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Gestational Diabetes – Causes, Symptoms and Treatment

Gestational diabetes is a form of diabetes that develops during pregnancy. It is caused by hormonal changes and requires early diagnosis and proper management to protect mother and child.

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Things worth knowing about "Gestational Diabetes"

Gestational diabetes is a form of diabetes that develops during pregnancy. It is caused by hormonal changes and requires early diagnosis and proper management to protect mother and child.

What is Gestational Diabetes?

Gestational diabetes mellitus (GDM) is a condition in which blood sugar levels become too high during pregnancy, in women who did not previously have diabetes. It is one of the most common complications of pregnancy, affecting approximately 5–10% of all pregnancies. With proper diagnosis and management, most women with gestational diabetes can have a healthy pregnancy and delivery.

Causes

During pregnancy, the placenta produces hormones that can block the effect of insulin -- a phenomenon known as insulin resistance. Normally, the pancreas compensates by producing more insulin. In some women, this compensation is insufficient, leading to elevated blood glucose levels.

Pregnancy hormones (e.g., human placental lactogen) that cause insulin resistance
Overweight or obesity before pregnancy
Family history of type 2 diabetes
Maternal age over 35 years
Previous birth of a baby weighing more than 4,500 g
Polycystic ovary syndrome (PCOS)

Symptoms

Gestational diabetes often causes no noticeable symptoms, which is why routine screening during pregnancy is essential. When symptoms do occur, they may include:

Increased thirst and frequent urination
Fatigue and unusual tiredness
Recurrent urinary tract infections
Blurred vision

Since many of these symptoms can also occur in a normal pregnancy, they are not reliable indicators on their own. Screening tests are therefore critical.

Diagnosis

Gestational diabetes is typically diagnosed between weeks 24 and 28 of pregnancy using an oral glucose tolerance test (OGTT). The woman drinks a glucose solution, and blood sugar levels are measured at multiple intervals.

Fasting blood glucose: 92 mg/dL or above is considered abnormal
1-hour blood glucose: 180 mg/dL or above is considered abnormal
2-hour blood glucose: 153 mg/dL or above is considered abnormal

If any one of these thresholds is exceeded, a diagnosis of gestational diabetes is made.

Risks for Mother and Baby

When left untreated or poorly managed, gestational diabetes can pose serious health risks to both the mother and the baby.

Risks for the Mother

Increased likelihood of urinary tract infections
Higher rate of cesarean delivery
Elevated risk of developing type 2 diabetes later in life
Preeclampsia (high blood pressure during pregnancy)

Risks for the Baby

Macrosomia (excessive fetal growth and high birth weight)
Complications during delivery due to the size of the baby
Neonatal hypoglycemia (low blood sugar after birth)
Increased risk of obesity and type 2 diabetes later in life

Treatment

The primary goal of treatment is to keep blood sugar levels within a healthy range throughout the remainder of the pregnancy, thereby reducing the risk of complications for both mother and baby.

Dietary Changes and Physical Activity

For most women, blood sugar levels can be controlled through a balanced, low-glycemic diet and regular moderate exercise. A diet rich in fiber and low in rapidly digestible carbohydrates is typically recommended. Suitable activities include walking, swimming, and prenatal yoga.

Blood Sugar Self-Monitoring

Women with gestational diabetes are advised to measure their blood glucose levels several times a day using a home glucose meter. This helps evaluate the effectiveness of lifestyle changes and guides treatment decisions.

Insulin Therapy

If diet and exercise alone are insufficient to control blood sugar levels, insulin therapy is initiated. Oral antidiabetic medications are generally not approved for use during pregnancy. Insulin does not cross the placenta and is considered safe for both mother and child.

After Pregnancy

In most women, blood sugar levels return to normal after delivery. However, gestational diabetes significantly increases the long-term risk of developing type 2 diabetes. It is recommended that women undergo a repeat OGTT 6–12 weeks postpartum. Maintaining a healthy weight, eating a balanced diet, and staying physically active are important preventive measures in the years following the pregnancy.

References

World Health Organization (WHO): Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy. WHO/NMH/MND/13.2, 2013.
American Diabetes Association (ADA): Standards of Medical Care in Diabetes -- Management of Diabetes in Pregnancy. Diabetes Care, 2023; 46(Suppl 1): S254–S266.
Kleinwechter H. et al.: Gestational diabetes mellitus. Diabetologie und Stoffwechsel, 2021; 16(S02): S268–S284.

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