Gestational Diabetes

How is Gestational Diabetes Diagnosed?

Diabetes is an extremely important health problem where the pancreas produces a very low amount of insulin or no insulin at all. Diabetes, which has increased in line with obesity, has become a global health problem.

Diabetes is a metabolic disease that involves is related to protein and fat metabolism, and particularly carbohydrates. Without insulin, sugar and other nutrients cannot enter the cells that need them. Thus, when cells lack sugar, glucose levels in the bloodstream increase above normal values. There are two different forms of diabetes: Type 1 and Type 2. In Type 1 diabetes, the pancreas cannot provide enough insulin to the body. It is usually diagnosed at an early age. Type 1 diabetes is always treated with insulin. Type 2 diabetes is known as insulin-independent diabetes. In women, it is observed especially in combination with polycystic ovary syndrome. However, a woman who has never been diagnosed with diabetes may be diagnosed with diabetes during pregnancy due to the risks involved. This condition known as gestational diabetes may go away on its own after the pregnancy. The risk group for gestational diabetes includes women with a family history of diabetes, high blood pressure, high cholesterol and excess weight problems. Gestational diabetes is observed in approximately 3 percent of all pregnant women, but in about 10 percent of these cases, the condition becomes permanent.

How does gestational diabetes occur?

Women with gestational diabetes do not have diabetes prior to pregnancy. Although insulin levels are high in these women, the hormones produced by the umbilical cord (placenta) prevent the insulin from acting and therefore the blood sugar level increases. This effect usually intensifies in the 20th and 24th weeks of pregnancy. However, in women with excess weight, blood glucose may be high from the first months of pregnancy. Since the placenta is discarded at delivery, these hormones disappear, and the disease goes away.

Who is at Risk of Gestational Diabetes?

• Women with a family history of diabetes,
• Overweight women,
• Women whose previous children were over 4kg at birth,
• Women who have had miscarriages,
• Pregnant women over the age of 25
• High glucose levels during previous pregnancies
• Sugar in urine

What should people at risk do?

Women in the risk group for gestational diabetes should take oral glucose tolerance test in the first months of pregnancy. Even if diabetes is not diagnosed at this stage, the test should be repeated at weeks 20-24 of gestation.

Since it shows no symptoms, all pregnant women should be screened for gestational diabetes. During the oral glucose tolerance test, a solution containing 50g of glucose is given at any time of the day. One hour later, glucose levels in the bloodstream are evaluated. If the level of glucose in the bloodstream is over 140mg/dl, another test with 100g of glucose is performed as the situation is assessed as risky. If the results show a level of glucose lower than 140g/dl, there is no risk of diabetes.

If a pregnant woman has a fasting glucose level of over 126g/dl, or if glucose levels evaluated at any given time are above 200g/dl, this means the diabetes precedes the pregnancy.

How does gestational diabetes affect the baby?

In women who have gestational diabetes, the blood sugar levels usually rise around the 24th week. This does not lead to any abnormalities in the baby. However, if the condition is diagnosed within the first trimester, the mother should be careful. Women diagnosed with diabetes prior to pregnancy can also deliver healthy babies. However, these women must have their blood glucose levels evaluated regularly.

Gestational diabetes is an important risk factor since it leads to heavy weight at birth. Since the mother has high blood sugar, the baby’s pancreas consequently produces more insulin, which leads to weight gain. Consequently, a C-section might be necessary. The baby might experience low blood sugar at birth, which is why the blood sugar of the baby should be monitored. In addition, these babies may suffer from low calcium and magnesium levels, which should also be monitored.

What should you look out for in gestational diabetes?

There are two ways to monitor gestational diabetes. The first way is to monitor the blood sugar of the mother. The second way is to follow up the development of the baby. The most important thing in gestational diabetes is to keep blood sugar under control. Blood sugar levels are kept between 60 and 120 mg/dl through regular blood tests. Fasting and random blood sugar levels should be measured. Besides, blood sugar levels should be measured before dinner and at 22:30 (sometimes at 3-4 in the morning). Fasting blood sugar should be equal or lower than 95mg/dl; and postprandial blood sugar levels should be equal or lower than 140mg/dl (one hour after meals) and 120 mg/dl (two hours after meals). In addition, it is important to measure ketone levels in urine from time to time. High ketone levels in urine is an important marker of diabetes.

Why is blood sugar monitoring important during pregnancy?

• If HbA1c levels are above 8 in the first months of pregnancy, the risk of miscarriage is multiplied by 3,
• While diabetic women have an 8-13% chance of giving birth to a baby with disabilities, this rate is about 2-4% for non-diabetic women
• The higher the HbA1c levels, the higher the risk of disabled babies,
• If blood sugar levels are above 250mg/dl, there is an increased risk of premature birth,
• In the second half of pregnancy, high blood sugar levels may cause heavy birth weight, difficult breathing in the baby, low blood sugar in the baby, jaundice, polycythaemia, low calcium and heart diseases.

Other tests to perform during pregnancy

• Ultrasound scans
• Monitoring the baby’s heartrate
• Amniocentesis: Aiming to diagnose Down syndrome, this test is usually performed on women over 35 years of age

Nutrition and exercise

Appropriate weight gain during pregnancy is between 9 and 12 kg. If the woman was overweight before pregnancy, then the appropriate weight gain is 7-8 kg; and if she was underweight, the appropriate weight gain should be 17-20 kg. Exercise and a healthy lifestyle are essential in diabetes. That is because exercise helps lower blood sugar as well as keep it under control. We recommend pregnant women to go on walks 4-5 times per week. In addition to walking, they can do daily aerobic exercises for 45 minutes. While nutrition is very important for all pregnant women, it is even more important for women with gestational diabetes. Vegetables, whole grains, dried legumes, and pulpy foods should be preferred. Olive oil, whole g Olive oil, whole wheat bread, fat-free yogurt and fat-free milk should be consumed. Margarine should not be consumed, and carbohydrate intake should be limited. Carbohydrates should not exceed 40% of the total daily calorie intake. Another important point is blood pressure values. Blood pressure should be monitored regularly; in case the systolic blood pressure exceeds 140, and the diastolic blood pressure exceeds 90, you should consult your doctor immediately.

When and how is gestational diabetes treated with insulin?

If fasting blood sugar exceeds 105 mg/dl despite diet, and postprandial blood sugar exceeds 120 mg/dl at 2 hours, insulin treatment is required. Pregnant women who start an insulin treatment have to monitor their blood sugar levels at home. Insulin can be taken several times a day, according to your doctor’s instructions. Oral antidiabetics are not used in pregnancy because they pass through the placenta.

Delivery and Postdelivery

Women diagnosed with gestational diabetes may have a vaginal birth. However, the situation of the baby is a factor in making the decision. Delivery usually happens at 38 weeks. If the blood sugar is high during labour, insulin is given through IV. It is possible to give birth to a healthy baby with regular monitoring.

In the postdelivery period, the nutrition of the mother should continue as in the pregnancy. When blood sugar levels go back to normal, the insulin treatment ends. For this reason, blood sugar levels should be regularly measured on the day of the delivery and the following days. If the postdelivery blood sugar level is within the normal range, it should still be measured 1-2 months after the delivery.

Women with gestational diabetes are at a higher risk (about 10%) of developing diabetes in the future. That is why they should keep their weight under control, exercise regularly and eat a healthy diet. Besides, fasting and postprandial blood sugar levels should be checked every six months, especially if the patient is planning another pregnancy in the future.

Another factor that is as important as weight is where fat is stored within the body. Men whose waist circumference exceeds 102 cm, and women over 88 cm are at higher risk of diabetes, even if their weight is within the normal range. Men whose waist circumference is over 94 cm, and women whose waist circumference is over 80 cm should be careful. Diabetes can be kept under control by means of individual weight control, balanced and proper diet and lifestyle changes along with an appropriate exercise program. If these preventive methods yield no results, the patient may resort to medical acupuncture or alternative medicine. Recent studies have proven the efficacy of medical acupuncture.