Diabetes In Pregnancy

What is Diabetes in Pregnancy?

Diabetes in Pregnancy or Gestational Diabetes, also known as gestational diabetes mellitus (GDM) or pregnancy-induced diabetes, is a condition in which a woman without a prior history of diabetes develops diabetes during pregnancy. Ideal blood sugar levels during pregnancy increase, resulting in pregnancy-induced diabetes. It commonly starts during the last three months of pregnancy. Approximately 2-5% of women develop diabetes during pregnancy. In 90% of the cases, pregnancy-induced diabetes resolves after childbirth. Nevertheless, these women are at a higher risk of developing diabetes in the future.

Is diabetes in pregnancy a medical emergency?

It is a medical emergency. Uncontrolled blood sugar levels can lead to serious complications during pregnancy and can affect the baby’s health.

Causes

The primary cause of gestational diabetes is hormonal changes. Changes in hormone levels during pregnancy make it difficult for the body to regulate insulin normally. This leads to a rise in blood glucose levels, which eventually leads to diabetes. Diabetes in Pregnancy can be hereditary. It means if parents have pregnancy-induced diabetes, it can also be inherited by the next generation.

Risk factors

Factors that increase the chance of developing diabetes in pregnancy are:

• Overweight
• Prior history of gestational diabetes
• Family history of type 2 diabetes
• History of polycystic ovarian syndrome
• Women who get pregnant at 35 years and above
• Women who smoke tobacco during pregnancy
• History of high blood pressure and other medical complications

Symptoms & signs

All women with gestational diabetes may not exhibit symptoms; however, some of the symptoms that can be noticed include:

• Excessive thirst
• Increased urination
• Fatigue and weakness
• Nausea and vomiting
• Bladder infections and yeast infections
• Blurry vision

Investigations

Ideal blood sugar levels during pregnancy are checked to determine pregnancy-induced diabetes. Investigation tests that are performed to diagnose gestational diabetes include:

• Non-challenge blood tests: They include,
  • Fasting glucose test: Blood glucose levels are checked after fasting from the night before the test
  • 2-hour after a meal glucose test: Blood glucose levels are checked 2 hours after eating a meal
  • Random glucose test: Blood glucose levels are checked at any time randomly
  • Screening glucose challenge test: The test is performed between 24 and 28 weeks of gestation. No fasting is required for this test.
• Oral glucose tolerance test (OGTT): This test is done in the morning after an overnight fast for 8 to 14 hours. During this test, the individual is given a solution containing a certain amount of glucose. Blood glucose levels are checked 1 hour after drinking the solution.
• Urinary glucose testing: High glucose levels in the urine during pregnancy also suggest gestational diabetes. Increased glomerular filtration rates during pregnancy contribute to high glucose levels in the urine.

Diagnosis

The diagnosis of Diabetes in Pregnancy or Gestational Diabetes is made considering the results of the investigation tests.

Treatment options

The main aim of treatment is to control ideal blood sugar levels during pregnancy. In most cases, diabetes in pregnancy is cured with dietary changes and exercise. Insulin therapy is also required. Dietary changes include dividing carbohydrate intake into small portions throughout the day and consuming food rich in fiber, such as whole grains, fruits, and vegetables. Gestational diabetes can be reversed. The woman can have a healthy pregnancy and prevent type 2 diabetes later in life by following an appropriate diet plan. In the majority of the cases, women gain weight with gestational diabetes; however, 25% of the women lose weight.

Medical treatment

Medical treatment for diabetes during pregnancy includes:

• Anti-diabetic medications such as metformin and glyburide are safe and effective during pregnancy.
• Insulin therapy to control blood glucose levels. Insulin is the gold standard treatment for gestational diabetes mellitus. Insulin lispro, aspart, and detemir are approved to be used in pregnancy.

A combination of medications and insulin therapy is also used.

Role of Diet/ Exercise/ Lifestyle changes/ Preventive measures

Lifestyle changes with gestational diabetes include:

• Blood sugar tests should be done four times a day in mothers with gestational diabetes to monitor glucose levels during pregnancy
• Breastfeeding can be continued after childbirth
• Blood glucose level is to be checked after delivery, in 6 to 12 weeks, and after that every 3 years
• Carbohydrates are to be taken in smaller amounts during meals and snacks
• The diet should include plenty of whole fruits and vegetables, moderate lean proteins, and healthy fats. Whole grains such as bread, cereal, pasta, and rice; starchy vegetables such as corn and peas
• Consume less sugary foods, including soft drinks, fruit juices, pastries, etc

Preventive measures for Diabetes in Pregnancy include:

• Maintain a healthy weight during pregnancy
• Perform moderate physical exercises
• Avoid smoking tobacco products during pregnancy

Complications

Though gestational diabetes is not dangerous, it causes major complications during pregnancy, like the following.

• Risk of pre-eclampsia
• Risk of intrauterine growth retardation
• Stillbirth
• Pre-term birth
• Polyhydramnios (excessive build-up of amniotic fluid)
• The necessity to deliver via cesarean section
• Depression in mother
• Higher risk of the mother developing diabetes in the future
• Mothers with gestational diabetes give birth to large babies with excessive birth weight
• Babies of gestational diabetes mothers are prone to develop chemical imbalances, risk of congenital malformations, low blood sugar, jaundice, and breathing difficulties. They may require admission to the neonatal intensive care unit. They are at a higher risk of developing type 2 diabetes and obesity as they grow

Prognosis

The overall prognosis of gestational diabetes varies from woman to woman. In most cases, gestational diabetes goes away after the delivery. It may recur again in future pregnancies. The risk of recurrence is higher if the next pregnancy occurs within a year. It is also important to note that in a few cases, gestational diabetes does not go away even after childbirth. The individual should continue to exercise and eat a healthy diet even after delivery to prevent or delay getting type 2 diabetes.

When to contact the doctor? / How to identify complications?

It is always advisable to get routine blood sugar checkups after being pregnant. On noticing abnormal blood glucose levels, the medical practitioner must initiate appropriate prenatal care.

Indications for hospitalization

Diabetes in pregnancy or gestational diabetes does not require any hospitalization.

Screening methods

Routine screening is done for all women who are pregnant. Screening glucose challenge test is performed around 24–28 weeks of pregnancy. If the woman has a family history of diabetes or other risk factors, a screening test is done earlier in pregnancy. In recent times, it has been mandatory to get checked for Gestational Diabetes in Pregnancy. In very rare cases, gestational diabetes may be misdiagnosed, and treatment would be provided for individuals who do not have the disease. This can lead to serious complications for the mother and the baby.

Suggested clinical specialists/ Departments to consult for this condition

Departments consulted for Diabetes in Pregnancy are endocrinology, obstetrics, and gynecology.