Definition

Gestational diabetes is a type of diabetes first diagnosed during pregnancy. Like other forms of diabetes, gestational diabetes affects how cells use sugar (glucose). During pregnancy, hormone levels prevent insulin from effectively regulating blood sugar, leading to higher blood sugar levels. This condition can affect both the mother and the baby.

Recommended blood sugar levels for pregnant women are:

• Before meals: < 95 mg/dL
• One hour after meals: < 140 mg/dL
• Two hours after meals or more: < 120 mg/dL

Pregnant women can manage gestational diabetes by eating a healthy and nutritious diet, exercising, and taking medication if necessary. Controlling blood sugar levels helps maintain the health of both the mother and the baby, preventing complications during childbirth.

If a woman experiences only gestational diabetes during pregnancy, her blood sugar levels typically return to normal soon after delivery. However, women with gestational diabetes are at higher risk of developing type 2 diabetes later in life and should regularly screen their blood sugar levels.

Gestational diabetes is fairly common among pregnant women. Still, since gestational diabetes screening is not yet mandatory in Indonesia, awareness among pregnant women about symptoms and risk factors is crucial for prevention.

Read more: Examination Of Blood Sugar At Once - Indications, Contraindications, and Preparations Before Examination.

Causes

The exact cause of gestational diabetes is still being researched. However, hormonal changes during pregnancy play a significant role. These changes affect how insulin works in the body. Normally, insulin regulates blood sugar levels, but in diabetes, insulin is insufficient to maintain normal blood sugar levels, leading to higher-than-normal levels.

Risk factor

Risk factors for gestational diabetes include:

• Obesity
• Sedentary lifestyle
• Prediabetes before pregnancy
• Previous gestational diabetes
• Polycystic Ovary Syndrome (PCOS)
• Family history of diabetes (gestational or type 2)
• Previous childbirth of a baby weighing over 4 kg
• Certain ethnic backgrounds (e.g., Latin, African, Asian descent)
• Previous miscarriage
• Age over 35 years
• History of high blood pressure, high cholesterol, and heart disease

Symptoms

Gestational diabetes often has no noticeable symptoms. However, pregnant women may experience classic diabetes symptoms such as:

• Frequent urination (polyuria)
• Increased thirst (polydipsia)
• Increased hunger (polyphagia)

Diagnosis

To diagnose gestational diabetes, doctors will conduct an interview, physical examination, and supportive tests.

Interview

The doctor will ask about:

• Main complaints
• Accompanying complaints
• Gestational age
• Pregnancy-related symptoms
• Previous medical history
• Family medical history
• Pregnancy and delivery history
• Specific medications taken

Physical Examination

A physical examination, typically done during antenatal care (ANC), will include checking blood pressure, respiratory rate, pulse, and body temperature. The doctor may also assess fetal weight, position, and the mother's general health.

Supportive Tests

Supportive tests include laboratory tests and ultrasounds. Blood tests check:

• Fasting blood glucose levels
• Random blood glucose levels
• HbA1c to detect possible prediabetes

The doctor may perform an Oral Glucose Tolerance Test (OGTT) between 24 and 28 weeks of pregnancy. This test involves fasting for 12 hours, checking fasting blood sugar, drinking a glucose solution (75-100 grams), and testing blood sugar again after one and two hours of fasting.

Additionally, the doctor may perform an ultrasound to estimate fetal length and weight, and a urine test to detect glucose, protein, and ketones.

You can further read HbA1c's checking article here: HbA1c Examination - Definition, Indication and Contraindication.

Management

Treatment for gestational diabetes depends on the mother's age, disease severity, and lifestyle. The focus is on maintaining normal blood sugar levels.

• Diet: Reduce sugar and carbohydrate intake.
• Exercise: Increase physical activity.
• Daily Blood Sugar Monitoring: Especially after meals.
• Insulin Injections: If necessary.
• Routine Monitoring: Regular antenatal care (ANC) for mother and baby.

Read more about empagliflozin here: Empagliflozin - How To Work, Prepare, Dose And Drug Interaction.

Complications

Gestational diabetes can cause complications for both the mother and the baby.

Mother

• High blood pressure and preeclampsia
• Cesarean delivery
• Increased risk of developing type 2 diabetes later

Baby

• Macrosomia (baby weighing over 4 kg)
• Premature birth
• Asphyxia (breathing difficulties at birth)
• Hypoglycemia (low blood sugar levels)
• Obesity and type 2 diabetes in adulthood
• Stillbirth

Prevention

Preventing gestational diabetes can begin before pregnancy or as soon as pregnancy is known.

• Healthy Diet: Eat a balanced diet high in fiber, low in fat and carbohydrates. Increase intake of whole grains, vegetables, and fruits. Avoid high-sugar foods.
• Physical Activity: Engage in regular exercise before and during pregnancy. Pregnant women can start with moderate-intensity activities like walking for at least 30 minutes daily, prenatal yoga, and prenatal Pilates if no contraindications.
• Maintain a Healthy Weight: Women planning pregnancy should maintain a normal body mass index (BMI) to reduce the risk of gestational diabetes. During pregnancy, ensure weight gain is within recommended limits based on pre-pregnancy weight.
• Avoid Excessive Stress: Excessive stress, especially during pregnancy, can increase the risk of gestational diabetes. Practice relaxation techniques to reduce stress.

When to see a doctor?

During pregnancy, regularly attend antenatal care with a midwife or obstetrician. Inform them of any family history of diabetes, previous gestational diabetes, or specific medications taken. If you experience frequent hunger, thirst, and urination during pregnancy, consult a specialist immediately.

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