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Gestational Diabetes

Gestational diabetes is the form of diabetes which occurs in pregnant women who have high blood sugar levels. In this condition, women who have no history of diabetes whatsoever but have increased levels of blood glucose in their body, suddenly develop diabetes when they conceive. The actual reason behind gestational diabetes is yet to be known, however, according to the various researchers, one of the main reasons behind this can be the insulin resistance offered by the placenta to the mothers’ body. 

Gestational diabetes is triggered when the mothers’ body is incapable of producing and using the right amount of insulin needed during the pregnancy period. Once the mother’s body encounters a deficiency of insulin, it is incapable of supplying the required energy to the glucose to leave the blood and be converted into useful energy. This glucose accounts for the rise in the blood glucose levels of the body. This condition is known as hyperglycemia.

 

Types of Gestational diabetes:

There are two types of gestational diabetes, namely:

- Type A1: It is the type of gestational diabetes where abnormal oral glucose tolerance test (OGTT) need to be conducted to confirm the presence of this condition. It is characterized by the presence of normal blood glucose levels during fasting and two hours after meals. The blood glucose levels can be brought back under control by sticking to a modified diet. 

- Type A2:  For this confirmation of this type of gestational diabetes, abnormal OGTT is conducted. It is characterized by the presence of abnormal glucose levels during fasting and after taking the meals. For the treatment of this condition, an additional therapy along with external intake of insulin and other medications is required.

 

Symptoms of Gestational diabetes:

The symptoms of gestational diabetes vary in between mild and non-existent. Some of the symptoms can also be misunderstood for normal pregnancy symptoms. Below mentioned are a few symptoms related to gestational diabetes which calls for an immediate attention of the doctor.

- Your vision might get blurry and unfocused from time to time.

- A tingling feeling in your hands and feet followed by a numbing sensation.

- An excessive thirst which does not seem to quench

- Often feeling the urge to urinate

- Feeling hungry every now and then

- Developing sores which take a prolonged time to be healed.

- Feeling an immense amount of fatigue.

 

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Causes of Gestational diabetes:

The main cause of gestational diabetes is yet to be known. In order to understand the possible causes of gestational diabetes, you need to first understand the glucose mechanism of the body.

The digestive system is responsible for digesting the food you intake in order to produce the required amount of glucose to carry out the various body processes.  Now, the pancreas intakes this glucose and use it to produce insulin. Insulin is the hormone which helps the glucose to move into the various cells of your body from the blood present in the arteries. Once the glucose enters the body’s cells, produces the energy required to do useful work.

Now, during the gestation period, the fetus is connected to the mother’s body with the help of the placenta. A placenta is a structure which is responsible for the conduction of oxygen and nutrients from the mother’s blood to the fetus’ body. It also produces the hormones required by the fetus. All these hormones weaken the action of the insulin thereby resulting in an accumulation of glucose in the body of the mother.

As the fetus grows, the placenta produces such hormones in a high quantity which counteract the action of the insulin, thereby resulting in gestational diabetes. It generally affects the growth and the health of the growing fetus. Gestational diabetes develops mainly during the last trimester. However, in some cases, it can develop in the 20th week as well, but not before that.

Below mentioned are a few other causes which trigger gestational diabetes:

- If you were overweight before you conceived

- Suffer from high blood glucose levels, however, not high enough to be termed as diabetes

- Diabetes is a hereditary disease in your family

- If you have had a previous encounter with gestational diabetes

- Suffer from high blood pressure and other related medical ailments

- Have a previous history of giving birth to an  overweight child (weight more than nine pounds)

- Have previously given birth to a stillborn child or a child with inborn defects.

 

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Diagnosis of Gestational diabetes:

Gestational diabetes mainly occurs in the last trimester of pregnancy. Every doctor checks for the symptoms of gestational diabetes when you go for the regular pregnancy checkup. Hence it can be easily diagnosed. However, the tests need to be conducted before it is too last.

The doctors carry out the following test to confirm whether or not you are suffering from gestational diabetes.  You will be needed to drink a sugary concoction. It will lead to an increase in your blood glucose levels. After an hour, a blood test will be conducted to check whether or not your body was able to handle the sugar content. If the blood test reports show your blood sugar levels to be more than the normal levels, it calls for more tests. 

No further tests will be conducted to check your blood glucose levels before and after the fasting period with a three-hour gap in between the taking of the blood samples.

However, if your results turn up to be normal do not stop checking for gestational diabetes. Let your gynaecologist test your blood glucose levels at each and every checkup.

 

Prevention of Gestational diabetes:

Gestational diabetes is mainly triggered by high blood glucose levels and obesity. Hence trying to bring about a change in your regime will help greatly to prevent the development of gestational diabetes. Even a few kilograms can make a huge difference in your risk level towards developing gestational diabetes.

- You need to be healthy before you decide to get pregnant

- In case, you are overweight then lose out the fat first and then try to conceive

- Eat healthy nutritious food. Switch to a healthy diet

- Seek the help of your doctor before you try out anything

- In case you are inactive, start doing regular exercises  to get back in shape

- However, once you get pregnant, do not try to lose the additional weight.  Now focus on a healthy diet consisting of vegetables, fruits, and proteins.

- Moreover, exercise regularly to at least half an hour each day to keep yourself fit.

 

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Treatment of Gestational diabetes:

If you are diagnosed with gestational diabetes, then you need to get your blood sugar levels within levels. You will be needed to make some changes in your lifestyle so as not to let your medical condition affect the child developing in your womb.

Maintain a healthy diet:

Consult with a doctor and prepare a health chart which you need to strictly stick to. This dietary chart will address all the problems related to gestational diabetes, however, it will be so formulated that it will at the same time provide the required nutrients to the growing fetus.

As per the health, the chart is given by your dietician, you need to daily consume a total of at least 2,200 to 2,500 calories every day. This amount of calories on a regular basis will render you with a normal weight. However, if you are slightly overweight you will be needed to cut down your calories intake to 1,800 calories per day.

The calorie intake should be as follow:

- Protein sources like meats, cheeses, eggs, seafood, and legumes account for ten to twenty percent of the calorie

- Fats account for less than thirty percent of the calorie

- Saturated fats account for less than ten percent of the total calorie

- Carbohydrates like bread, cereals, pasta, rice, fruits, and vegetables account for the remaining forty percent

- Regular exercise: Once your doctor has conducted a thorough checkup, he will be able to tell you the type of exercises you need to do in order to keep both yourself and your baby healthy. Exercise at least15 minutes a day as it will not only help to keep your insulin levels within control but will also help your body to use up the accumulated glucose.

- Keep your blood sugar levels under check: If your blood glucose levels are quite high, you need to follow the health chart prescribed by your doctor and do the required exercise in order to keep your blood glucose levels under check.  It is recommended to buy a blood glucose meter so that you can regularly check your blood glucose levels right at your home during the pregnancy period.

- Take proper medications: Even if regular exercise and a changed diet plan is incapable of bringing your blood glucose levels under control, your doctor might prescribe the consumption of diabetes pills and the intake of insulin injections in order to keep the blood sugar levels in check

- Keep track of your Baby’s Growth: Your doctor will be needed to keep track of your diabetes and maintain a complete report as to how it is affecting your pregnancy. He will observe the size of the fetus more closely towards the last few months of your pregnancy. He might get an ultrasound done to keep track of the growth of your child.

 

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Complications:

Congenital malformations

The risks of congenital malformations are quite high in the mothers who are suffering from gestational diabetes. Generally, there are two types of gestational diabetes, namely:

- Gestational diabetes which is strictly related to pregnancy in which there is an increased risk of congenital malformations

- Gestational diabetes which has been diagnosed during the pregnancy period but it was present in the body of the mother before the pregnancy period with similar risks of congenital malformations

Thus, there is an increased risk of developing congenital malformations if the mother is suffering from gestational diabetes.  There is a relationship existing among the risks of developing congenital malformations, the blood sugar levels of the mother, the pregnancy period at which gestational diabetes has been diagnosed and whether or not the mother is obese. It is believed that the malformations present in the body right from birth follow a pattern which is quite similar to the malformations which are seen in the bodies of the individuals suffering from pre-existing diabetes.

- Child born is overweight: There exists a positive relationship between the blood glucose levels of the mother, the child born to be overweight and the presence of neonatal adiposity. The fact that the condition of fetal hyperinsulinism is consequential to the presence of maternal hyperglycemia can be one of the major reasons behind the existence of this relationship.

- Perinatal death: There is an increased risk of perinatal death in the fetus of the mother who is suffering from gestational diabetes.  Maternal obesity is generally linked to type-2 diabetes or even gestational diabetes and it acts as an additional risk factor for perinatal death.

- Birth Injuries: Gestational diabetes is often characterized by the presence of birth injuries along with brachial plexus. There is also an increased risk of suffering from birth injuries which are not treated due to the improper demonstration of untreated gestational diabetes. 

However, till date, no link has been found in between gestational diabetes and neonatal respiratory problems

- Neonatal hypoglycemia: It is quite difficult to quantify the risks of developing a neonatal hypoglycemia posed by the presence of gestational diabetes in the body of the mother. However, the risks of developing hypoglycemia as a side effect of intravenous therapy are quite low.

The fetus present in the body of the mother suffering from gestational diabetes has equal risks of developing both hypocalcemia and hyperbilirubinemia.

 

Conclusion:

Gestational diabetes is one of the most common medical ailments which occur during the pregnancy period. Women who pose a high risk of developing gestational diabetes should be immediately screened in order to lower the maternal and fetal risks of suffering from any disease.

To manage the blood glucose levels and the other factors which are triggered by the presence gestational diabetes, there needs to be a team consisting of a diabetologist, an obstetrician, a dietician and a paediatrician along with a diabetes nurse educator to monitor the health conditions of both the mother and the child.

 

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Last updated on : 26-10-2018

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