What is Gestational Diabetes
Gestational diabetes is a type of carbohydrate intolerance that develops during the second or third trimester of pregnancy in women who did not have diabetes before becoming pregnant. 1 In a normal pregnancy, hormonal changes combined with insulin-blocking hormones produced by the placenta lead to insulin resistance. 2 To compensate, the pancreas’s beta cells increase insulin secretion. 3 This resulting high insulin level (hyperinsulinemia) overcomes the peripheral insulin resistance, and carbohydrate tolerance is maintained. However, in women predisposed to diabetes, the pancreas may not be able to produce enough insulin to overcome the insulin resistance during pregnancy, leading to gestational diabetes. 4 This condition is usually diagnosed between the 24th and 28th weeks of pregnancy, and blood sugar levels may return to normal after delivery. However, if left untreated, it can lead to health problems for both the mother and the baby. 5
What are the Symptoms of Gestational Diabetes?
Gestational diabetes doesn’t always cause obvious symptoms, which is why regular medical check-ups are very important during pregnancy. All pregnant women should have an initial risk assessment and their fasting blood sugar (glucose) level checked as part of their first prenatal care. However, the following symptoms can often occur:
- Increased Thirst (Polydipsia) and Frequent Urination (Polyuria): The body needs more fluids to flush out excess glucose.
- Tiredness (Fatigue) and Weakness (Adynamia): High blood sugar levels can lead to a decrease in energy levels.
- Blurred Vision: Sudden high blood sugar can cause osmotic changes in the lens of the eye.
- Increased Appetite and Rapid Weight Gain: A disruption in how insulin works can lead to increased hunger.
Why Do Some Women Get Gestational Diabetes?
The exact reason why some women develop gestational diabetes isn’t known, but several risk factors can increase the likelihood of this condition:
- Family History of Diabetes: Having a family history of diabetes, especially in a close relative, and having had gestational diabetes in a previous pregnancy increases the risk.
- Older Maternal Age: Pregnant women over the age of 40 have a higher risk of developing gestational diabetes.
- Being Overweight or Obese: Being overweight before pregnancy can increase insulin resistance, making gestational diabetes more likely.
- Polycystic Ovary Syndrome (PCOS): Hormonal imbalances associated with PCOS can worsen insulin resistance.
- Previous Large Baby: Mothers who have previously given birth to a baby weighing over 9 pounds (approximately 4 kilograms) have a higher risk.
- Other Health Factors: A history of smoking, cardiovascular disease, high blood pressure (above 140/90 mmHg), high triglycerides (above 250 mg/dl), and low HDL cholesterol (below 35 mg/dl) can also increase the risk.
How is Gestational Diabetes Diagnosed?
Gestational diabetes can be diagnosed based on medical guidelines using either a two-step or a one-step testing procedure:
Two-Step Diagnostic Approach:
- Glucose Challenge Test (GCT): This is usually done between the 24th and 28th weeks of pregnancy. You’ll drink a sugary glucose solution (50 grams) without needing to fast beforehand. One hour later, a blood test will measure your blood sugar (plasma glucose) level. A result of 140 mg/dL or higher indicates the need for further diagnostic testing. Generally, if the one-hour plasma glucose level after the 50-gram glucose drink is very high (above 180 mg/dL), a full Oral Glucose Tolerance Test (OGTT) might not be necessary, and these cases may be treated and monitored as gestational diabetes.
- 100-gram Oral Glucose Tolerance Test (OGTT): After an initial fasting blood sugar (plasma glucose) test, you will drink a more concentrated glucose solution (100 grams). Your blood sugar levels will then be checked at 1, 2, and 3 hours. If at least two of these blood sugar readings are higher than the established cut-off values, it confirms a diagnosis of gestational diabetes.
One-Step Diagnostic Approach:
- 75-gram Oral Glucose Tolerance Test (OGTT): In this test, after an initial blood draw to measure your fasting blood sugar, you will drink a 75-gram glucose solution. Your blood sugar levels will then be measured again at 1 and 2 hours. A diagnosis of gestational diabetes can be made if even one of these blood sugar values is above the defined threshold.
Generally, a one-step 75-gram glucose OGTT is the recommended method for diagnosing gestational diabetes between the 24th and 28th weeks of pregnancy.
How is gestational diabetes treated?
Managing gestational diabetes is very important to protect the health of both mother and child. Uzm. Dr. Burcu Meryem Atak Sançmış will help you get your gestational diabetes under control with personalized monitoring and treatment methods. The treatment process includes the following steps:
- Nutrition and Diet Management:
- Choose low glycemic index foods: These foods are digested and absorbed more slowly, leading to a more gradual rise in blood sugar levels.
- Avoid simple carbohydrates: Limit sugary drinks and processed foods, and focus on consuming fiber-rich foods like whole grains, fruits, and vegetables.
- Eat regular and balanced meals: Consistent meal times and balanced portions help stabilize blood sugar levels throughout the day.
- Physical Activity:
- Gentle exercise with doctor’s approval can help regulate blood sugar: Always consult your healthcare provider before starting any new exercise program during pregnancy.
- If there are no medical reasons against it, pregnant women with diabetes are advised to do 20-50 minutes of moderate aerobic exercise (like walking, swimming, Pilates, yoga) and strength or structured muscle-strengthening exercises daily: Choose activities you enjoy and can sustain comfortably.
- Avoid group sports, diving, and flying: These activities may carry specific risks during pregnancy with diabetes.
- Exercise has been shown to reduce cardiovascular (CV) risk, preeclampsia risk, and the risk of cesarean section (C-section): Staying active offers multiple health benefits for both mother and baby.
- Blood Sugar Monitoring:
- Blood sugar should be checked regularly throughout the day and monitored according to your doctor’s recommendations: Frequent monitoring helps you understand how your blood sugar levels respond to food and activity.
- It’s important to check fasting blood sugar before each meal and 1-hour and 2-hour post-meal blood sugar levels: These measurements provide a comprehensive picture of your glucose control.
- Medication or Insulin Therapy (if needed):
- If blood sugar cannot be controlled with diet and exercise, your doctor may recommend insulin therapy: Insulin is a safe and effective way to manage blood sugar levels during pregnancy when lifestyle changes are not sufficient.
How is Gestational Diabetes Diagnosed?
Untreated gestational diabetes can negatively impact the baby’s health:
- Macrosomia (excessive size of the baby at birth): The baby may be larger than normal, which can lead to difficulties during delivery.
- Hypoglycemia: The baby’s blood sugar level may drop suddenly after birth.
- Respiratory problems: Newborns may experience breathing difficulties after birth.
Frequently Asked Questions
Does gestational diabetes disappear after birth?
For most women, blood sugar levels return to normal after birth. However, in later years (after ages 22 to 28), the risk of developing type 2 diabetes can increase by up to 70%. Therefore, regular follow-up checkups are important, especially 6–12 weeks after birth. An oral glucose tolerance test (75 g) should be performed weekly.
Does gestational diabetes harm the baby?
If this condition is not controlled, risks such as a large baby, premature birth, or low blood sugar levels can occur. These risks can be minimized with regular follow-up and treatment.
Can women with gestational diabetes have a normal delivery?
It is possible. However, if there is a risk of a large baby, a cesarean section may be recommended. This decision will be made by your doctor.
How often should I test my blood sugar if I have gestational diabetes?
Generally, 4–6 measurements per day are recommended (on an empty stomach, before, and after meals). It’s important to measure your hunger before each meal and your satiety 1 and 2 hours after each meal. However, it’s best to have your blood pressure measured as often as your doctor recommends.
For more information and to develop your individual treatment plan, please contact Uzm. Dr. Burcu Meryem Atak Sançmış.
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