver your baby – the team could include a doctor specialized in this condition, a diabetes educator (a professional figure widespread in many countries, able to educate people with diabetes), and a dietician. to help you with meal planning. Therefore, if you already have type 1 or type 2 diabetes, and are considering conceiving a child, consult your GP before doing so. Untreated or poorly controlled diabetes can also cause serious problems for the fetus.

The cause

Gestational diabetes occurs when your body fails to produce enough insulin (the hormone that lowers blood glucose levels) during pregnancy.

Insulin is a hormone produced by the pancreas, an organ located behind the stomach. It helps the body use glucose for energy, and control blood sugar levels.

During pregnancy, a woman’s body produces more hormones and also undergoes other changes, including weight gain. This causes her cells to use insulin less effectively: this condition is called “insulin resistance”.

It increases your body’s need for insulin. So if the pancreas fails to produce enough insulin, gestational diabetes will result.

All pregnant women develop some level of insulin resistance towards the end of their pregnancy. However, some six women are affected by this condition even before becoming pregnant , usually due to being overweight.

The risk factors

Your chances of developing this pathology are higher,

• if you are overweight;
• if you have already been affected before;
• if you gave birth to a baby heavier than 4 kg;
• if you have a parent, brother or sister with type 2 diabetes;
• if you have pre-diabetes, meaning your blood sugar levels are higher than normal although not high enough to justify a diagnosis of diabetes;
• if you have a particular hormonal disorder known as polycystic ovary syndrome.

How to reduce the chances of developing it

If you’re thinking about getting pregnant , and if you’re overweight, you can lower your chances of getting gestational diabetes.

• losing excess weight;
• increasing your physical activity before pregnancy begins.

This will make your body’s use of insulin more efficient and help your blood sugar levels stay normal.

Once pregnant, however, you shouldn’t try to lose weight: – in fact – you’ll need to put it on to make sure your baby grows healthily.

However, even gaining weight too quickly would multiply the chances of contracting gestational diabetes: your doctor will suggest the correct weight gain and the right level of physical activity for you.

The diagnosis

You will probably be tested for gestational diabetes between weeks 24 and 28 of your pregnancy.

If your chances of getting gestational diabetes are higher than normal, your doctor may want you to get tested at your first visit since you became pregnant.

If your blood sugar levels were above normal at the time, you could be diagnosed with “classical” diabetes rather than gestational diabetes.

Doctors diagnose it by having you take blood tests. However, all diabetes tests include a blood draw by your doctor or clinic. The blood samples taken from these are then sent to the laboratory for analysis.

The oral glucose tolerance test / OGTT

As for the oral glucose tolerance test (also called oral glucose tolerance test, or OGTT –  Oral Glucose Tolerance Test ) you will have to start by drinking a sugary solution , then you will have to have your blood sugar checked one hour later : this check can be done at any time of the day.

If abnormal values ​​are found, you may need to do an oral glucose challenge. Before undergoing this test you will have to fast for at least 8 hours: fasting means not eating, not drinking anything except water. However, your doctor will give you further instructions to follow before the test.

Your fasting blood glucose levels will then be measured. Next you will need to drink a sugary drink. Your blood sugar will be checked one hour, two hours and possibly three hours later.

The effects of diabetes on the unborn child

In case your blood sugar levels are high due to uncontrolled gestational diabetes, your baby will also have high blood glucose; to compensate for this, your pancreas will have to produce “extra” insulin;. the “extra” glucose in your baby’s body and is stored as fat.

Untreated or out of control gestational diabetes can cause many problems for your baby. It can for example,

• being born with a larger than normal body – a condition called “macrosomia” – which can also complicate delivery;
• give him low blood glucose, a condition called hypoglycaemia, soon after birth;
• cause breathing problems, a condition called respiratory distress syndrome;
• make him more likely to die, before or soon after birth.

Your baby may also be born with jaundice, a common condition in infants of pregnant mothers with diabetes: his skin and the whites of his eyes turn yellow.

Jaundice usually goes away on its own, but your baby may need to be exposed to special lights to help it go away. To help the disease go away, you’ll also want to make sure he’s getting enough nutrition by breastfeeding.

If you have gestational diabetes, your doctor may recommend extra tests, such as:

• an ultrasound, which uses sound waves to produce images that show your baby’s growth and any size abnormalities;
• a nonstress test, which uses a monitor placed on your abdomen to see if your baby’s heart rate is increasing as it should when he is active;
• a kick count, to know how much time passes between your baby’s movements.

The effects of gestational diabetes on women

Gestational diabetes could increase your chances of:

• have high  blood pressure and have too much protein in the urine (a condition called preeclampsia);
• having to undergo surgery – such as a caesarean section – to deliver your baby as big as normal:
• become depressed;
• develop type 2 diabetes and associated problems.

preeclampsia

It is a condition that occurs during the second half of pregnancy (second half of the  second  trimester, and all of the third trimester of pregnancy ).

• If left untreated, it can cause problems for you and your baby, problems that could even lead to death.
• The only cure for preeclampsia is childbirth.
• If you develop it during the late stage of pregnancy, you may need a C-section to deliver sooner.
• If you develop preeclampsia in its early stages, you may need medication and rest. or to be hospitalized so that your baby develops as much as possible before delivery.

the Depression

Depression can make you too tired to manage your diabetes and care for your baby. If during or after pregnancy, you feel anxious, tired, or unable to deal with the changes that arise, consult the team of professionals who follow you.

They can advise you on how to find support and how to treat it. Remember that in order to take care of your baby, you must first take care of yourself.

control visits

Continue to monitor your health. “Feeling good” doesn’t mean you should skip visits to the doctor. Women with gestational diabetes often have no symptoms.

after childbirth

Gestational diabetes will likely go away after your baby is born. However, even if it will be gone,

• you could get gestational diabetes again if you get pregnant again;
• you will be more likely to get type 2 diabetes in your lifetime.

Treatments and cures

Treating this pathology means keeping blood sugar levels regular. Your doctor will help you define your normal values.

You will control your blood glucose levels with,

• a healthy diet;
• constant physical activity;
• with insulin injections if necessary.

A healthy diet will help your blood sugar levels stay normal.

diet and nutrition

Your dietician will help you design a healthy diet plan, with food choices that are helpful for you and your baby. Follow it: it will do you good, both during and after pregnancy. This will help your blood sugar levels stay within the normal range. It will tell you what, how much and when to eat. The quality, quantity and timing of food intake help keep blood sugar at normal levels.

physical activity

Physical activity can help regulate blood sugar. Consult your doctor to find out which activity is best for you. If you’re already physically active, let him know what you’re doing.

Getting some exercise will also help reduce your chances of getting type 2 diabetes – and its related problems – in the future. So,

• be as active as possible: try to do at least 30 minutes of physical activity a day;
• give preference to aerobic activities in order to increase the heart rate: try walking, swimming or dancing, or other low-impact aerobic activities;
• if you are already practicing them, ask your doctor if you can continue to do high-intensity sports to strengthen muscles and bones, such as lifting weights or running at high speed;
• avoid those activities, such as basketball or football, in which you could get a blow to the stomach,
• also avoid activities that could cause you to fall, such as horseback riding or skiing;
• in the last trimester do not sleep flat on your back, as this can put too much pressure on some major vein, restricting the blood flow to your baby.

insulin injections

In addition to a healthy diet and adequate physical activity, if you continue to have problems staying in the right blood sugar levels, you may need insulin. Your doctor will teach you how to inject it. It won’t harm your baby.

How to check blood sugar

To check your blood sugar levels yourself, your doctor may ask you to use a small device called a blood glucose meter for this purpose:

• he will teach you how to use it;
• he will show you how to prick your finger to get a drop of blood;
• will indicate what your ideal blood sugar value is;
• it will tell you when to check your glycemic index.

You may be asked to double-check it:

• when you wake up;
• just before meals;
• 1-2 hours after breakfast;
• 1-2 hours after lunch;
• 1-2 hours after dinner.

The following table shows the ideal glycemic indexes for women with gestational diabetes at various times of the day.

Ideal glycemic indexes (mg/dL) for women with gestational diabetes

Also ask your doctor if these values ​​are right for you.

Every time you check your blood sugar, write the results in a diary. Bring your glucometer and your diary to check-ups so that you can establish with the doctors how to achieve ideal blood sugar values.

The ketones . When our body does not have glucose available (or when it is unable to use it) and needs energy, it produces organic compounds called ketones.

Your doctor may teach you how to test for the presence of ketones, either in your urine in the morning or in your blood.

High ketone levels mean your body is using your body fat for energy, rather than the food you’re eating. This is not recommended during pregnancy. In fact, ketones could harm your baby.

If your ketone levels are high, your doctor may suggest changing the type or amount of food you eat, or changing the timing of your meals.

Postpartum diabetes

To find out after giving birth if you still have diabetes, you will need to go to your doctor to get a blood sugar test done – 6 to 12 weeks after your baby is born.

In 5-10% of cases of women with gestational diabetes, glycemic values ​​remain abnormal: they are usually affected by type 2 diabetes, and therefore will have to manage it with diet, physical activity, and if necessary with medicines.

Even if your glycemic indexes return to normal after pregnancy, your chances of being diabetic later on remain high: usually type 2.

For this reason you should, at least every 3 years, get tested for the presence of diabetes or pre-diabetes.

How to prevent or delay the onset of type 2 diabetes

To prevent or delay the onset of type 2 diabetes, you can make these lifestyle changes.

• Get to a healthy weight and then maintain it. Try to get back to your pre-pregnancy weight within 6 to 12 months of giving birth. After that, if you still weigh too much, try to lose at least 5-7% of your weight: for example, if you weigh 90 kilos, losing about 5 can greatly reduce your chances of contracting diabetes.
• Exercise for at least 30 minutes every day.
• Follow a healthy diet: eat grains, fruits and vegetables; reduce fat and calories: your dietician can help you develop an appropriate diet.
• Talk to your doctor about taking metformin, a diabetes drug that can reduce your chances of getting type 2, especially if you are young, heavy, and have prediabetes, or have had gestational diabetes .

Delaying or preventing type 2 diabetes as you age will also reduce your chances of heart disease and other problems.

Consult your doctor if you are planning to have another baby, a doctor who can help you be ready for the next child: for his safety, your blood sugar must be at normal levels before starting a new pregnancy.

How to ensure your baby has a healthy birth

By breastfeeding, you can give your baby a good start. Thus you will provide him with the best nutrition, and protection against certain diseases.

Prepare to breastfeed. To this end,

• talk to your GP about your plans for this; ask him if the place where you want to give birth has the staff and equipment to allow you to breastfeed in the right conditions;
• attend a specific course: pregnant women who learn to breastfeed do it better than those who don’t;
• ask your doctor to recommend a lactation consultant who can help you;
• talk to your friends who have already breastfed or join a support group.

In order for your child to have a good start in life, the following “steps” may also be needed.

• Start breastfeeding as soon as possible after birth. From the first hour of life, the sucking instinct is very strong.
• Ask the hospital staff not to give your baby formula or other foods unless it is necessary.
• Keep your baby with you in the hospital room day and night so you can breastfeed often. Or, ask the nurses to bring it to you when he needs to eat.
• Try not to give your baby pacifiers or artificial teats so that he gets used to latching only on your breast.

According to some of the leading health organizations, your baby shouldn’t eat or drink anything other than your milk for the first 6 months. Then he can start eating other foods as well.