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Last Updated on May 23, 2022 by Neelam Singh
Gestational Diabetes Mellitus is a kind of diabetes or a form of high blood sugar affecting pregnant women. But very few know that women who develop gestational diabetes during pregnancy are at a higher risk of developing Type 2 diabetes later in life.
High blood sugar has a bearing on the metabolic health of the unborn child, and the child may be at an increased risk of developing diabetes when they grow up too. In most cases, Gestational Diabetes Mellitus doesn’t have any pronounced symptoms, and the treatment mostly includes a healthy diet, exercise and close monitoring of the blood sugar during pregnancy.
The not-so-known fact for women is that breastfeeding for at least six months can considerably reduce the chances of developing diabetes later in life. To understand the nitty-gritty of Gestational Diabetes Mellitus, we spoke at length with Dr. Anjali Bhatt, diabetologist.
What is gestational diabetes, and how can it be diagnosed?
Gestational Diabetes Mellitus is a kind of diabetes that occurs during pregnancy or happens because of pregnancy. There is a slight difference between being diabetic and getting pregnant and not having diabetes before pregnancy but developing diabetes during pregnancy. It’s crucial to differentiate between these two because the treatment will be slightly different from each other. The complications that will occur from either of them will be very different. So these are two different categories of ladies who come to us.
So before pregnancy women can have Type-2 or Type-1 one diabetes, and they get pregnant, and they come to you in the initial stages of pregnancy. In another situation patients come to us with a diagnosis of diabetes during the pregnancy. In such cases, some women had diabetes even before pregnancy but could not get diagnosed earlier and in some it is caused by pregnancy, which is purely Gestational Diabetes Mellitus.
Why does pregnancy cause diabetes?
Normally, we have three major food patterns in our body which gives us energy: carbohydrate, protein, and fat. Carbohydrates give energy; proteins are the source of muscle building, and fats are the main source of storage. During pregnancy, the mother’s body tries to shift the carbohydrate energy towards the child. There is a small artificial development of insulin resistance inside the body for a temporary period during the pregnancy. And women who cannot handle this commonly occurring change during pregnancy develop diabetes during pregnancy, which is typically called Gestational Diabetes Mellitus.
The diagnosis is dependent on the glucose level. Various organizations across the world have given different definitions of Gestational Diabetes Mellitus (GSD). Usually, the doctors ask the woman to come empty stomach, check the glucose level, then ask her to drink 75 grams of glucose mixed in water and recheck the glucose after an hour and two. If the blood sugar value in fasting is more than 92 milligrams per decilitre, the woman has diabetes. Suppose the value after an hour of drinking 75 grams of glucose is more than 180 milligrams per decilitre, then the woman is advised to get a detailed evaluation or assessment for GSD.
What are the significant maternal and fetal complications of undiagnosed or inadequately treated Gestational Diabetes Mellitus?
As said earlier, it is important to differentiate between a woman with diabetes getting pregnant and a woman getting diabetes during pregnancy. The complications are different. In the former, the woman is exposed to high blood glucose from the first three months of gestation. This period is crucial for developing the fetus’ organ systems. And suppose the woman has diabetes before pregnancy, then high blood glucose is likely to affect the organ development of the fetus. That is why women with diabetes must control their blood glucose much before the pregnancy to have a normal pregnancy. Because sometimes these complications can be very severe. For example, if a woman or a fetus has been exposed to high blood glucose during the first three months of pregnancy then there are chances of abnormal development of various body organs of the child, especially the heart.
The complications of Gestational Diabetes Mellitus typically occur in pregnancy-induced diabetes. So this happens after the pregnancy is halfway through. After that, the physiology would change, and pregnancy would cause diabetes, but the organ development has
already happened. So the organ dysfunction risk is significantly less. What matters is the size of the child. So if the nutrition to the child is not proper, then the baby size can be large, which can cause complications during delivery and higher chances of the child developing diabetes when the child grows up. This is very important because in our country, many of our mothers are malnourished. So it’s a very tightrope walk when we create a diet chart for pregnant women to make sure that the baby doesn’t grow too large and gets proper nutrition.
This is about the child when it comes to the mother, again it is essential to have a normal blood glucose level during pregnancy. Otherwise, the woman can have complications of diabetes, especially eye complications, because diabetes can get worse during the pregnancy in women who were diabetic before getting pregnant.
Women who develop diabetes during the pregnancy have a higher chance of having a Caesarean delivery than normal delivery. The worst and the most important thing to know about pregnancy-induced diabetes is that it increases the mother’s risk of developing type two diabetes in the latter part of her life if they do not take proper measures. Also, It has a very long term impact on the mothers as well as the next generation’s metabolic health.
Do you think that lifestyle changes can help to prevent gestational diabetes to some extent before and after delivery?
Yes, absolutely. I would say that Gestational Diabetes Mellitus doesn’t only originate during pregnancy, rather it is just an unmasking of an issue that has probably been present before. So if you want to prevent Gestational Diabetes Mellitus, the best time is before conception. In fact, we need to concentrate on our lifestyle measures as early as possible to prevent gestational diabetes to a large extent. So proper nutrition, weight loss, regular exercise, being physically fit, and avoiding stress before pregnancy and during early periods of pregnancy go a long way in preventing Gestational Diabetes Mellitus. And still if you develop it, the management becomes very easy if you have adopted these measures on time.
What is the preconception care that one should take?
A woman should ensure proper nutrition and regular exercise. There are various aspects of nutrition. We need to worry about the macronutrients that give us energy and the micronutrients that give us fine skin. Different metabolic processes like energy formation or tiny nerve endings happen inside the body. These are all dependent on the supply of micro to macronutrient or energy-giving foods or carbohydrates, protein and fat. So depending on your preconception weight, your calorie intake should include reasonable amounts of carbohydrates that is 40 to 50%, around 25 to 30% of proteins which are very important for the development of muscles and around 25% of fat, which will be very important as energy to mother when she’s pregnant, as well as the development of the breast for breastfeeding the child at a later date. So a good macronutrient proportion and enough supply of micronutrients is very important to improve the mother and child’s metabolic health.
Then comes the exercise. At least one hour of aerobic exercise every day is essential. So five days a week and two hours of strength training, including muscle exercises like small weight lifting that will stimulate your muscle development. In the same way yoga, and functional exercises at home like squats, planks are very important. Stress relief is also important. Since this is one of the most beautiful parts of a mother’s life, enjoying the whole process is also very important.
Does paternal diabetes also affect the conception process?
Yes, it does. As we all know, the mother has a huge role in the child’s health. But now we also have evidence that says that the father’s health also affects the long-term metabolic health of a child. That means the fathers who have diabetes and uncontrolled high blood glucose, their children will have a greater chance of developing heart disease and diabetes when they grow up. Therefore, it is the responsibility of fathers also to keep their metabolic health and blood glucose in check before they plan a child. Both mother and father’s health will significantly impact the next generation’s health.
How does Gestational Diabetes Mellitus affect a woman’s quality of life?
When it comes to the diagnosis and treatment of any disease during pregnancy, it’s a huge trauma to the mother and the whole family. Pregnancy is supposed to be a physiological process; it is not a disease or a problem. So when you attach a diagnosis of diabetes to pregnancy, certainly that pregnancy becomes a medical event. The woman needs to check her blood glucose levels. That causes mental stress to the unborn child and the mother. The treatment of Gestational Diabetes Mellitus involves mainly insulin, though there are some tablets, and nutrition plays a very important role. But insulin is often required in pregnancy to manage hyperglycemia arrival throughout because not many oral pills for diabetes are safe during pregnancy. So in lots of cases, we need to use insulin. And that is why diabetes in pregnancy can create a lot of mental health problems.
But I would like to differ slightly from this scenario and tell you a very positive aspect of getting diagnosed with diabetes during pregnancy. It is a very important window of opportunity to improve the mother and child’s metabolic health because during pregnancy, the woman gets emotionally sensitive and would be receptive to accepting the advice for lifestyle. She will follow her best to get a better metabolic profile. It will prevent complications of the pregnancy and help reduce the chances of developing Type-2 Diabetes Mellitus in future. So if we take good care of the pregnant woman’s nutrition, exercise, and overall health, we are improving her metabolic health and the health of the next generation.
Post-delivery, how does gestational diabetes affect a baby?
If the mother has very high blood glucose levels, the immediate thing that can happen to a child after birth is low blood sugar, which is very easy to diagnose. The paediatricians are experts in diagnosing that and treating it right but what we are worried about is a long-term risk of developing type two diabetes. So women who have Gestational Diabetes Mellitus have the risk of giving birth to a child with a higher risk of developing diabetes later. But if the child’s lifestyle is managed properly, the long term risk of type two diabetes can be improved very well. Also, if we properly manage the mother’s blood glucose during the pregnancy, then the complications can be reduced further.
Do obesity and diet have a role to play in gestational diabetes?
Yes, obese women have a higher risk of developing Gestational Diabetes Mellitus in comparison to a normal-weight woman. An overweight woman has two times higher risk of developing it, while severe obesity increases the risk by eight times. The calculation goes like this: normal weight, very low risk; overweight, double the risk; obese, four times the risk and very severe obese means eight times the risk. So weight loss before pregnancy is the most important treatment of preventing Gestational Diabetes Mellitus during the pregnancy for both the parents.
What are the effects of gestational diabetes on postnatal obesity?
Women who are overweight before pregnancy gain a lot of weight and develop Gestational Diabetes Mellitus. These women will have a tough time losing weight after delivery, so the effort to reduce weight should start very early, even before pregnancy. We suggest them to gain a moderate amount of weight during the pregnancy. Neither too much, nor too less, so that the child remains healthy and the postnatal recovery of the gained weight can be easy. A significant thing that can have a beneficial impact on losing weight is breastfeeding. A woman who has GSD, but goes on to breastfeed the child exclusively for six months, then her chances of developing Type-2 diabetes later goes down drastically. Children who are breastfed exclusively during the first six months have a very lesser risk of developing metabolic abnormalities when they grow up than those fed with formula.
On an average, how many cases do you come across for gestational diabetes every month?
The prevalence of gestational diabetes has gone up like anything in the past few decades. In my clinic, I see around five to six women every month with new cases of Gestational Diabetes Mellitus. But I have been a part of a community survey where we try to know the percentage of Gestational Diabetes Mellitus in rural areas. We found that around 70% of pregnancies have diabetes. In the urban area, the percentage is almost up to 20-25%. That means every one in five pregnancies has diabetes. A sedentary lifestyle, obesity, less physical activity and poor food habits are driving us towards this problem.
Any word of precaution for women planning to go the family way?
Women who have diabetes before pregnancy must plan their pregnancy properly. Glucose should be controlled. Weight should be managed. And then, under medical supervision, pregnancy should be planned to avoid complications to the mother and prevent Gestational Diabetes Mellitus. Nutrition would be enough to control in most of the cases of this type of diabetes. Women need to make sure that they eat properly, eat healthily, and breastfeed the child postnatally to reduce their complications of developing Type-2 diabetes later. And if you have diabetes during pregnancy, take extra care of your lifestyle to avoid long term complications for your and your child’s metabolic health.
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