Gestational diabetes: a common but preventable pregnancy complication

Sync team
Sync team
October 27, 2021

Pregnancy is a very special period for women. Nutritional needs change significantly, hormones follow different patterns and women often deal with metabolic changes that make it necessary to adapt their diet and lifestyle. One of the conditions that can develop is Gestational Diabetes (which occurs in 3-10% of pregnancies). The condition is on the rise for various reasons, including a higher obesity rate in young women worldwide and an average increase in the age of the first pregnancy in developed countries.

What is gestational diabetes?

Gestational Diabetes or Gestational Diabetes Mellitus (GDM) is one of most common complications that develops during pregnancy. The term refers to the development of hyperglycaemia (i.e. elevated blood sugar) during pregnancy, that resolves immediately after the birth of the baby. It is usually detected late in the second trimester (around 13-26 completed weeks) by performing an Oral Glucose tolerance Test (OGTT). Women usually realise they have Gestational Diabetes due to frequent urination, excessive thirst, dry mouth, hunger and fatigue. It should be stressed that some of these symptoms, i.e. frequent urination and fatigue are common symptoms of every pregnancy. Women who are pregnant and over the age of 35 or overweight should be more cautious about developing Gestational Diabetes.

What are the risks?

Glucose is the main energy source for the baby and steady levels of glucose in the mother’s bloodstream ensures the prevention of the fetal overgrowth and many pregnancy complications. If left untreated, short-term complications include pre-eclampsia, cesarean delivery, preterm delivery for the mother and increased birth weight, neonatal respiratory problems and the need for intensive neonatal care for babies. An additional long-term risk for the mother is a seven-fold increased risk for diabetes occurrence 5-10 years after birth, as well as the increased risk that comes with hyper-insulinemia, such as metabolic syndrome and cardiovascular disease.

Why does gestational diabetes develop?

Among the risk factors for developing Gestational Diabetes are a medical history of glucose intolerance, the existence of polycystic ovary syndrome, obesity, and weight gain in the first trimester of the pregnancy. In Europe the prevalence of Gestational Diabetes was found to be 5.4% in a meta-analysis, which included more than 1.7 million participants. In women below 30 the risk was found to be about 50% less than in women over 31 years of age.  Moreover, almost 50% of the cases of the condition in USA can be attributed to being overweight or obese. The risk in USA women was also found to be increased with age, with women >40 years having more than two fold increased risk of GDM compared to women <30 years of age. Genetics and our environment also seem to play a significant role. Stress and negative events during pregnancy have been associated with increased cortisol (stress hormone) levels, which can influence glucose regulation.

What can you do?

Prevention

Weight management

Gaining weight during pregnancy is absolutely normal. But the total weight you will gain depends on the weight you had before being pregnant. If your weight was within the healthy range (a BMI between 18.5 and 24.9), gaining 12-15 kg until birth is normal. In the first trimester an increase of 1-1.5 kg is considered ideal and then 1.5 – 2 kg every month until birth. If you were overweight before pregnancy (a BMI over 25) you should gain less and an increase of 7-10 kg is considered adequate. On the other hand, women who are very slim with a BMI<18.5 can gain up to 18 kg during pregnancy.  

Early detection

Follow regular testing according to your doctor’s guidance. Measuring your blood sugar on a frequent basis will help you make sure it’s regulated. In case you are advised to measure your blood sugar, continuous glucose monitoring (CGM) can be really helpful, as it helps you to detect hypoglycaemic and hyperglycaemic episodes more efficiently than the traditional, finger-prick monitoring of blood glucose.

Management

Nutrition

Eating the right foods can have a direct impact in managing glucose levels and keeping blood sugar steady.

Among the therapeutic steps that help in the management of blood glucose, nutrition has been recognised as a cornerstone. For obese women or for women with excessive weight gain in the first semester of the pregnancy, a modest caloric restriction and a limitation of the carbohydrate intake to 35-45% of the total calories seems to be a safe and effective approach.  

The ideal diet should include nutrient dense foods, to cover the needs of macro and micronutrients and should prevent glucose spikes. Carbohydrates should be consumed in moderation and eaten in combination with fats and fibre. This will not only help regulate blood sugar but also help avoid weight gain and the prevalence of constipation, which is also a common problem for pregnant women.

Exercise

Unless advised against it by doctors, women are encouraged to lead an active way of life. The Endocrine Society suggested a moderate exercise of 30 minutes or more a day. A walk or light exercise after a meal can be particularly helpful in preventing blood sugar spikes.

Conclusion

Gestational diabetes  is a common condition that develops during pregnancy. Close monitoring of glucose is a necessity, to make sure that the baby will not be affected by the glucose spikes of the mother, and at the same time the future mother will be protected against the negative effects of the elevated blood sugar.

Continuous Glucose Monitoring is an extremely easy and effective way to have continuous snapshots of your blood sugar throughout the day and make sure that your metabolism is regulated in the best possible way. As CGM technology is becoming more accessible and increasingly accurate, glucose monitoring and its subsequent help in identifying the effect of meals on our blood sugar will make it a valuable tool for the best management of Gestational Diabetes.

References

Maternal obesity in Europe: where do we stand and how to move forward?

Trends in Obesity Among Adults in the United States, 2005 to 2014

Gestational Diabetes Mellitus

Hyperglycemia and adverse pregnancy outcomes

Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis

Percentage of Gestational Diabetes Mellitus Attributable to Overweight and Obesity

A prospective study of pregravid determinants of gestational diabetes mellitus

Psychological distress and salivary cortisol covary within persons during pregnancy

Diabetes and pregnancy: an endocrine society clinical practice guideline

Gestational diabetes mellitus

Application and Utility of Continuous Glucose Monitoring in Pregnancy: A Systematic Review

Prevalence of gestational diabetes mellitus in Europe: A meta-analysis

Pregnancy is a very special period for women. Nutritional needs change significantly, hormones follow different patterns and women often deal with metabolic changes that make it necessary to adapt their diet and lifestyle. One of the conditions that can develop is Gestational Diabetes (which occurs in 3-10% of pregnancies). The condition is on the rise for various reasons, including a higher obesity rate in young women worldwide and an average increase in the age of the first pregnancy in developed countries.

What is gestational diabetes?

Gestational Diabetes or Gestational Diabetes Mellitus (GDM) is one of most common complications that develops during pregnancy. The term refers to the development of hyperglycaemia (i.e. elevated blood sugar) during pregnancy, that resolves immediately after the birth of the baby. It is usually detected late in the second trimester (around 13-26 completed weeks) by performing an Oral Glucose tolerance Test (OGTT). Women usually realise they have Gestational Diabetes due to frequent urination, excessive thirst, dry mouth, hunger and fatigue. It should be stressed that some of these symptoms, i.e. frequent urination and fatigue are common symptoms of every pregnancy. Women who are pregnant and over the age of 35 or overweight should be more cautious about developing Gestational Diabetes.

What are the risks?

Glucose is the main energy source for the baby and steady levels of glucose in the mother’s bloodstream ensures the prevention of the fetal overgrowth and many pregnancy complications. If left untreated, short-term complications include pre-eclampsia, cesarean delivery, preterm delivery for the mother and increased birth weight, neonatal respiratory problems and the need for intensive neonatal care for babies. An additional long-term risk for the mother is a seven-fold increased risk for diabetes occurrence 5-10 years after birth, as well as the increased risk that comes with hyper-insulinemia, such as metabolic syndrome and cardiovascular disease.

Why does gestational diabetes develop?

Among the risk factors for developing Gestational Diabetes are a medical history of glucose intolerance, the existence of polycystic ovary syndrome, obesity, and weight gain in the first trimester of the pregnancy. In Europe the prevalence of Gestational Diabetes was found to be 5.4% in a meta-analysis, which included more than 1.7 million participants. In women below 30 the risk was found to be about 50% less than in women over 31 years of age.  Moreover, almost 50% of the cases of the condition in USA can be attributed to being overweight or obese. The risk in USA women was also found to be increased with age, with women >40 years having more than two fold increased risk of GDM compared to women <30 years of age. Genetics and our environment also seem to play a significant role. Stress and negative events during pregnancy have been associated with increased cortisol (stress hormone) levels, which can influence glucose regulation.

What can you do?

Prevention

Weight management

Gaining weight during pregnancy is absolutely normal. But the total weight you will gain depends on the weight you had before being pregnant. If your weight was within the healthy range (a BMI between 18.5 and 24.9), gaining 12-15 kg until birth is normal. In the first trimester an increase of 1-1.5 kg is considered ideal and then 1.5 – 2 kg every month until birth. If you were overweight before pregnancy (a BMI over 25) you should gain less and an increase of 7-10 kg is considered adequate. On the other hand, women who are very slim with a BMI<18.5 can gain up to 18 kg during pregnancy.  

Early detection

Follow regular testing according to your doctor’s guidance. Measuring your blood sugar on a frequent basis will help you make sure it’s regulated. In case you are advised to measure your blood sugar, continuous glucose monitoring (CGM) can be really helpful, as it helps you to detect hypoglycaemic and hyperglycaemic episodes more efficiently than the traditional, finger-prick monitoring of blood glucose.

Management

Nutrition

Eating the right foods can have a direct impact in managing glucose levels and keeping blood sugar steady.

Among the therapeutic steps that help in the management of blood glucose, nutrition has been recognised as a cornerstone. For obese women or for women with excessive weight gain in the first semester of the pregnancy, a modest caloric restriction and a limitation of the carbohydrate intake to 35-45% of the total calories seems to be a safe and effective approach.  

The ideal diet should include nutrient dense foods, to cover the needs of macro and micronutrients and should prevent glucose spikes. Carbohydrates should be consumed in moderation and eaten in combination with fats and fibre. This will not only help regulate blood sugar but also help avoid weight gain and the prevalence of constipation, which is also a common problem for pregnant women.

Exercise

Unless advised against it by doctors, women are encouraged to lead an active way of life. The Endocrine Society suggested a moderate exercise of 30 minutes or more a day. A walk or light exercise after a meal can be particularly helpful in preventing blood sugar spikes.

Conclusion

Gestational diabetes  is a common condition that develops during pregnancy. Close monitoring of glucose is a necessity, to make sure that the baby will not be affected by the glucose spikes of the mother, and at the same time the future mother will be protected against the negative effects of the elevated blood sugar.

Continuous Glucose Monitoring is an extremely easy and effective way to have continuous snapshots of your blood sugar throughout the day and make sure that your metabolism is regulated in the best possible way. As CGM technology is becoming more accessible and increasingly accurate, glucose monitoring and its subsequent help in identifying the effect of meals on our blood sugar will make it a valuable tool for the best management of Gestational Diabetes.

References

Maternal obesity in Europe: where do we stand and how to move forward?

Trends in Obesity Among Adults in the United States, 2005 to 2014

Gestational Diabetes Mellitus

Hyperglycemia and adverse pregnancy outcomes

Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis

Percentage of Gestational Diabetes Mellitus Attributable to Overweight and Obesity

A prospective study of pregravid determinants of gestational diabetes mellitus

Psychological distress and salivary cortisol covary within persons during pregnancy

Diabetes and pregnancy: an endocrine society clinical practice guideline

Gestational diabetes mellitus

Application and Utility of Continuous Glucose Monitoring in Pregnancy: A Systematic Review

Prevalence of gestational diabetes mellitus in Europe: A meta-analysis