How to Navigate Gestational Diabetes and What to Do Once Diagnosed

According to data from the U.S. National Library of Medicine, a diagnosis of gestational diabetes can lead to several undesirable negative outcomes for both the mother and the child.

Gestational diabetes is typically diagnosed between the 24th and 28th week of pregnancy, although it can also develop earlier. Later on, unmanaged and uncontrolled gestational diabetes may lead to type 2 diabetes and cardiovascular diseases.

A woman with gestational diabetes is at increased risk for pre-eclampsia (or eclampsia - a complication of pre-eclampsia, 1 in 1,000 births), undergoing a cesarean section, preterm birth, prolonged hospital stay after birth, and delivering macrosomia babies - babies much larger than normal. All the nutrients the fetus receives come directly from the mother's blood, resulting in larger and heavier babies.

Before a woman becomes pregnant, knowing her family history of diabetes is significant. This information is an important tool for prevention.

Risk Factors for Gestational Diabetes

• Overweight: A BMI of 30 and above before pregnancy is one of the most common risk factors for gestational diabetes.
• Older age: Women over the age of 30 have a higher risk of developing gestational diabetes, with the risk increasing with age.
• Family history: A family history of diabetes, especially among close relatives, increases the risk of gestational diabetes.
• Personal history of gestational diabetes: Gestational diabetes during previous pregnancies.
• Pre-diabetes diagnosis: A fasting blood sugar level before pregnancy between 100-125 mg/dL or hemoglobin A1c of 5.7% - 6.4% is called pre-diabetes, and it is a condition that requires consultation with a doctor upon becoming pregnant.
• Another medical condition related to the development of diabetes: This can include metabolic syndrome, polycystic ovary syndrome, high blood pressure, or cardiovascular diseases.
• Multiple pregnancy: Twins, triplets (more than one fetus) may increase the risk of gestational diabetes.

Symptoms

• Excessive thirst unusual and excessive
• Frequent urination in large amounts (usually, in early pregnancy there are light increases in urination).
• Extreme fatigue episodes (typically, in early pregnancy there are intermittent episodes of fatigue).
• Presence of sugar in urine (a fasting blood glucose test and/or glucose tolerance test should be done even in the early weeks of pregnancy). If the blood sugar level is high, a three-hour glucose tolerance test should be performed to determine if it is gestational diabetes.

How to Reduce the Risk of Developing Gestational Diabetes?

• Physical activity: It is recommended that women with gestational diabetes remain active through walking, aerobic activities, and resistance training at moderate to medium intensity on most days of the week, for at least 20-30 minutes each time. Key tip: Physical activity has been proven beneficial in improving pregnancy outcomes as it allows the body to burn glucose.

• Dietary changes: Women with gestational diabetes are encouraged to eat a mixture of fruits (in controlled quantities) and fresh or frozen vegetables, healthy proteins, and complex carbohydrates. Recommendations include whole grains, legumes, nuts, seeds, tofu, fish, lean red meat, poultry, and low-fat dairy products.
• Gradual weight gain: Pregnant women should generally gain between 5-15 kilograms depending on their pre-pregnancy weight.

Tips for a Healthy Pregnancy

• Measure what you eat and consume smaller portions.
• Avoid packaged foods – junk food, sweets, and snacks.
• Avoid consuming processed meats, eat more lean protein, lean meats, poultry, fish, and tofu.
• Increase fiber intake by consuming more fruits, vegetables, and whole grains.
• Drink water regularly and in moderation.

Conclusion

In the end, there is no way to cheat the system. Proper management of gestational diabetes and implementing lifestyle changes are crucial for a healthy mother and baby.

Pregnancy with diabetes is considered high-risk for conditions such as hypertension in pregnancy and pre-eclampsia which can threaten the life of both the mother and the baby.

Women with gestational diabetes need a close follow-up by a multidisciplinary team that includes a high-risk pregnancy gynecologist, a dietitian, a nurse, and if necessary, an endocrinology/diabetes specialist. They should monitor blood sugar levels throughout the pregnancy and perform a glucose load test about 4-12 weeks after delivery. During pregnancy, continuous glucose monitoring without pricking is recommended and preferred.

In the long term, a woman with a history of gestational diabetes should continue regular annual follow-ups for diabetes exclusion since her risk of developing type 2 diabetes is higher than usual.

Dr. Mariana Yaron is a specialist in internal medicine and endocrinology at the DMC Diabetes Treatment Center and the Institute of Endocrinology, Metabolism, and Hypertension at Ichilov Medical Center Tel Aviv.