What is gestational diabetes?
Gestational diabetes mellitus (GDM), also called pregnancy diabetes, can be defined as high blood sugar diagnosed for the first-time during pregnancy and it usually resolves after birth. It can happen at any stage of pregnancy, but it is commonly diagnosed in the second or third trimester.
Gestational diabetes mellitus (GDM) results in high blood sugar (hyperglycemia) that can affect your pregnancy and baby negatively. It is therefore crucial to discuss briefly who is at risk and how the risks can be minimized.
The risk factors include women over the age of 40 (and 25 in the Ascian ethnicity), a positive family history of GDM, an overweight or obese lady (Body Mass index (BMI) over 30), a woman who has previously given birth to a big baby, still births, premature births, history of typical symptoms of diabetes such as excessive thirst, excessive urine production, and vaginal thrush. There are other risk factors not listed here.
While the diagnosis of GDM can be devastating because of its known complications, do not worry. With healthy lifestyle changes (healthy balanced diet, regular exercise, and weight loss) and medical intervention, when necessary, GDM can be treated and controlled, resulting in a healthy pregnancy and healthy baby.
What can be expected to gestational diabetes?
When gestational diabetes is not treated and controlled it can result in adverse risks occurring at different stages in the perinatal period. Here we focus on effects that can be expected after birth, either short-term or long-term, affecting the mother and the baby.
For the mother:
Recurrent gestational diabetes and type 2 diabetes
Immediately after birth gestational diabetes is expected to disappear. If the mother’s blood sugar remains high after birth it is likely type 2 diabetes that had not yet been diagnosed, but now unmasked by pregnancy. Several studies also reveal that a woman who has had gestational diabetes has a high risk of recurrent gestational diabetes, and the risk increases with every subsequent pregnancy. However, not every woman who has had gestational diabetes will have gestational diabetes in future pregnancies.
Research has also demonstrated that one in two women who have had GDM will develop type 2 diabetes later in life. Type 2 diabetes is a lifelong condition characterized by high blood sugar. It can be diagnosed before pregnancy. Besides GDM, other risk factors of type 2 diabetes include a close family member with type 2 diabetes, being overweight, and smoking to list a few.
Should you develop this condition, ensure that you get regular check-ups as it may cause serious complications in the future. Early pregnancy loss (miscarriage) and stillbirths are the obstetric problems that can be expected. Other problems include heart problems, strokes, vision problems, and effects caused by nerve damage such as numbness and a feeling of pins and needles. The good news is that, just like GDM, type 2 diabetes can also be treated and controlled by adopting healthy lifestyle and through medical intervention if necessary.
GDM has also been associated with increased risk of developing heart and kidney problems. This is because the high blood sugars damage the blood vessels supplying these organs.
Postpartum hemorrhage
A mother may experience a postpartum hemorrhage (which is heavy bleeding after birth) because of trauma caused by the difficult delivery of a big baby (shoulder dystocia).
Perinatal depression
This is depression that occurs within the first year after having a baby. It may be caused by the fact that a mother had a difficult pregnancy, or complications of gestational diabetes such as stillbirth (death of a baby after 20 weeks of pregnancy).
For the baby:
Short-term:
A baby may be born prematurely. Doctors may decide to induce labour and deliver a baby early when there are complications related to gestational diabetes. As a result of prematurity, a baby may be born with the following short-term conditions:
Hypoglycemia is low blood sugar that may be additionally caused by high levels of insulin (hormone that controls blood sugar) induced by high blood sugar in a newborn baby born to a mother with diabetes.
respiratory distress syndrome is a condition that causes serious breathing problems due to underdeveloped lungs
jaundice causes yellow discoloration of the skin, eyes, and hands.
Long-term:
Birth defects are caused by uncontrolled high blood sugar during conception or while organs were developing (embryogenesis). Such birth defects include heart defects, spinal cord defects (spina bifida), skeletal defects, and rarely sacral agenesis (absence of a lower part of the spinal cord). Other birth defects occur because of shoulder dystocia. A baby may have a collarbone fracture and inability to move the shoulder, arm, and hands due to the damage of the nerve that control these activities (brachial plexus).
Type 2 diabetes, obesity and overweight- research has also revealed that a baby born from a diabetic mother, may develop diabetes, obesity (BMI over 30), or become overweight as he grows into adulthood.
Health tips going forward?
Tips for mother:
Get blood sugar test (OGTT) 3 months after delivery and yearly afterwards.
Continue and maintain healthy eating habits and regular physical activity.
See your doctor or go to the local health facility after a confirmed pregnancy test and inform them that you have had gestational diabetes so that investigations and appropriate management can be initiated.
Tips for baby:
Breastfeeding is highly recommended and is beneficial in decreasing the risk of obesity and diabetes.
Vitamins and mineral supplement: Take a preventative high dose folic acid 3 months before getting pregnant to prevent birth defects caused by high levels of blood sugar (hyperglycemia).
Encourage healthy diet and physical activity as the baby grows older.
This article is written by Dr Katleho Tau (MBChB)
References:
1. March of dimes. Gestational diabetes. [Internet]. March of dimes. 2022. Available from: https://www.marchofdimes.org/complications/gestational-diabetes.aspx
2. Tommy’s. Long term implications of gestational diabetes. [Internet]. Tommy’s. 2020. Available from: https://www.tommys.org/pregnancy-information/pregnancy-complications/gestational-diabetes/long-term-implications-gestational-diabetes
3. CDC. Gestational diabetes. [Internet]. CDC. Available from: https://www.cdc.gov/pregnancy/diabetes-gestational.html
4. Chong S, Yu-Mei W, Chen w, Xia-Hui. Updates in long-term Maternal and Fetal Adverse Effects of Gestational Diabetes Mellitus. Maternal-Fetal-Medicine. 2019, October. vol 1. issue 2. Page 91-94 Available from: https://journals.lww.com/mfm/fulltext/2019/10000/updates_in_long_term_maternal_and_fetal_adverse.7.aspx
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