Understanding Gestational Diabetes: Causes, Symptoms, and Treatment Options

by sinitta bajaj

June 10, 2023

Gestational diabetes is a type of diabetes that occurs during pregnancy. It is characterized by high blood sugar levels in pregnant women who did not have diabetes before becoming pregnant. This condition typically develops around the 24th to 28th week of pregnancy and affects about 2-10% of pregnant women.

Causes:

The exact cause of gestational diabetes is not fully understood, but it is believed to be related to hormonal changes that occur during pregnancy. The placenta produces hormones that can impair the action of insulin in the mother's body, leading to elevated blood sugar levels. Some women may be more prone to developing gestational diabetes due to pre-existing risk factors such as obesity, a family history of diabetes, or a history of gestational diabetes in previous pregnancies.

Symptoms:

Gestational diabetes often does not cause noticeable symptoms. However, some women may experience increased thirst, frequent urination, fatigue, and blurred vision. These symptoms can be subtle and may be attributed to the normal changes that occur during pregnancy, so it's important to get regular prenatal check-ups and undergo the recommended screenings.

Diagnosis: Gestational diabetes is usually diagnosed through a glucose tolerance test. This test involves drinking a sugary solution and then having blood drawn to measure blood sugar levels. If the blood sugar levels are higher than normal, further testing may be done to confirm the diagnosis.

Treatment:

The primary goal in managing gestational diabetes is to keep blood sugar levels within a target range to minimize any potential risks to the mother and the baby. Treatment options may include:

Dietary changes: A registered dietitian can help create a meal plan that focuses on balanced nutrition, portion control, and adequate intake of carbohydrates, proteins, and healthy fats. Monitoring carbohydrate intake is particularly important to manage blood sugar levels.

Eat regular, balanced meals: Aim for three meals and two to four snacks spread throughout the day. Avoid skipping meals, as it can lead to fluctuations in blood sugar levels.
Choose complex carbohydrates: Opt for carbohydrates that are high in fiber and have a lower glycemic index (GI). These carbohydrates are digested more slowly, causing a gradual rise in blood sugar levels. Examples include whole grains (brown rice, quinoa, whole wheat bread), legumes (beans, lentils), and non-starchy vegetables (broccoli, spinach, cauliflower).
Limit simple sugars and refined carbohydrates: Avoid or minimize the consumption of sugary foods, beverages, and processed snacks. These can cause rapid spikes in blood sugar levels. Be cautious of foods with added sugars, such as sodas, candies, cakes, and sweetened cereals. Also, reduce the intake of white bread, white rice, and pasta, as they are quickly digested and can raise blood sugar levels

Include lean protein: Protein-rich foods help stabilize blood sugar levels and promote satiety. Include lean sources of protein in your meals, such as skinless poultry, fish, lean meats, tofu, eggs, and low-fat dairy products.
Healthy fats: Incorporate healthy fats in moderation, such as avocados, nuts, seeds, and olive oil. These fats can help slow down digestion and promote better blood sugar control.
Portion control: Be mindful of portion sizes to manage carbohydrate intake effectively. Consider working with a registered dietitian who can provide guidance on appropriate serving sizes.
Monitor carbohydrate intake: Spread your carbohydrate intake evenly throughout the day. This helps prevent large spikes in blood sugar levels. Consider carbohydrate counting or the use of the glycemic index to help manage your intake effectively.
Stay hydrated: Drink plenty of water throughout the day. Avoid sugary beverages and fruit juices, as they can rapidly raise blood sugar levels.

2. Regular physical activity: Engaging in regular exercise, as approved by your healthcare provider, can help lower blood sugar levels and improve insulin sensitivity. Walking, swimming, and prenatal yoga are often recommended activities.

Consult with your healthcare provider: Before starting or modifying any exercise routine, it's crucial to consult with your healthcare provider. They can evaluate your individual situation and provide personalized recommendations based on your health, pregnancy, and any potential complications.
Choose low-impact activities: Opt for low-impact exercises that are gentle on your joints and reduce the risk of injury. Walking, swimming, stationary cycling, prenatal yoga, and water aerobics are excellent options for pregnant women. These activities provide cardiovascular benefits without putting excessive stress on your body.
Start slowly and gradually increase intensity: If you were not physically active before pregnancy, begin with shorter durations and low-intensity exercises. Gradually increase the duration and intensity of your workouts over time. Aim for at least 150 minutes of moderate-intensity aerobic activity spread throughout the week.
Monitor your heart rate: It's important to avoid overexertion and overheating during exercise. Use the "talk test" as a guideline: you should be able to carry on a conversation comfortably while exercising. If you find it difficult to talk, you may be exercising too intensely.
Listen to your body: Pay attention to how you feel during and after exercise. If you experience any discomfort, dizziness, chest pain, or vaginal bleeding, stop exercising and consult your healthcare provider immediately.
Stay hydrated: Drink plenty of water before, during, and after exercise to prevent dehydration. Avoid exercising in hot and humid conditions, as it can increase the risk of overheating.
Modify exercises as your pregnancy progresses: As your pregnancy advances, your body undergoes changes that may affect your exercise routine. Modify exercises to accommodate your growing belly and any physical discomfort. Avoid activities that involve lying flat on your back, as it can hinder blood flow to the uterus.
Be consistent: Aim for regular physical activity throughout the week. Try to establish a routine that works for you and stick to it. Consistency is key in reaping the benefits of exercise for gestational diabetes management.

3. Monitoring blood sugar levels: Regular monitoring of blood sugar levels using a glucose meter is essential to determine how certain foods, physical activity, and other factors affect blood sugar levels. This information helps adjust the treatment plan accordingly.

Frequency of testing: Your healthcare provider will guide you on how often to test your blood sugar levels. Typically, you'll be advised to test your blood sugar levels multiple times a day, such as before and after meals.
Target blood sugar levels: The target blood sugar levels may vary depending on your healthcare provider's recommendations. Generally, the target ranges for blood sugar levels in gestational diabetes are:
Fasting (before meals): 95 mg/dL (5.3 mmol/L) or less

One hour after a meal: 140 mg/dL (7.8 mmol/L) or less
Two hours after a meal: 120 mg/dL (6.7 mmol/L) or less

It's essential to work with your healthcare provider to determine your specific target ranges.
Glucose meter: Use a glucose meter to test your blood sugar levels. Your healthcare provider or diabetes educator can provide guidance on selecting a suitable glucose meter and teach you how to use it correctly. Make sure to follow the instructions provided with the meter.
Record-keeping: Keep a record of your blood sugar readings. Note the date, time, and corresponding meal or activity. This record helps you identify patterns and trends, and it can be valuable information for your healthcare provider to adjust your treatment plan if needed.
Understanding your readings: Learn to interpret your blood sugar readings. Work with your healthcare provider or a diabetes educator to understand what the numbers mean and how they relate to your dietary choices, physical activity, and overall management plan.
Adjustments based on readings: Based on your blood sugar readings, you may need to make adjustments to your meal plan, physical activity, or medication (if prescribed). Your healthcare provider or registered dietitian can guide you on making these adjustments.
Seek support and guidance: If you have any concerns or difficulties managing your blood sugar levels, don't hesitate to reach out to your healthcare provider, diabetes educator, or a registered dietitian specializing in gestational diabetes. They can provide ongoing support, answer your questions, and help you navigate the challenges of monitoring blood sugar levels effectively.

4. Insulin injections or oral medication: If dietary and lifestyle changes are not enough to control blood sugar levels, insulin injections or oral medications may be prescribed. These medications are considered safe for use during pregnancy.

Insulin Injections: Insulin is a hormone that helps regulate blood sugar levels. If lifestyle modifications alone are not effective in controlling blood sugar levels, insulin injections may be prescribed. Insulin therapy is considered safe for both the mother and the baby during pregnancy.
Types of insulin: There are different types of insulin available, including rapid-acting, short-acting, intermediate-acting, and long-acting insulin. Your healthcare provider will determine the most appropriate insulin regimen for you based on your blood sugar levels and individual needs.
Insulin administration: Insulin is typically injected using a fine needle and syringe or an insulin pen. Your healthcare provider or diabetes educator will guide you on the correct technique for self-administration. They will also provide instructions on timing, dosage, and monitoring for potential side effects.
Oral Medication: While insulin is the most common medication used for gestational diabetes, in some cases, oral medications may be prescribed if insulin is not feasible or if blood sugar levels are not well controlled.
Glyburide: This oral medication stimulates the pancreas to produce more insulin and helps lower blood sugar levels. It has been used as an alternative to insulin in some cases of gestational diabetes. However, the safety and effectiveness of glyburide during pregnancy are still a topic of ongoing research and debate, and its use may vary depending on individual circumstances and healthcare provider preferences.
Metformin: Metformin is another oral medication that helps lower blood sugar levels by improving insulin sensitivity. It is sometimes used in the management of gestational diabetes, but its use may also depend on individual factors and healthcare provider recommendations.
It's important to note that the decision to initiate insulin injections or oral medication is made based on the specific needs of each individual. Your healthcare provider will evaluate your blood sugar levels, overall health, and the potential risks and benefits associated with each option. They will work closely with you to determine the most appropriate treatment plan to achieve optimal blood sugar control and ensure the well-being of both you and your baby.
Regular monitoring of blood sugar levels and ongoing communication with your healthcare provider are crucial when using insulin injections or oral medication, as dosage adjustments may be needed throughout the course of your pregnancy.

5. Regular prenatal care: Close monitoring of the pregnancy by healthcare professionals is important to ensure the well-being of both the mother and the baby. This may involve more frequent prenatal visits, additional ultrasounds, and fetal monitoring.

Increased frequency of prenatal visits: Women with gestational diabetes typically require more frequent prenatal visits than those without the condition. The exact frequency may vary depending on individual circumstances, but it often involves visits every 1-2 weeks initially and then more frequent visits as the due date approaches.
Blood sugar monitoring: Regular monitoring of blood sugar levels is a vital part of prenatal care for gestational diabetes. Your healthcare provider will guide you on the frequency of testing and the target ranges for blood sugar levels to maintain optimal control.
Ultrasound examinations: Ultrasound examinations are commonly performed throughout pregnancy to monitor the growth and development of the baby. In the case of gestational diabetes, additional ultrasounds may be recommended to assess the baby's size, amniotic fluid levels, and overall well-being.
Fetal movement monitoring: Paying attention to fetal movements is important. If you notice any changes in the baby's usual patterns of movement, inform your healthcare provider immediately.
Nutritional guidance: Working with a registered dietitian who specializes in gestational diabetes is highly beneficial. They can help create a personalized meal plan, monitor your nutritional needs, and provide guidance on managing blood sugar levels through diet.
Medication management: If you require insulin injections or oral medication, regular monitoring and adjustments of your treatment plan will be part of your prenatal care. This may involve dose adjustments based on blood sugar readings and the guidance of your healthcare provider.
Education and support: Prenatal care visits offer an opportunity for education and support. Your healthcare provider and the healthcare team can provide information about gestational diabetes management, self-care practices, and any concerns or questions you may have. They can also address lifestyle factors such as exercise, stress management, and weight management.
Coordination with other specialists: Depending on your specific situation, your healthcare provider may collaborate with other specialists, such as endocrinologists or perinatologists, to ensure comprehensive care throughout your pregnancy.

It's important to note that gestational diabetes usually resolves after childbirth. However, women who have had gestational diabetes are at an increased risk of developing type 2 diabetes later in life. Therefore, it's important to maintain a healthy lifestyle, including regular physical activity and a balanced diet, after pregnancy.

If you suspect you may have gestational diabetes or have any concerns, it's crucial to consult with your healthcare provider for proper diagnosis, guidance, and treatment.