Pregnancy diabetes (gestational diabetes): causes, symptoms and treatment

Medically reviewed: 15, February 2024

What is gestational diabetes?

Pregnancy diabetes or in medical language – gestational diabetes, is a type of diabetes that occurs during pregnancy and normally disappears just after delivery. The disease is most common among women who are overweight or have family members with diabetes. A healthy lifestyle considerably reduces the risk of developing Type 2 diabetes.

What is the cause of pregnancy diabetes?

The hormone insulin is produced in the pancreas and acts to decrease blood sugar. When a woman is pregnant, her body needs more insulin. Insulin is a special hormone that helps control the amount of sugar in our bodies. Sometimes, if the body can’t make enough insulin during pregnancy, it can cause a problem called diabetes. After delivery, the need for insulin decreases back to normal levels and the diabetes will disappear.

A mother who has had gestational diabetes will have an increased risk of developing Type 2 diabetes later on in life as the production of insulin decreases with increasing age. This risk can be considerably reduced if a healthy lifestyle is adopted. This should involve following a healthy diet, exercising regularly and maintaining a healthy body weight.

What are the symptoms of pregnancy diabetes?

In most cases, pregnancy diabetes has no external symptoms and is only detectable through screening. Only rarely do symptoms appear.

Screening can be done in the following ways.

A pregnant woman may have her fasting blood sugar measured. This is done if the pregnant woman possesses any of the mentioned characteristics:

• a lineage characterized by the presence of Type 1 or Type 2 diabetes in previous generations.
• she has previously given birth to very large children (over 4kg)
• she was overweight prior to pregnancy
• she is above 35 years of age
• glucose is present in the urine.

If the fasting person’s blood glucose value is in a ‘grey zone’, another test is often carried out, which is called the ‘sugar-loading’ test. This test is able to detect the existence of pregnancy diabetes. If the blood glucose value is normal, then another reading of the blood glucose level is taken in the 32nd to 33rd week of pregnancy.

What happens to the baby if his mother has gestational diabetes

Through the bloodstream in the placenta from mother to child, glucose penetrates in unlimited quantities. Maternal insulin does not cross the placenta. Therefore, the fetal pancreas produces an excess amount of its own insulin in response to excess glucose from the mother’s body. Under the action of insulin, glucose in the fetus is converted into fat, which is deposited in the internal organs, leading to their increase, and subcutaneous fat. The so-called diabetic fetopathy is formed, which is manifested by disproportions in the body parts of the fetus – a large belly, a wide shoulder girdle and small limbs. As a result, children are often born overweight.

Excess insulin negatively affects the production of surfactant (a substance necessary for the proper functioning of the lungs), which causes respiratory problems in the newborn, up to the need for mechanical ventilation after the baby is born.

Diabetes mellitus in the mother often provokes the formation of congenital malformations. Most often, heart defects are observed – defects of the interatrial or interventricular septum.

In some cases, microangiopathy associated with diabetes mellitus in pregnancy can, on the contrary, lead to a delay in intrauterine development of the child, and such children are born with low body weight, with a deficiency of subcutaneous fat and difficulties in adapting to extrauterine life.

What happens to a newborn: a large baby does not mean healthy

After ligation of the umbilical cord in a newborn, the supply of glucose from the mother abruptly stops. Therefore, a child born to a mother with GDM may experience symptoms such as hypoglycemia (low blood sugar) shortly after birth, as he still has an increased secretion of insulin.

The tendency to hypoglycemia may continue for several days after birth. This can lead to neurological disorders and may further affect the mental development of the child, since hypoglycemia seriously affects the functioning of brain neurons. Therefore, such newborns require more frequent breastfeeding, supplementation, and, in severe cases, intravenous glucose.

Increased production of insulin by the pancreas of the fetus and then the newborn depletes his pancreas and can cause the development of beta-cell pancreatic insufficiency of the child and contribute to the transmission of this pathology from generation to generation – therefore, there is an increase in diabetes and type 1 and 2 in the population.

Maternal GDM programs the development of chronic diseases in the child in the future, such as obesity, arterial hypertension, and type 1 and type 2 diabetes mellitus.

All of these complications of GDM for a child can be prevented. The main method of preventing complications of GDM is the careful monitoring and correction of blood sugar levels in pregnant women from the very first moment of diagnosis of GDM.

Sometimes during pregnancy, insulin may be given to control blood glucose levels.

There is an opinion that the appointment of insulin during pregnancy will provoke a lifelong need for it – this is a myth! Insulin is canceled after childbirth.

Clinical case with gestational diabetes

A pregnant woman with GDM (gestational diabetes mellitus) was delivered ahead of schedule at 32 weeks. 6 days due to complications in the child, identified during the next ultrasound. Since the risk of intrauterine death of the fetus increases. The weight of the newborn was almost 2 times higher than normal. However, the baby was born prematurely and required treatment in the neonatal intensive care unit. On the first day and during the next 4 days, due to the low level of glucose in the blood of the newborn, intravenous glucose was required.

Subsequently, the baby was transferred to the department of pathology of newborns and premature babies, where doctors observed him for another 7 days.

Compliance with the elementary rules of nutrition before pregnancy and during it will help to avoid the adverse effects of hyperglycemia both for the body of the pregnant woman and for the body of the unborn child. Do not abuse fast food, fast carbohydrates (pastries, sweets, sugary drinks).

The dietary needs of a pregnant woman should be well-rounded and diverse. The misconception that “eating for two” implies consuming twice the amount of food is false. Eating for two means a responsible attitude to the diet in order to provide yourself and the child with the necessary substances and trace elements for a favorable course of pregnancy and intrauterine development of the fetus. It is of utmost importance not to overlook or dismiss the guidance and recommendations provided by medical professionals.

Monitor your blood glucose levels, especially if you have a family history of any type of diabetes.

How is pregnancy diabetes diagnosed?

By screening and measuring the blood glucose values through a sugar-loading test.

It is also important to consult a diabetologist.

Gestational diabetes treatment

How is pregnancy diabetes treated?

Pregnancy diabetes, also known as gestational diabetes, necessitates the implementation of a specialized diet plan specifically designed to manage and control blood sugar levels.

Sometimes it is also necessary to include insulin in the treatment. Quick-acting insulin will be given at mealtimes and slow-acting insulin at bedtime.

Which types of medication can be used?

• Quick-acting insulin as injection.
• Slow-acting insulin as injection.
• Mixed-insulin as injection.

Note: antidiabetic tablets should be avoided because diabetes can be controlled more tightly during pregnancy with insulin and this reduces the chances of complications.

What can be done by the patient?

Maintain a healthy ‘diabetes’ diet that is low in fat and rich in complex carbohydrates such as potatoes, rice and pasta. The diet should also include daily portions of fresh vegetables and fiber.

The patient must measure their blood sugar very regularly in order to decide if the prescribed treatment is helping.

The patient should also consult a diabetologist who has a joint clinic with a specialist obstetrician to monitor the diabetes and the baby’s progress carefully during pregnancy.

After the pregnancy, it is important to get examined once a year in order to find out if the diabetes has developed again.

The likelihood of developing diabetes later in life can be reduced by:

• avoiding becoming overweight
• eating a healthy diet
• exercising regularly
• not smoking (this will benefit both the fetus and mother).

Pregnancy diabetes treatment: Future possibilities

A patient who has not followed proper treatment for pregnancy diabetes will risk their baby being born with a low blood sugar count, being born too large, or other complications. Proper treatment will also lower the risk of deformities and other serious illnesses.

As mentioned, pregnancy diabetes carries a greater risk of developing Type 2 diabetes later in life. Furthermore, this heightened condition also indicates a greater likelihood of developing toxemia, which refers to the presence of blood poisoning, as well as experiencing elevated levels of blood pressure throughout the duration of the pregnancy.