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Monday, July 13, 2020

Gestational Diabetes: Causes, Symptoms and Treatment

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Gestational diabetes is a type of diabetes diagnosed initially during pregnancy, also known as gestation. Like every other type of diabetes, gestational diabetes affects how the cells absorb sugar.

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Gestational diabetes triggers high blood sugar that can affect one’s pregnancy and the baby’s health. During pregnancy, some women experience high blood sugar levels.

This condition usually develops between the end of the second trimester of pregnancy. According to the Centers for Disease Control and Prevention, it’s calculated to occur in over 2 to 10 percent of pregnancies in the United States of America.

If an expecting mother develops gestational diabetes while pregnant, it doesn’t mean that they had diabetes before the pregnancy or will have it afterward. But gestational diabetes does raise the risk of developing type 2 diabetes later on.

If poorly managed, it can also pose the child’s risk of developing diabetes and increase the risk of complications for the mother and child during pregnancy and even delivery.

Although the expecting mother can control gestational diabetes by eating healthy foods, exercising, and, if required, taking the prescribed medication, controlling blood glucose levels can keep the mother and child health and prevent delivery complications.

In women with gestational diabetes, blood sugar usually returns to normal soon after delivery. Still, gestational diabetes puts one at a higher risk of getting type 2 diabetes, necessitating regular tests to detect changes in blood sugar.

What are the symptoms of gestational diabetes?

Symptoms for gestational diabetes are rare, and if one experiences symptoms, they are likely to be mild. They may include:

  • Increased thirst
  • Blurred vision
  • An excessive need to urinate
  • Increased thirst
  • Snoring

What causes gestational diabetes?

Although being obsessed before pregnancy can be a risk factor, the exact cause of gestational diabetes is unknown, but hormones likely play a role. Normally, various hormones work to keep the blood sugar levels regulated.

But during pregnancy, hormone levels change, making it difficult for the body to process blood sugar efficiently. This can increase blood sugar. When one is pregnant, the body produces more substantial quantities of some hormones, including

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  • Human placental lactogen (hPL)
  • Hormones that increase insulin resistance

These hormones have functions they undertake in the placenta to help sustain the pregnancy.

Over time, the quantity of these hormones in the body is increased, which can start to make the body resistant to insulin, the hormone that regulates blood glucose.

Insulin aid moves glucose out of the blood into the cells, where it’s processed into energy. In pregnancy, the body naturally becomes a bit insulin resistant, so that glucose is available in the bloodstream to be passed to the baby.

If the insulin resistance becomes severe, the blood glucose levels may increase abnormally, which can lead to the mother developing gestational diabetes

Who is at risk for gestational diabetes?

One is at a higher risk of developing gestational diabetes if they are:

  • Have a preexisting condition like polycystic ovary syndrome (PCOS), acanthosis nigricans, or any other conditions related to insulin resistance
  • Were overweight before they became pregnant
  • Added a larger than normal amount of weight while pregnant
  • Have high blood pressure
  • Have a family history of diabetes
  • Are expecting multiple babies
  • Have had gestational diabetes in the past
  • Have previously given birth to a baby weighing more than 9 pounds
  • Have had an unexplained miscarriage or stillbirth
  • Over the age of 25
  • Are not physically active
  • Have been on glucocorticoids
  • Have African, Native American, Asian, Pacific Islander, or Hispanic ancestry

How is gestational diabetes diagnosed?

The American Diabetes Association (ADA) recommends doctors to test pregnant women for signs of gestational diabetes routinely.

If one has no known history of diabetes and healthy blood sugar levels at the beginning of the pregnancy, the doctor will likely screen pregnant women for gestational diabetes when they’re are in their third trimester.

Glucose challenge test

Some doctors may commence testing with a glucose challenge test. No preparation is needed for this test. The patient will be required to drink a glucose solution.

After one hour, a blood test will be conducted. If the blood sugar level is high, the doctor may perform a three-hour oral glucose tolerance test, which is considered a two-step testing.

Some doctors do not conduct the glucose challenge test altogether and only perform a two-hour glucose tolerance test. This is considered one-step testing.

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One-step test

The doctor will start by testing fasting blood sugar levels. They’ll ask one to drink a solution containing 75 grams (g) of carbohydrates.

They’ll test the blood sugar levels again after one hour and two hours. They’ll likely diagnose  one with gestational diabetes if one has any of the following blood sugar values Trusted Source:

  • Fasting blood sugar level higher than or about 92 milligrams per deciliter (mg/dL
  • One-hour blood sugar level higher than or about 180 mg/dL
  • Two-hour blood sugar level higher than or about 153 mg/dL

Two-step test

For the two-step test, one will not need to be fasting. The patient will be asked one to drink a solution containing 50 g of sugar. They’ll test the blood sugar after one hour.

If, at that point, the blood sugar level is higher than or about 130 mg/dL or 140 mg/dL, the doctor will conduct a follow-up test on another day. The threshold level for concluding this is decided by the doctor.

During the second test, the doctor will start by testing the fasting blood sugar level and ask one to drink a solution with 100 g of sugar in it.

The doctor will test the blood sugar one, two, and three hours later. They will likely diagnose one with gestational diabetes if  one has at least two of the following result:

  • Fasting blood sugar level higher than or about 95 mg/dL or 105 mg/dL
  • One-hour blood sugar level higher or about 180 mg/dL or 190 mg/dL
  • Two-hour blood sugar level higher or about 155 mg/dL or 165 mg/dL
  • Three-hour blood sugar level higher than or about 140 mg/dL or 145 mg/d

Different forms of gestational diabetes

Gestational diabetes is classified into two classes. Class A1 refers to gestational diabetes that can be controlled by dieting alone, while persons with class A2 gestational diabetes need insulin or oral medications to regulate their condition.

If one is diagnosed with gestational diabetes, the treatment plan will depend on how high the blood sugar levels are throughout the day.

In some cases, the doctor will recommend one to test their blood sugar before and after meals and manage one’s condition by eating healthy and staying physically active. In other cases, they may also add insulin injections If required.

According to the Mayo Clinic, about 10 to 20 percent of women with gestational diabetes need insulin to help regulate their blood sugar. If the doctor advises one to monitor one’s blood sugar levels, they may supply the patient with a special glucose-monitoring device.

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They can also prescribe insulin injections for the expectant mother until she delivers her baby. One should be sure to ask the doctor about properly timing their insulin injections to correlate with one’s meals and exercise to avoid low blood sugar.

What should I eat if I have gestational diabetes?

A balanced diet is essential to properly handling gestational diabetes.

In particular, women with gestational diabetes are advised to pay close attention to their fat, protein, and carbohydrate intake by regularly eating — as often as every two hours — can also aid in controlling blood sugar levels.

Carbohydrates

Properly spacing out foods that contain carbohydrates will help to avert blood sugar spikes. The doctor will help to determine exactly how much carbohydrates one should eat daily.

They may also recommend consulting a registered dietician to help with meal plans. Healthy carbohydrate choices include:

  • Whole grains
  • Brown rice
  • Beans, peas, lentils, and other legumes
  • Starchy vegetables
  • Low-sugar fruits

Protein

Expecting mothers are advised to eat two to three servings of protein daily. Food sources of protein include tofu, lean meats, poultry, and fish.

Fat

Healthy fats to integrate into one’s diet are avocado, seeds, olive oil, and unsalted nuts.

Complications are associated with gestational diabetes

If gestational diabetes is poorly managed, the blood sugar levels may remain higher than they should be throughout pregnancy. This can result in complications and affect the overall health of the child.

For example, when the baby is born, he or she may suffer from:

  • Shoulder dystocia, which can cause their shoulders to get stuck in the birth canal during labor
  • A high birth weight
  • Breathing complications
  • Low blood sugar

They may also be at an increased risk of being diabetic later in life. That’s why it’s so important to take steps to manage gestational diabetes by following the doctor’s recommended treatment plan.

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What is the outlook for gestational diabetes?

The blood sugar should return to normal after delivery. But developing gestational diabetes raises the risk of type 2 diabetes later in life.

One should talk to the doctor about how to lower the risk of developing these conditions and associated complications.

When to see a doctor?

One is advised to seek health care as soon as possible, as early detection is paramount. Women are advised to check their risk of gestational diabetes along with their overall wellness.

Once pregnant, the doctor will check for gestational diabetes as part of prenatal care.

If gestational diabetes is discovered, the expecting mother may require regular checkups. These are most likely to happen during the last trimester of pregnancy when the doctor will monitor the blood sugar level and the baby’s health.

Complications

Gestational diabetes that’s not well managed can result in high blood sugar levels. High blood sugar can trigger complications for the mother and baby, including an increased likelihood of needing a C-section to deliver.

Complications that may affect the baby

If one has gestational diabetes, the baby may be at an increased risk of:

  • Blood sugar levels higher than normal in mothers can make their babies grow too large. Very large babies can weigh 9 pounds or more and are more likely to become wedged in the birth canal, cause birth injuries, or need a C-section birth.
  • High blood sugar can increase women’s risk of early labor and delivery before the due date, Or early delivery may be recommended because the baby is large, which can also be a result of high blood sugar levels.
  • Babies born delivered before due dates to mothers with gestational diabetes may experience respiratory distress syndrome — a condition that makes breathing hard.
  • Sometimes babies of mothers with gestational diabetes experience low blood sugar shortly after delivery, a condition called hypoglycemia—severe occurrences of hypoglycemia, which can result in seizures in the baby. Prompt feedings and even an intravenous glucose solution can return the baby’s blood sugar level to normal.
  • Babies of mothers who experience gestational diabetes have a higher risk of developing obesity and type 2 diabetes later in life.
  • Untreated, gestational diabetes can result in infant mortality either before or shortly after birth.

Complications that may affect the mother

Gestational diabetes may also increase the risk of;

Gestational diabetes elevates the risk of high blood pressure, as well as preeclampsia — a severe complication of pregnancy that causes high blood pressure and other symptoms that can threaten the lives of both mother and baby.

Having a surgical delivery (C-section): One is more likely to have a C-section if one has gestational diabetes.

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If one has gestational diabetes, one is more likely to get it again during a future pregnancy and also have a higher risk of type 2 diabetes as one gets older.

Prevention

There are no sure routes to preventing gestational diabetes — but the healthier life choices one can adopt before pregnancy, the better.

If one suffered gestational diabetes, these healthy choices might also cut down the risk of developing it again in future pregnancies or type 2 diabetes later on in life.

Consuming only healthy foods: It is recommended for one to only eat foods high in fiber and low in fat and calories. Focus on fruits, vegetables, and whole grains. Strive for variety to help one achieve the goals without compromising taste or nutrition, and one should stick to portion sizes.

Keeping physically active. Exercising before and during pregnancy can help prevent gestational diabetes. One should aim for 30 minutes of moderate activity on most days of the week.

Take a brisk daily walk, Ride the bike, Swimming, Short bursts of activity — such as parking further away from the store when one runs errands or takes a short walk break — all add up to being physically active.

Start pregnancy at a healthy weight. If one is planning to get pregnant, losing extra weight beforehand may help one have a healthier pregnancy. Focus on making lasting changes to the eating habits that can help one through pregnancy, such as consuming more vegetables and fruits.

Don’t gain excessive weight than recommended. Gaining some weight during pregnancy is healthy and normal. But gaining excess weight too quickly can increase the risk of gestational diabetes

Diagnosis

If one is at average risk of gestational diabetes, they should likely have a screening test during the 24 and 28 weeks of pregnancy.

If one is at the high risk of diabetes — for example if you’re overweight or obese before pregnancy or one has a mother, father, sibling, or child with diabetes — the doctor may test for diabetes early in pregnancy, likely at the first prenatal visit.

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Routine screening for gestational diabetes

Screening tests may vary slightly depending on the health care provider, but generally include:

The initial glucose challenge test is when the patient will drink a syrupy glucose solution. One hour later, they will conduct a blood test to measure the blood sugar level. A blood sugar level of 190 milligrams per deciliter (mg/dL), or 10.6 millimoles per liter (mmol/L) means gestational diabetes.

A blood sugar level lower than 140 mg/dL (7.8 mmol/L) is usually considered normal on a glucose challenge test, although this may vary by clinic or lab. If the blood sugar level is higher than normal, one will need another glucose tolerance test to determine if one has the condition.

Follow-up glucose tolerance testing test is similar to the initial test — except the sweet solution will have even more sugar, and the blood sugar will be checked every hour for three hours.

If at least two of the blood sugar readings are higher than expected, they can be diagnosed with gestational diabetes.

Treatment

Treatment for gestational diabetes includes:

  • Lifestyle changes
  • Blood sugar monitoring
  • Medication, if necessary.
  • Managing blood sugar levels helps keep one and the baby healthy. Close management can also help one avoid complications during pregnancy and delivery.

Lifestyle changes

One’s lifestyle — how one eats and exercise— is an important part of keeping the blood sugar levels in a healthy range.

Doctors don’t recommend losing weight during pregnancy — the body is working hard to support the growing baby. But the doctor can help one set weight gain goals based on the weight before pregnancy.

Healthy diet

A healthy diet should incorporate fruits, vegetables, whole grains, and lean protein — foods that are high in nutrition and fiber and low in fat and calories — and reduce highly refined carbohydrates, ding sweets.

A registered dietitian or a diabetes educator can help one create a meal plan based on the current weight, pregnancy weight gain goals, blood sugar level, exercise habits, food preferences, and budget.

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Staying physically active

Regular physical activity plays a role in every woman’s wellness plan before, during, and after pregnancy.

Exercise lowers the blood sugar, and as an added bonus, regular exercise can help relieve some common discomforts of pregnancy, including back pain, muscle cramps, swelling, constipation, and trouble sleeping.

With the doctor’s OK, aim for 30 minutes of moderate exercise on most days of the week. If one hasn’t been active for a while, start slowly and build up gradually.

By walking, cycling and swimming are good choices during pregnancy. Everyday activities such as housework and gardening also count.

Monitor the blood sugar

While one is pregnant, the health care team may ask one to check the blood sugar four or more times a day — first thing in the morning and after meals — to make sure the level stays within a healthy range.

Medication

If diet and exercise aren’t enough, one may need insulin injections to lower the blood sugar. About 10% and 20% of women with gestational diabetes need insulin to reach their blood sugar goals.

Some doctors recommend an oral medication to regulate blood sugar, while others believe more research is needed to confirm that oral drugs are as safe and as effective as injectable insulin to control gestational diabetes.

Close monitoring of the baby

A crucial part of the treatment plan is the close observation of the baby. The doctor may check the baby’s growth and development with repeated ultrasounds or other tests.

If one doesn’t go into labor by the due date — or sometimes earlier — the doctor may induce labor. Delivering after the due date may raise the risk of complications for one and the baby.

Follow-up after delivery

One’s doctor will check the blood sugar after delivery and again in six to 12 weeks to make sure that the level has returned to normal.

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If the tests are normal — and most are — one will need to have the diabetes risk assessed at least every three years.

If future tests indicate type 2 diabetes or prediabetes, talk with the doctor about increasing the prevention efforts or starting a diabetes management plan.

Coping and support

It’s stressful to know one has a condition that can affect the unborn baby’s health. But the steps that will help control the blood sugar level — such as eating healthy foods and exercising regularly — can help relieve stress, nourish the baby and help prevent type 2 diabetes in the future.

One may feel better if one learns as much as one can about gestational diabetes. Talk to the health care team or read books and articles about gestational diabetes. Some women find a support group for women with gestational diabetes helpful.

Preparing for the appointment

One will likely find out one has gestational diabetes from routine screening during the pregnancy. The doctor may refer one to additional health professionals who specialize in diabetes, such as an endocrinologist, a registered dietitian, or a diabetes educator.

They can help one learn to manage the blood sugar level during the pregnancy.

Here’s some information to help one get ready for the appointment and know what to expect from the doctor or other health professional.

What one can do?

  • Be aware of pre-appointment restrictions. When one makes the appointment, ask if one needs to fast for lab tests, or do anything else to prepare for diagnostic tests.
  • Write down symptoms one is having, including those that may seem unrelated to gestational diabetes.
  • One may not have noticeable symptoms, but it’s good to keep a log of anything unusual one notice.
  • Write down key personal information, including major stresses or recent life changes.
  • Make a list of all medications, including over-the-counter drugs and vitamins or supplements one is taking.
  • Take a family member or friend along, if possible. Someone who accompanies one may remember something that one missed or forgot.

Questions to ask the doctor?

Make a list of questions to help make the most of the time with the doctor. For gestational diabetes, some basic questions to ask the doctor include:

  • What can I do to help control my condition?
  • Can the doctor recommend a dietitian or diabetes educator who can help with meals plans, an exercise program, and coping strategies?
  • Will I need medication to control my blood sugar?
  • What symptoms should prompt me to seek medical attention?
  • Are there brochures or other printed materials I can take? What websites does one recommend?

What to expect from the doctor?

  • The doctor is also likely to have questions for one, especially if one is seeing him or her for the first time. The doctor may ask:
  • Have one experienced increased thirst or excessive urination? If so, when did these symptoms start? How often does one have them?
  • The doctor will inquire if one has noticed other unusual symptoms?
  • Does one have a parent or sibling who’s ever been diagnosed with diabetes?
  • If one has been pregnant before? If one experienced gestational diabetes during the previous pregnancies?
  • If one has other problems in earlier pregnancies?
  • If one has other children, how much did each weigh at birth?

References;

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Jennifer Aigbini
I am a language enthusiast, studying Linguistics at the University of Benin, in Nigeria.
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