How to Manage Diabetes During Pregnancy?

Gestational diabetes is when a pregnant woman is diagnosed for the first time with diabetes.

It typically develops in women during the second and third trimesters but can develop as early as the first trimester. This happens when hormonal changes during pregnancy cause insulin resistance.

Gestational diabetes affects approximately 2% to 10% of pregnant women, with prevalence varying based on factors such as ethnicity, genetic predisposition, and lifestyle habits.

Certain risk factors such as being overweight or obese, having a sedentary lifestyle, and a family history of diabetes can heighten the likelihood of developing this condition during pregnancy.

Gestational diabetes can cause problems for both the mother and the developing fetus.

Maternal problems may include:

1. Hypertensive Disorders:
   • Preeclampsia: Increased risk of high blood pressure and damage to other organ systems, most often the liver and kidneys.
   • Gestational Hypertension: Elevated blood pressure during pregnancy.
2. Increased Risk of C-Section:
   • Cesarean Delivery: Larger babies due to excess fetal growth (macrosomia) may increase the likelihood of cesarean delivery.
3. Type 2 Diabetes Risk:
   • Higher risk of developing type 2 diabetes after pregnancy.
4. Recurrent Gestational Diabetes:
   • Higher risk in subsequent pregnancies.
5. Infections:
   • Increased risk of urinary tract infections (UTIs) and other infections.
6. Polyhydramnios:
   • Excess amniotic fluid that can lead to premature labor or complications during delivery.
7. Preterm Labor:
   • Elevated risk of early labor due to complications related to blood sugar levels.

Fetal Complications of Gestational Diabetes:

1. Macrosomia:
   • Excessive fetal growth, leading to a birth weight over 4 kg (8.8 lbs), which can complicate delivery.
2. Neonatal Hypoglycemia:
   • Low blood sugar levels in the newborn immediately after birth due to the baby’s pancreas producing extra insulin.
3. Respiratory Distress Syndrome (RDS):
   • Difficulty breathing due to immature lung development, even if the baby is born at term.
4. Premature Birth:
   • Higher risk of preterm delivery, which can result in underdeveloped organs and additional complications for the baby.
5. Jaundice:
   • Increased likelihood of hyperbilirubinemia, causing yellowing of the baby’s skin and eyes.
6. Birth Injuries:
   • Due to macrosomia, the baby may experience shoulder dystocia or other injuries during vaginal delivery.
7. Stillbirth:
   • Rare but possible in uncontrolled or poorly managed gestational diabetes.
8. Obesity and Type 2 Diabetes Later in Life:
   • The child has an increased risk of developing obesity and type 2 diabetes during childhood or adulthood.
9. Congenital Malformations (rare):
   • Though less common than in pre-existing diabetes, there is still a slightly increased risk of certain birth defects if blood sugar is not well controlled.

It is crucial for expecting mothers to undergo gestational diabetes diagnosis through routine screening, typically conducted through a glucose tolerance test, to monitor their glucose levels throughout pregnancy.

Ensuring proper monitoring and management of gestational diabetes is vital for the health of both mother and child.

Pregnant women with gestational diabetes can manage their condition through a balanced diet, regular exercise, and insulin therapy if necessary. Regularly checking blood sugar levels helps protect the health of both mother and child.

How to Diagnose Gestational Diabetes?

Gestational Diabetes is commonly diagnosed using the Glucose Challenge Test (GCT) and the oral glucose tolerance test (OGTT).

The glucose challenge test is typically conducted around the 24th to 28th week of pregnancy. In this non-fasting test, the patient consumes a sugary drink containing 50 grams of glucose.

After one hour, a blood sample is taken to measure blood sugar levels. If the results indicate that the blood sugar levels exceed 140 mg/dL, the individual may require further evaluation through the oral glucose tolerance test.

The oral glucose tolerance test is a more comprehensive assessment. In this test, the patient must fast for at least eight hours before consuming a glucose-rich drink, typically containing 75 grams of glucose.

Blood samples are drawn at intervals—usually fasting, one hour, and two hours post-consumption—to evaluate how the body processes sugar.

According to established diagnostic criteria, gestational diabetes is diagnosed if any of the blood sugar levels exceed the thresholds:

• 92 mg/dL (fasting),
• 180 mg/dL (one hour), or
• 153 mg/dL (two hours).

It is crucial to conduct these diagnostic tests within the specified timeframe during pregnancy to avoid complications associated with gestational diabetes.

Women identified as at risk, such as those with a family history of diabetes or a history of prior gestational diabetes, may be screened earlier.

If gestational diabetes is diagnosed, follow-up procedures, including regular monitoring of blood sugar levels and nutritional counseling, are essential to manage the condition effectively and reduce the risk of complications for both mother and child.

How to manage Diabetes with pregnancy?

Pre-Pregnancy:

If you have diabetes, it’s important to talk to your doctor before you get pregnant. Your doctor will help you keep your blood sugar under control. He will make changes to your treatment plan for a healthy pregnancy.

During Pregnancy:

Managing diabetes during pregnancy is essential for both your and your baby’s health. This means seeing your doctor often, checking your blood sugar, eating healthy foods that are right for you, exercising, and taking insulin as prescribed by the doctor.

Post-Pregnancy:

Having gestational diabetes during pregnancy puts you at a higher risk of getting type 2 diabetes. So, take a diabetes test 4 to 12 weeks after birth, even if your blood sugar is back to normal. Keep getting tested every 1 to 3 years to make sure you’re perfectly healthy.

If you have diabetes, keep checking your blood sugar levels and discuss it with your doctor about any changes. You may need to adjust your treatment plan to stay healthy and take care of any other health issues related to your diabetes.

How to Manage Gestational Diabetes?

Regular Monitoring and Adjustments

If you have gestational diabetes, expect more prenatal appointments where your healthcare provider will:

Monitor fetal growth: Regular ultrasounds monitor your baby’s growth, catching any unusual growth patterns early on for a healthy pregnancy.

Review blood sugar levels: Check your blood sugar levels to see if they’re often too high or too low.

To check your blood sugar at home, you need a glucose meter, lancets, and test strips. Prick your finger with a tiny needle, then put a tiny drop of blood on a test strip, and finally, put it into the meter. Your doctor or teacher will show you how to do it and help you until you do it yourself.

Recording and Adjustments

Keep a record of your meals and your blood sugar levels. Your doctor will check this log regularly and might change your diet, like reducing carbs, to help control your blood sugar.

Insulin Therapy for GDM:

You have only a few options to control your blood glucose during pregnancy. These include:

• Insulin
• Metformin
• Glyburide

Glyburide is the least preferred option. Metformin is usually the first drug prescribed. If blood sugars are not controlled despite increasing the dose of metformin to 2 g per day, insulin is the next preferred option.

Insulin treatment may be initiated as once-a-day long-acting insulin or multiple doses of insulin before meals.

Glargine (Lantus and Toujeo) and Detimer (Levemir) are the preferred once-a-day insulins used with metformin especially to control fasting blood glucose in pregnant women with fasting hyperglycemia.

In patients who do not achieve optimal glucose control, premixed insulins are prescribed as twice or thrice daily injections or as a basal-bolus regimen (a basal insulin at bedtime and a bolus insulin before each meal).

Insulin is injected into the skin of the tummy, thighs, or buttock as a subcutaneous injection.

A Balanced Diet for Gestational Diabetes:

• Food Group:
  • Grains, Beans, and Starchy Vegetables
• Recommended Servings Per Day:
  • 6 or more
• Healthy Choices:
  • Whole grains, cereals, beans, brown rice, whole-wheat pasta, corn, peas

• Food Group:
  • Vegetables
• Recommended Servings Per Day:
  • 3 – 5 per day
• Healthy Choices:
  • Leafy greens, dark green and deep yellow vegetables, frozen vegetables without added sauces, fats, or salt

• Food Group:
  • Fruits
• Recommended Servings Per Day:
  • 2 – 4
• Healthy Choices:
  • Whole fruits, citrus fruits, fruit juices without added sugar, fresh fruits and juices

• Food Group:
  • Milk and Dairy
• Recommended Servings Per Day:
  • 4
• Healthy Choices:
  • Low-fat or nonfat milk or yogurt, dairy products without added sugar and artificial flavors

• Food Group:
  • Protein (Meat, Fish, Dry Beans, Eggs, Nuts)
• Recommended Servings Per Day:
  • 2 – 3
• Healthy Choices:
  • Fish, poultry, lean cuts of meat, beans, eggs, nuts

• Food Group:
  • Sweets
• Recommended Servings Per Day:
  • Avoid
• Healthy Choices:
  • Small portions, avoid sugar-free sweets and artificial sweeteners, canned fruits, and high fructose corn syrup.

• Food Group:
  • Healthy oils (olive oil), nuts, avocados, olives
• Recommended Servings Per Day:
  • Limit
• Healthy Choices:
  • Healthy oils (olive oil), nuts, avocados, olives

General Dietary Recommendations for Women with GDM:

Carbohydrates: Get most of your calories from healthy foods like fruits, vegetables, and whole grains. Limit carbs to less than half of your daily intake.

Whole grains: Select whole grains options for bread, cereal, and rice, and add pasta to increase nutrients and fiber intake.

Fruits and vegetables: Limit your intake of fruit juices and eat whole fruits and vegetables.

Dairy: For a healthy diet, choose dairy products that are low in fat or contain no fats.

Fats: Use healthier oils such as olive, avocado, or canola oil instead of saturated fats. 

Portion control: Maintain a healthy balance by paying attention to the amount of food you eat.

Meal planning: Fuel your body with regular meals and snacks to stay energetic and focused all day.

How to prevent Type 2 Diabetes after Gestational Diabetes?

After having gestational diabetes, you can lower the risk of type 2 diabetes by making these simple changes:

• Eat a balanced diet rich in veggies, fruits, and whole grains.
• Exercise regularly, aiming for 150 minutes weekly.
• Check your blood sugar levels regularly and make a plan with your doctor.
• Having support from family and friends will keep you on track.