What is gestational diabetes?

Veröffentlicht am: October 08, 2024
Irina Fink
Irina Fink

Naturopath

Gestational diabetes, also known as gestational diabetes, is one of the most common concomitant diseases during pregnancy. The diagnosis of gestational diabetes is probably a shock for many women at first. However, with good treatment, the health of mother and child can be ensured and risks can be avoided.

What is gestational diabetes?

Gestational diabetes is a short-term diabetes disorder. The body does not produce enough insulin to adequately regulate sugar levels during pregnancy. Sometimes it is also referred to as glucose intolerance or carbohydrate intolerance. Between two and five percent of pregnant women develop gestational diabetes. Among women who belong to a risk group, the proportion rises to seven to nine percent. After delivery, the blood sugar level normally returns to normal. However, women with gestational diabetes have an increased risk of developing type II diabetes later on.

If gestational diabetes is recognized and treated in time, there is only a low risk of complications. Women usually give birth to healthy babies and the diabetes disappears shortly after delivery.

Causes of gestational diabetes

During digestion, the body produces glucose from the ingested food, which is then released into the bloodstream. As part of this process, insulin is produced in the pancreas - a large gland directly behind the stomach. Insulin is a hormone and is needed to release the glucose in the blood into the body's cells, where it is used as energy. If the body does not produce enough insulin or the cells do not respond to it, too much glucose remains in the blood instead of in the cells and cannot be converted into energy.

During pregnancy, the female body is more resistant to insulin. This leaves more glucose to supply the baby. This is not a problem for most pregnant women: if the body needs more insulin to process excess glucose in the blood, the pancreas secretes additional insulin.

During pregnancy, a number of other hormones are produced in high quantities in the placenta, through which the baby is connected to the mother's blood supply. Almost all of them affect the action of insulin in the body's cells and lead to an increase in blood sugar levels. A moderate rise after meals is quite normal during pregnancy. However, if the pancreas can no longer meet the increased demand for insulin during pregnancy, the blood sugar level rises too high because the body's cells do not utilize the glucose. This condition is known as insulin resistance. With insulin resistance, the mother's body has difficulty using the insulin. She needs up to three times more insulin than normal. The result is gestational diabetes. Without sufficient insulin, glucose cannot get from the blood into the cells and be converted into energy. The glucose builds up more and more in the blood. This is known as hyperglycemia. 

In the course of gestational diabetes, the hormones of the placenta provoke an increase in blood sugar levels, which can affect the growth and healthy development of the baby. Gestational diabetes usually occurs in the second half of pregnancy, sometimes as early as the 20th week, but usually later.

Who is affected by gestational diabetes?

Any woman can develop gestational diabetes. However, some women are at increased risk. The risk factors include

  • Older than 25 years: Pregnant women over the age of 25 are more likely to be affected by gestational diabetes.
  • Diseases in the family or personal pre-existing conditions: The personal risk of gestational diabetes increases if the woman suffers from prediabetes, i.e. a slightly elevated blood sugar level, which can be a precursor to type II diabetes. If a close relative in the woman's family (parents and siblings) suffers from type II diabetes, the risk is also increased. Women who have previously suffered from gestational diabetes are more likely to develop it if they become pregnant again. There is also a higher risk with previous births of children with a birth weight of over 4.1 kg or with unexplained stillbirths.
  • Overweight: Significantly overweight women with a body mass index (BMI) of 30 or more have a higher risk.
  • Ancestry: Women of African, Native American, Asian, Hispanic or Pacific Islander descent are also at higher risk.

Symptoms of gestational diabetes

Most women who suffer from gestational diabetes do not normally notice any symptoms or only mild symptoms. These include, for example, increased thirst or a more frequent urge to urinate. Most women find out about their condition during check-ups after the appropriate tests have been carried out.

Consequences and risks of gestational diabetes

Most women with gestational diabetes give birth to healthy children. However, gestational diabetes that is not optimally treated can lead to uncontrolled blood sugar levels, which can be dangerous for both the expectant mother and the baby. This also increases the likelihood of delivery by caesarean section.

Complications that can affect the baby

If you have gestational diabetes, your baby is at increased risk of:

  • a higher birth weight. Additional glucose in your bloodstream also reaches the placenta. This causes your baby's pancreas to secrete extra insulin. This can lead to increased growth of the baby (macrosomia). Very large babies with a birth weight of more than 4.1 kg are more likely to get stuck in the birth canal, suffer birth injuries or require a caesarean section.
  • premature birth and respiratory distress syndrome. A high blood sugar level in the mother increases the risk of premature birth. The baby may be delivered prematurely. Sometimes doctors recommend premature delivery in such cases because the baby is so large.

Babies who are delivered prematurely are more likely to suffer from respiratory distress syndrome and have difficulty breathing. These babies may need help breathing until their lungs have fully matured and become stronger. The children of mothers with gestational diabetes are more likely to suffer from respiratory distress syndrome even if they are not delivered prematurely.

  • Low blood sugar level (hypoglycemia). Sometimes the baby's blood sugar level drops too low after birth (hypoglycemia) because the baby produces too much insulin. Severe hypoglycemia can lead to seizures. A rapid supply of food or, in some cases, a glucose infusion can balance the baby's blood sugar level.
  • Type II diabetes later in life. Children of mothers with gestational diabetes have a higher risk of type II diabetes later in life.

Untreated gestational diabetes can lead to the death of the baby either shortly before or shortly after birth.

Complications affecting the expectant mother

With gestational diabetes, the mother is at increased risk of:

  • High blood pressure and pre-eclampsia. With gestational diabetes, there is an increased risk of high blood pressure and pre-eclampsia. The latter is a serious pregnancy complication that causes high blood pressure and other symptoms that threaten the life of both the baby and the mother.
  • Diabetes at a later stage. Women who have developed gestational diabetes once have a greater risk of developing the disease during another pregnancy. In addition, the risk of developing type II diabetes increases with age. However, you can reduce this risk by adopting a healthy lifestyle with a balanced diet and regular exercise.

Less than one in four women who suffered from gestational diabetes develop type II diabetes if they maintain their ideal weight after pregnancy.

Diagnosis of gestational diabetes

Your doctor will evaluate your personal risk of gestational diabetes early on in your pregnancy.

If you belong to a risk group - for example because your BMI is 30 or more (before pregnancy) or your parents, siblings or one of your children has diabetes - your doctor will carry out a diabetes test at your first prenatal visit.

At average risk, the doctor normally carries out a diabetes test in the second trimester between the 24th and 28th week of pregnancy. In Austria, this routine examination has already been included in the mother-child passport and in Germany, the test is also part of the maternity guidelines.

Routine screening for gestational diabetes

  • Initial glucose tolerance test: You must drink a syrupy glucose solution. After an hour, a small amount of blood will be taken and your blood glucose level will be measured. A value below 130 to 140 milligrams per deciliter (mg/dl) or 7.2 to 7.8 millimoles per liter (mmol/l) is considered normal. Sometimes this value varies depending on the test laboratory or clinic.

A higher value only means that you have an increased risk of gestational diabetes. A further glucose tolerance test is necessary for a diagnosis.

  • Follow-up glucose tolerance test: If your blood glucose level is elevated after one hour, your doctor will order an oral glucose tolerance test. This can be used to determine whether you have gestational diabetes or another disease. You must be fasting for the test, i.e. you must not eat or drink anything (except water) in the eight to twelve hours beforehand. First, some blood will be taken from you and your fasting blood sugar level will be determined. You will then drink a sugar solution. After one, two and three hours, your blood glucose level will be measured. If one of these measurements shows an elevated level, you probably do not have gestational diabetes. However, your body may have difficulty maintaining a balanced blood sugar level. Your doctor will give you recommendations on how to avoid this. This usually requires a change in diet. If two or more of these measurements show an elevated value, you are suffering from gestational diabetes. Your doctor will now discuss the next steps and draw up an individual treatment plan.

Treatment of gestational diabetes

The treatment of gestational diabetes aims to balance blood sugar levels so that they are at the same level as those of pregnant women without gestational diabetes. Treatment always includes special dietary plans and scheduled physical activity.

If you have been diagnosed with gestational diabetes, your doctor will recommend regular check-ups, especially during the last three months of pregnancy. Your blood glucose level will be checked at these check-ups. You may have to measure your blood glucose level yourself every day and document it accurately.

If your blood sugar level cannot be kept in balance with these measures, you will need insulin. If additional pregnancy complications occur, further examinations are necessary to check the baby's state of health in detail. These examinations include a check of the placenta function. The placenta supplies your baby with oxygen and nutrients. Your baby's blood circulation is connected to you via this organ.

If gestational diabetes cannot be brought under control, this can affect the placenta and impair the baby's oxygen and nutrient supply.

Your doctor will carry out further tests to closely monitor the baby's health.

1. nutrition for gestational diabetes

The best way to control your blood sugar levels is to eat the right foods at the right time and in the right portion sizes. This will prevent excessive weight loss, which poses an additional risk of complications. Doctors recommend not losing weight during pregnancy. A pregnant woman's body is already working at its limit to care for her unborn child. However, your doctor can set weight goals based on your pre-pregnancy baseline weight.

A healthy diet includes fruits, vegetables and whole grains, foods that are high in nutrients and fiber and low in fat and calories. At the same time, the consumption of highly processed carbohydrates, including sweets, is limited.

Regular (snack) meals that provide carbohydrates evenly distributed throughout the day prevent large spikes in blood sugar levels. The American Diabetes Association recommends that women with gestational diabetes eat three small to medium-sized meals and two to four snacks a day.

A healthy diet that helps you regulate your blood sugar levels includes

  • Not too many carbohydrates at the same time
  • Complex carbohydrates with a high fiber content
  • Carbohydrates only in combination with proteins or healthy fats
  • No skipping meals
  • Protein- and fiber-rich carbohydrates for breakfast
  • little to no food with a high sugar content
  • a variety of whole grain products, fruit and vegetables daily
  • limited alcohol consumption
  • little salt

Foods with a low glycemic index

In the case of gestational diabetes, you should eat foods with a low glycemic index.

The glycemic load is determined by multiplying the amount of carbohydrates in grams in a portion of a particular food by its glycemic index (GI). This number gives a better indication of the true effect of the food on blood sugar levels.

Foods with a low glycemic load are digested more slowly than simple carbohydrates in foods with a normally high GI.

A glycemic load of ten or less is considered low and therefore ideal for women with gestational diabetes who want to keep their blood sugar levels in balance.

Foods with a low glycemic load include

  • 100 percent wholemeal bread or wholemeal cereal products
  • low-starch vegetables
  • some starchy vegetables such as peas and carrots
  • some types of fruit such as apples, oranges, grapefruit, peaches and pears
  • Beans
  • Lenses
  • Chickpeas

All these foods release sugar slowly into the bloodstream and thus support a stable blood sugar level.

More proteins

In addition to carbohydrates, you should eat more protein or switch to protein-containing carbohydrates. This will help you to keep your blood sugar levels in balance. Women with gestational diabetes should eat lean, protein-rich foods. For example:

  • Fish, chicken and turkey
  • Eggs
  • Tofu
  • Beans
  • Nuts
  • Seeds and kernels
  • Quinoa
  • Legumes

Unsaturated fats

Unsaturated fats are also part of a healthy diet. Unsaturated fats are contained in:

  • Olive oil
  • Peanut oil
  • Avocados
  • Most nuts and seeds
  • Salmon
  • Sardines
  • Tuna
  • Chia seeds

Avoid foods containing sugar

You should avoid sugary foods or sugary drinks as much as possible. This will help you to reduce the effects of gestational diabetes.

Blood sugar levels rise after consuming sugary foods, especially if they have been refined and processed. Women with gestational diabetes are advised to limit or avoid the consumption of sugary foods as much as possible.

These include:

  • Cake
  • Pastry
  • Sweets
  • Pudding
  • Lemonade
  • Fruit juice with added sugar

Avoid foods with a high starch content

Starchy foods contain a lot of carbohydrates and have a high impact on blood sugar levels. You should therefore only eat small portions. Some foods with a very high starch content should be severely restricted or preferably avoided altogether. These include

  • Potatoes
  • White bread
  • white rice
  • light pasta

Avoid hidden sugars and carbohydrates

Some foods don't even look like they contain sugar or carbohydrates. Here are a few examples:

  • Highly processed foods
  • some condiments such as dressing and ketchup
  • Fast food
  • Alcohol

Milk and fruit naturally contain sugar and can be consumed in moderate amounts.

There is no diet plan that suits all women. Talk to your doctor or a dietitian at a diabetes counseling center and create a diet plan together. This will be based on your current weight, your pregnancy weight goals, blood glucose levels, level of physical activity, food preferences and your budget.

 

2. exercise for gestational diabetes

Regular exercise is important for every woman before, during and after pregnancy. Exercise lowers the blood sugar level. Glucose is increasingly released into cells, where it is converted into energy. In addition, the insulin sensitivity of the cells is increased. The body therefore has to produce less insulin to transport the sugar to the cells.

In addition, exercise alleviates common pregnancy complaints such as back pain, muscle cramps, swelling, constipation and difficulty sleeping. Exercise will get you in shape for the last strenuous weeks of pregnancy and the delivery.

Get your doctor's approval and make sure you do moderate strengthening exercises several times a week. If you have not exercised for a long time, start slowly and increase gradually. Swimming, walking and cycling are all suitable during pregnancy. So are yoga and aerobics. Everyday household chores and gardening also count as physical exercise.

Swimming

Many doctors and fitness trainers believe that swimming is one of the safest sports for pregnant women. Swimming gets your body in shape without straining your joints. It raises your heart rate and allows for cardiovascular exercise without the risk of overheating.

In addition, you cannot fall while swimming. Pregnant women often have difficulties with their sense of balance and are particularly at risk of tripping or falling. This cannot happen to you when swimming (as long as you are still in the pool). Swimming is one of the water sports. However, not all water sports are recommended for pregnant women.

Pregnant women should avoid scuba diving or water skiing.

Walking

Walking is a well-suited sport that is, above all, safe. It puts less strain on the knees than running. Most people can easily integrate walking sessions into their daily schedule. Start slowly and warm up well beforehand. Set yourself realistic goals and wear sensible shoes. This will help you avoid falls and take the strain off your feet.

Running & jogging

If you were already running regularly before your pregnancy, you can continue to do so. If not, you should definitely discuss with your doctor whether it is safe and advisable for you to start running during pregnancy. When running, make sure you drink enough fluids, avoid overheating and wear good running shoes.

Ride a bike

A bike carries your weight. This reduces the strain on your body. A fitness bike is best suited as the risk of falling is lower. As your waistline increases, your center of gravity shifts and the risk of falling increases. The strain on your back also increases. Start slowly and don't overdo it.

Yoga

Yoga has long been considered a good way to reduce stress and relieve the body. Most of the exercises are safe for you and your baby as long as you don't overexert yourself. There are also special yoga classes for pregnant women. Avoid lying flat on your back for too long and do not overstretch.

Aerobics

If you were already doing aerobics before your pregnancy, you can continue to do so. However, be sure to talk to your doctor if you want to start again. Some women have difficulty keeping their balance. Be especially careful as your pregnancy progresses. Perhaps you would like to attend a special class just for pregnant women? Most gyms offer such classes. Make sure that you don't lie flat on your back for too long.

3. insulin therapy for gestational diabetes

Most women manage their gestational diabetes with a special diet plan and regular exercise.

However, 15 percent of all affected women require insulin therapy.

These are usually insulin injections. If you are one of them, you will need three insulin injections a day. Your doctor will show you how to inject yourself.

It is very important that you monitor your blood glucose level closely. You will be given a special test device for this purpose and will be instructed in detail. You have to prick your finger with a sharp needle every morning and one or two hours after every meal. For most women, this is the most uncomfortable part of the whole treatment.

After the pregnancy

Have a diabetes test carried out six to twelve weeks after giving birth and every one to three years. In most women, the diabetes disappears quite soon after giving birth. If this is not the case, you have type II diabetes. However, even those women whose diabetes disappears again after giving birth are at high risk of developing permanent diabetes. Around half of them will develop type II diabetes later in life. It is therefore particularly important for women who have suffered from gestational diabetes to continue to exercise regularly and eat a healthy diet. This can reduce your personal risk. Remind your doctor to carry out a diabetes test every one to three years.

 

Sources (in English):

Shepherd, E., Gomersall, J. C., Tieu, J., Han, S., Crowther, C. A. & Middleton, P. (2017, November). Combined diet and exercise interventions for preventing gestational diabetes mellitus. The Cochrane Database of Systematic Reviews, 11:CD010443, doi: 10.1002/14651858.CD010443.pub3

Brown, J., Grzeskowiak, L., Williamson, K., Downie, M. R. & Crowther, C. A. (2017, November). Insulin for the treatment of women with gestational diabetes. The Cochrane Database of Systematic Reviews. 11:CD012037. doi: 10.1002/14651858.CD012037.pub2

Cordero, Y., Mottola, M. F., Vargas, J., Blanco, M. & Barakat, R. (2015, July). Exercise Is Associated with a Reduction in Gestational Diabetes Mellitus. Medicine and Science in Sports and Exercise, 47(7):1328-33, doi: 10.1249/MSS.0000000000000547

Wang, C., Guelfi, K. J., Yang, H. X. (2016, December). Exercise and its role in gestational diabetes mellitus. Chronic Diseases and Translational Medicine. 2(4):208-214, doi: 10.1016/j.cdtm.2016.11.006

Brown, J., Alwan, N. A., West, J., Brown, S., McKinlay, C. J., Farrar, D. et al. (2017, May). Lifestyle interventions for the treatment of women with gestational diabetes. The Cochrane Database of Systematic Reviews, 5:CD011970, doi: 10.1002/14651858.CD011970.pub2 

Tieu, J., Shepherd, E., Middleton, P. & Crowther, C. A. (2017, January). Dietary advice interventions in pregnancy for preventing gestational diabetes mellitus. The Cochrane Database of Systematic Reviews, 1:CD006674, doi: 10.1002/14651858.CD006674.pub3 

Han, S., Middleton, P., Shepherd, E., Van Ryswyk, E. & Crowther, C. A. (2017, February). Different types of dietary advice for women with gestational diabetes mellitus. The Cochrane Database of Systematic Reviews, 2:CD009275, doi: 10.1002/14651858.CD009275.pub3 

Brown, J., Ceysens, G. & Boulvain, M. (2017, June). Exercise for pregnant women with gestational diabetes for improving maternal and fetal outcomes. The Cochrane Database of Systematic Reviews, 6:CD012202, doi: 10.1002/14651858.CD012202.pub2 

Bain, E., Crane, M., Tieu, J., Han, S., Crowther, C. A. & Middleton, P. (2015, April). Diet and exercise interventions for preventing gestational diabetes mellitus. The Cochrane Database of Systematic Reviews, (4):CD010443, doi: 10.1002/14651858.CD010443.pub2