What is Gestational Diabetes?

Gestational diabetes (GD) is a form of diabetes that occurs during pregnancy. It is characterized by elevated blood sugar levels due to the body’s inability to produce or use insulin effectively because of hormonal changes from the placenta. GD usually develops between 24 and 28 weeks of pregnancy.

Risk Factors:

• Medical Conditions: High blood pressure, heart disease, PCOS (polycystic ovary syndrome)
• Body Weight: Obesity or overweight before pregnancy
• Family History: Personal or family history of diabetes
• Age: Advanced maternal age
• Ethnicity: Higher risk in South Asian, East Asian, Hispanic, Native American, and Pacific Islander communities
• Other Factors: Prediabetes or previous gestational diabetes

Prevalence:

Worldwide: Prevalence ranges from 14% to 17%, with higher rates observed in certain regions and populations.

Causes:

Gestational diabetes arises from hormonal changes during pregnancy that impact insulin function. During pregnancy, hormones from the placenta interfere with insulin’s ability to regulate blood sugar levels effectively, leading to elevated blood glucose levels.

Symptoms

GD often has no clear symptoms, but if present, they may include:

• Frequent urination
• Excessive thirst
• Fatigue
• Nausea

Complications of Unmanaged GD:

• Increased risk of cesarean delivery
• Higher likelihood of preeclampsia (high blood pressure during pregnancy)
• Greater risk of developing Type 2 diabetes later in life

Effects on Baby:

• Increased birth weight (fetal macrosomia)
• Risk of breathing problems at birth
• Hypoglycemia (low blood sugar) in the newborn, which can lead to seizures
• Higher likelihood of obesity and Type 2 diabetes later in life
• Potential for premature birth

Diagnosis and Tests

 

Testing Timeline:

• Standard Screening: Conducted between 24 and 28 weeks of pregnancy.
• Early Screening: May be recommended for those with risk factors or previous history of GD.

Diagnostic Tests:

75-gram Oral Glucose Tolerance Test (OGTT) for
Gestational Diabetes Mellitus (GDM)

Overview

The 75-gram Oral Glucose Tolerance Test (OGTT) is a diagnostic tool used to determine if a pregnant person has Gestational Diabetes Mellitus (GDM). It is typically performed between 24 and 28 weeks of gestation in individuals not previously diagnosed with diabetes.

Preparation:

1.       Timing: Schedule the OGTT in the morning.

2.       Fasting: The patient must fast for at least 8 hours overnight prior to the test. Water is usually permitted during the fasting period

Test Administration:

1.       Initial Blood Sample (Fasting): Measure the patient’s fasting plasma glucose level.

2.       Glucose Solution: The patient drinks a 75-gram glucose solution within 5 minutes.

3.       Subsequent Blood Samples: Collect blood samples at 1 hour and 2 hours after consuming the glucose solution.

The diagnosis of Gestational Diabetes Mellitus (GDM) is confirmed if any of the following plasma glucose levels are met or exceeded:

Fasting Plasma Glucose:

1.       Threshold: ≥92 mg/dL (5.1 mmol/L)

2.       Action: If the fasting plasma glucose is 92 mg/dL or higher, it indicates GDM

1-Hour Postprandial Plasma Glucose:

1.       Threshold: ≥180 mg/dL (10.0 mmol/L)

2.       Action: If the glucose level is 180 mg/dL or higher at 1 hour after drinking the glucose solution, it indicates GDM.

2-Hour Postprandial Plasma Glucose:

1.       Threshold: ≥153 mg/dL (8.5 mmol/L)

2.       Action: If the glucose level is 153 mg/dL or higher at 2 hours after drinking the glucose solution, it indicates GDM.

Diagnostic Criteria Summary

• Fasting Plasma Glucose: ≥92 mg/dL (5.1 mmol/L)
• 1-Hour Postprandial Plasma Glucose: ≥180 mg/dL (10.0 mmol/L)
• 2-Hour Postprandial Plasma Glucose: ≥153 mg/dL (8.5 mmol/L)

Any value meeting or exceeding these thresholds confirms the diagnosis of GDM.

Currently, the Diabetes in Pregnancy Study Group of India advocates for universal
screening using a single non-fasting 2-h 75 g OGTT, with 2 h value >
140 mg/dL being diagnostic of GDM 

Universal screening recommended AT YOUR FIRST CLINIC OR HOSPITAL VISIT  of pregnancy for all pregnant individuals, regardless of risk factors.

  

Management and Treatment

Managing Gestational Diabetes:

Frequent Checkups:

·        
 

• Regular visits to monitor fetal growth, maternal weight, and blood sugar levels.
• Extra ultrasounds may be required to ensure the fetus is not growing excessively.

Blood Sugar Monitoring:    

 

• Use a glucose meter to check levels before and after meals.
• Record readings consistently and share with your healthcare provider for necessary adjustments.

Diet and Nutrition:

·        
 

• Avoid processed foods and sugary drinks.
• Opt for a balanced intake of proteins, carbohydrates, fiber, and fats.
• Eat smaller, more frequent meals and maintain a consistent eating schedule.

Exercise:   

 

• Regular physical activity helps manage blood sugar levels. Discuss a safe exercise plan with your healthcare provider.

Medication:

 

• If lifestyle changes are insufficient, insulin injections may be required.
• Learn and adhere to the correct insulin administration techniques.
• METFORMIN also have some role.

 

 

Blood Sugar Targets:

• Before a meal: ≤95 mg/dL
• One hour after a meal: ≤140 mg/dL
• Two hours after a meal: ≤120 mg/dL

Hydration:

• Staying hydrated supports overall health and helps with blood sugar regulation, though water alone does not directly
  lower blood sugar levels.

Reversal:

• Gestational diabetes resolves after childbirth, but postpartum testing is necessary to confirm normalization.

Prevention

Reducing Risk:

• Although not entirely preventable, maintaining a healthy diet and regular exercise before and during pregnancy can lower
  the risk of developing gestational diabetes.

Outlook / Prognosis

Managing GD:

• With proper management, most individuals with gestational diabetes can have a healthy pregnancy and delivery.
• Adhering to the treatment plan and attending all prenatal appointments are crucial for a positive outcome.

 

Postpartum:

• Blood sugar levels typically return to normal after delivery, but approximately 50% of individuals with GD develop Type
  2 diabetes later in life. Regular monitoring and maintaining a healthy lifestyle can reduce this risk.

Pregnancy Risk:

• GD makes a pregnancy high risk due to potential complications, but with effective management, most babies are born
  healthy.

Living with Gestational Diabetes

Daily Management Tips:

• Integrate blood sugar checks, meal planning, and exercise into your daily routine.
• Work closely with your healthcare provider or diabetes educator for personalized advice and support.

When to Contact Your Provider:

• Persistent high or low blood sugar levels
• Illness affecting your ability to manage blood sugar
• Difficulty adhering to your management plan

 

Understanding and managing gestational diabetes effectively is essential for ensuring a healthy pregnancy and reducing
potential risks to both you and your baby.