Diabetes Complications

Gestational Diabetes – Signs and Symptoms

Pregnancy puts a lot of stress on a woman’s body, which can result in several physical side effects and health changes during her pregnancy. Some women develop gestational diabetes, which is diabetes that occurs during pregnancy even if they don’t have a personal history of diabetes. 

Gestational diabetes is considered high-risk criteria for pregnancy, requiring extra monitoring and sometimes additional testing to ensure the mother and baby stay healthy. Some complications can occur due to gestational diabetes, so it’s something that healthcare providers routinely screen for in every pregnancy.

If you have gestational diabetes, it’s completely possible to have a healthy pregnancy and baby. Knowing the signs and symptoms of gestational diabetes and how to effectively treat it will give the expectant mother the knowledge she needs to make informed choices during her pregnancy.

What is gestational diabetes?

Gestational diabetes, commonly abbreviated as GDM, is when a woman develops high blood sugar levels during pregnancy and is diagnosed with diabetes. About 10% of pregnant women end up diagnosed with gestational diabetes each year in the United States.

Unlike type 1 and type 2 diabetes, gestational diabetes often goes away once the pregnancy is over. However, having gestational diabetes does increase the chance of developing type 2 diabetes later in life.

Gestational diabetes develops when pregnancy hormones cause insulin resistance, raising blood sugar levels. Insulin is a hormone produced by the pancreas and is needed to help glucose (sugar) enter the bloodstream cells. When the body doesn’t use insulin properly, such as insulin resistance, blood sugar accumulates and rises in the bloodstream, unable to enter the cells.

As the placenta feeding the baby grows, certain hormones that can act against insulin are produced, further worsening insulin resistance. Some of these hormones include cortisol, estrogen, and human placental lactogen. This typically occurs during weeks 20 and 24 of pregnancy, which is why most pregnant women are asked to be screened for gestational diabetes after 24 weeks.

While any woman can develop gestational diabetes, certain risk factors increase the likelihood of being diagnosed. Some of the known risk factors are:

  • Overweight and obesity; a pre-pregnancy body mass index (BMI) over 25 indicates being overweight, and a pre-pregnancy BMI over 30 indicates obesity

  • A lack of physical activity.

  • Previous gestational diabetes or prediabetes.

  • Polycystic ovary syndrome (PCOS)

  • Diabetes in an immediate family member.

  • Previously delivering a baby weighing more than 9 pounds

  • Race; women who are Black, Hispanic, American Indian, and Asian American have a higher risk of developing gestational diabetes.

  • Advanced maternal age (being 35 or older during pregnancy)

Gestational diabetes carries risks of complications for both the mother and the baby if it’s not well-controlled during pregnancy. According to the Mayo Clinic, some of the possible complications of gestational diabetes include:

  • Excessive birth weight. Higher than normal blood sugar in mothers can cause their babies to grow too large. Babies who weigh 9 pounds or more may be more likely to become wedged in the birth canal, have birth injuries, or need a cesarean section birth.

  • Early (preterm) birth. High blood sugar may increase women’s risk of early labor and delivery before the due date.

  • Serious breathing difficulties. Babies born early to mothers with gestational diabetes may experience respiratory distress syndrome, which makes breathing difficult.

  • Low blood sugar (hypoglycemia). Sometimes babies of mothers with gestational diabetes have low blood sugar (hypoglycemia) shortly after birth due to high insulin levels in the womb. Severe episodes of hypoglycemia may cause seizures in the baby. Prompt feedings and sometimes an intravenous (IV) glucose solution can return the baby’s blood sugar level to normal.

  • Obesity and type 2 diabetes later in life. Babies of mothers who have gestational diabetes have a higher risk of developing obesity and type 2 diabetes later in life.

  • Stillbirth. Untreated, gestational diabetes can result in a baby’s death either before or shortly after birth.

Gestational diabetes is most often diagnosed with a one-hour oral glucose tolerance test, which is when a sugary solution is drunk. Then the person’s blood sugar is tested an hour later. If the glucose test is failed (meaning the blood glucose is higher than the standard), a three-hour glucose tolerance test is usually the next step. In a three-hour glucose tolerance test, the person drinks the sugary drink and has their blood sugar tested one, two, and three hours afterward. If the three-hour test is failed, then gestational diabetes is diagnosed.

What are the signs and symptoms?

Some women may not notice any gestational diabetes symptoms before they are diagnosed around week 24 of pregnancy. Women who have a history of gestational diabetes are usually screened earlier in their pregnancy because they are at increased risk.

The signs and symptoms of gestational diabetes are similar to those of type 1 and type 2 diabetes and include:

  • Increased thirst: When blood sugar levels are high, the body tries to rid the extra sugar through urination. Urinating more frequently leads to dehydration, which triggers a sensation of thirst. If you’re pregnant and notice that you feel much more thirsty than normal, it could be a sign of gestational diabetes.

  • Dry mouth: As the body becomes more dehydrated from trying to get rid of the extra sugar, you may develop a dry mouth from the lack of lubricating saliva.

  • Fatigue: The body uses sugar to fuel its cells, which drives all of our body’s functions. When the sugar is unable to enter the cells due to insulin resistance, the cells don’t get the energy they need, which can lead to a feeling of tiredness and fatigue.

  • Frequent urination: While increased urination is a normal pregnancy symptom, it can also be a sign of gestational diabetes. The kidneys filter out the extra glucose and excrete it into the urine, which increases the volume of urine. The increased thirst from the dehydrating effect of increased urination can further increase urine output, and the cycle continues.

  • Sugar in the urine: A urine test can detect if sugar is present, which is a sign that blood glucose levels are higher than normal. Urine tests checking for glucose are a routine part of prenatal check-ups.

How to reduce your risk

Healthy diet: Diets rich in whole grains, fruits, vegetables, legumes, and nuts and low in refined (white) grains, red meat, and sugar-sweetened beverages have been found to help promote healthy blood sugar levels. A Mediterranean diet has been shown to reduce diabetes risk and is a very healthy style of eating for pregnancy.

Carbohydrates such as grains, fruit, milk, yogurt, and starchy vegetables like potatoes have the biggest impact on blood sugar levels. Keeping your carbohydrates intake consistent throughout the day can help promote more steady blood sugar levels and minimize blood sugar spikes. The Sweet Success program is often used as a resource for healthy eating for women with gestational diabetes and can also help diabetes prevention.

Avoiding added sugars is also very important when it comes to reducing gestational diabetes risk. Sugars are added to many foods and drinks and can raise blood sugar levels very quickly. Added sugars are prevalent in many processed foods, which many people rely on due to convenience.

It’s estimated that up to 74% of processed foods contain added sugar. Added sugar has many names, which can make it difficult to spot. The new nutrition facts label now has a line for added sugars, which makes it easier to identify. Some labels still don’t contain a line for added sugars, so checking the nutrition facts ingredient label is important to determine if added sugars are present. Some of the names for added sugar include:

  1. Agave nectar  
  2. Barbados sugar  
  3. Barley malt 
  4. Beet sugar  
  5. Blackstrap molasses  
  6. Brown rice syrup  
  7. Brown sugar  
  8. Buttered syrup  
  9. Cane juice crystals  
  10. Cane sugar  
  11. Caramel  
  12. Carob syrup  
  13. Castor sugar  
  14. Confectioner’s sugar  
  15. Corn syrup 
  16. Corn syrup solids 

The American Heart Association recommends that women don’t consume more than 6 teaspoons (24 grams) of added sugar per day. Unfortunately, the average American adult consumes around 77 grams of added sugar per day. Tip: Find the “added sugars” or “sugars” line under the “Total Carbohydrates” on a food label.

Get active: Aim to get at least 30 minutes of physical activity most days of the week, with the goal of getting at least 150 minutes per week. Being active can help promote healthy blood sugar levels and improve insulin sensitivity.

Weight maintenance: Working to lose some weight before getting pregnant if you’re overweight can help reduce your risk of gestational diabetes. Weight loss improves insulin sensitivity, which helps to lower blood sugar levels. Aiming to gain the recommended amount of weight during pregnancy can also help.

Blood sugar control: For those diagnosed with gestational diabetes, checking blood sugar levels frequently is the best way to reduce risks during pregnancy. Many women can manage their gestational diabetes through diet alone, while others may take medications such as metformin or insulin.

Blood sugar goals for women with gestational diabetes are more strict than for most people with type 2 diabetes. Blood sugar goals for gestational diabetes are:

  • Before a meal: 95-105 mg/dL or less

  • 1 hour after a meal: 140 mg/dL or less

  • 2 hours after a meal: 120 mg/dL or less

Conclusion

Gestational diabetes occurs when high blood sugar develops during pregnancy and affects women without a history of diabetes. Having gestational diabetes can cause some complications to both mother and baby, making it a high-risk diagnosis that requires increased monitoring throughout pregnancy.

Some of the signs of gestational diabetes include increased thirst, increased urination, dry mouth, fatigue, and sugar present in the urine. Women are usually screened for gestational diabetes after week 24 of pregnancy using a glucose tolerance test.

To lower your risk of developing gestational diabetes, aim to eat a healthy diet low in added sugars, be physically active for at least 150 minutes per week and try to work on weight management if you’re overweight prior to getting pregnant.

Sources

  1. Ley SH, Hamdy O, Mohan V, Hu FB. Prevention and management of type 2 diabetes: dietary components and nutritional strategies. Lancet.
  2. https://www.responsiblefoods.org/sugar_names/
  3. https://sugarscience.ucsf.edu/hidden-in-plain-sight/#.X6dBSe2IbIU
  4. Salas-Salvadó J, Bulló M, Estruch R, Ros E, Covas MI, Ibarrola-Jurado N, Corella D, Arós F, Gómez-Gracia E, Ruiz-Gutiérrez V, Romaguera D, Lapetra J, Lamuela-Raventós RM, Serra-Majem L, Pintó X, Basora J, Muñoz MA, Sorlí JV, Martínez-González MA. Prevention of diabetes with Mediterranean diets: a subgroup analysis of a randomized trial. Ann Intern Med. 2014 Jan 7;160(1):1-10. doi: 10.7326/M13-1725.
  5. Erratum in: Ann Intern Med. 2018 Aug 21;169(4):271-272. PMID: 24573661.
  6. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sugar/how-much-sugar-is-too-much

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