Here is a review of risks associated with gestational diabetes for a mother and a baby in the index pregnancy.
Risks to mother:
Development of pre-eclampsia and blood pressure
Development of type 2 diabetes as a woman gets older
Delivery by caesarian-section
Risks to a baby:
Before birth:
Preterm birth
Intrauterine death (death of a baby while in the womb)
Fat baby
During birth:
shoulder dystocia: This is a birth injury that occurs when the baby’s shoulders get stuck inside the mother’s pelvis during birth.
After birth:
Low blood sugar
Difficulty breathing
Polycythemia (a condition whereby there are many red blood cells in the bone marrow and blood causing blood to thicken) and Hyperbilirubinemia, a condition which there is high levels of bilirubin (a bi-product of red cell breakdown) in the blood causing a yellowish discoloration of the baby’s skin and mucosae.
Development of obesity and type 2 diabetes later in life
What can I expect in subsequent pregnancies?
There is increased risk of recurrent gestational diabetes in the following pregnancies:
Several studies have shown that mothers with gestational diabetes in their first pregnancy are at an increased risk of gestational diabetes in the subsequent pregnancies and risk increases with each pregnancy. However, the risk is not 100%, meaning that not every woman with gestational diabetes in a previous pregnancy will develop the condition in the next pregnancies.
There is an increased risk for the development of type 2 diabetes later in life.
According to some medical literature, approximately 50% of all women who had gestational diabetes will develop type 2 diabetes later in life.
Type 2 diabetes is common type of diabetes, it is chronic (lifelong) and is characterized by high levels of blood sugar. Unlike gestational diabetes, it can be diagnosed before pregnancy and persist after pregnancy.
Women who have had gestational diabetes can still have a healthy pregnancy and baby.
What are the factors that increase the likelihood of gestational diabetes recurring?
If risk factors for recurrent gestational diabetes can be identified, possibly the recurrence can be prevented. There are factors that cannot be changed (non-modifiable) and that can be changed (modifiable):
Non-modifiable: risk is higher with age (women above 40 years) and certain ethnic groups (noted especially in Hispanic and Asian women).
Modifiable: obesity, degree of elevation of blood sugar in the index pregnancy, short space between pregnancies, and increased weight gain.
What can I do to reduce the risk of gestational diabetes?
While absolutely nothing can be done to prevent gestational diabetes, there is good news. There are healthy lifestyle changes that can be adopted to reduce the risk of gestational diabetes with subsequent pregnancies.
Healthy diet
Eat foods that are high in fiber but are low in fats and calories. Eat appropriate portions at appropriate intervals.
Exercise regularly
Keep physically active by doing moderate-intensity exercises for about 20-30 min three times a day regularly.
Keep healthy weight
Maintain healthy eating habits and keep physically active. Lose weight before planning to fall pregnant and avoid gaining weight before pregnancy as well.
Stop smoking
Smoking is a risk factor for diabetes and poor pregnancy outcomes, quit smoking before pregnancy.
What can be done about type 2 diabetes?
Although gestational diabetes will resolve after delivery, type 2 diabetes is a lifetime condition. It is crucial to ensure that it is under control even before conceiving. A glycated hemoglobin test (HBA1c) test which assesses control, should be offered yearly.
In a case where the diagnosis of type 2 diabetes is already made, a referral to a diabetes pre-conception clinic can be made whereby the condition can be managed and well controlled before pregnancy. Further advice can be given on attendance of antenatal care clinic (only when pregnant). At the antenatal clinic tests will be offered to monitor the blood sugar levels at the time of booking the appointment and if normal, another one will be offered between 24 and 28 weeks of pregnancy.
Counselling on lifestyle modification should be offered and initiated.
What to do when planning for future pregnancies?
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.
Take preventative high dose folic acid 3 months before getting pregnant to prevent birth defects caused by high levels of blood sugar (hyperglycemia).
This article is written by Dr Katleho Tau (MBChB-UKZN)
References:
1. Mann D, Martin LJ. Study measures Gestational Diabetes Risk. [Internet]. WebMD. 2010. Available from: https://www.webmd.com/baby/news/20100712/study-measures-gestational-diabetes-risk
2. Mayo Clinic. Gestational diabetes. [Internet]. Mayo clinic. 2022. Available from: https://www.mayoclinic.org/diseases-conditions/gestational-diabetes/symptoms-causes/syc-20355339
3. Tommy’s pregnancy Hub. Planning a pregnancy if you have had gestational diabetes before. [Internet]. Tommy’s. 2020. Available from: https://www.tommys.org/pregnancy-information/im-pregnant/planning-pregnancy-if-youve-had-gestational-diabetes
4. Our Health Service. After the birth Gestational diabetes. [Internet]. HSE. 2019. Available from: https://www2.hse.ie./conditions/gestational-diabetes/after-birth/
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