- ATHENS OFFICE MED4WOMAN ATHENS
- VOLOS OFFICE MED4WOMAN VOLOS
Obstetrician-Gynecologist
PhD, University of Athens Medical School
Obstetrician-gynecologist Panagiotis Polyzos practices at the Institute of Life, the IVF Unit of IASO Maternity Hospital.
Diabetes mellitus is characterized by elevated blood glucose levels. In gestational diabetes, this disorder of the woman's sugar metabolism is discovered or first appears during pregnancy, usually in the second trimester. It occurs in 4-8% of pregnancies. The placenta produces hormones that reduce the action of insulin (the hormone produced by the woman's pancreas to regulate her blood sugar). In women with gestational diabetes, insulin cannot properly regulate blood sugar levels, so the excess sugar passes through the placenta to the fetus.
Most pregnant women have no symptoms. Even so, some symptoms may appear, such as frequent urinary tract infections and vaginitis, increased thirst, increased appetite, frequent urination, changes in vision, tiring easily and weakness.
From the very first visit to the obstetrician, a pregnant woman should have her fasting blood glucose measured and rechecked at regular intervals. If fasting glucose is higher than 92 mg/dl, then the diagnosis of gestational diabetes is made, and the pregnant woman requires further management.
Today, it is recommended to measure fasting blood glucose and repeat the measurement one to two hours after consuming 75 grams of glucose. If even one value is equal to or higher than the normal range, the diagnosis of gestational diabetes is established.
The normal values for the glucose tolerance test (with 75 grams of glucose) are:
Before the test, the proper preparation instructions for the pregnant woman are as follows: Two days before the test, she should consume carbohydrates (pasta, rice, cereals, sweets). The test must be performed in the morning, and she should remain fasting (only water is allowed) from the previous night until 12 hours have passed.
Gestational diabetes can occur in any pregnant woman, even without any predisposing factor. That’s why the glucose tolerance test is done in everyone. The likelihood is higher when:
In high-risk women, the doctor may order a blood sugar test as early as the first trimester and repeat the glucose tolerance test at 24 to 28 weeks.
While you wait, you stay seated, do not eat and do not smoke. The test takes about two and a half hours. The solution is very sweet and makes some women nauseous. If you vomit, the test is repeated on another day.
When the diagnosis is made: a single value equal to or above the limits is enough, that is 92 mg/dl fasting, 180 mg/dl at one hour or 153 mg/dl at two hours.
When the mother's blood sugar stays high, it passes to the fetus through the placenta. The fetal pancreas responds by producing more insulin, which acts like a growth hormone. If the diabetes is not controlled, the likelihood increases for:
The key point is that with proper blood sugar control, these risks come close to those of a pregnancy without diabetes. Gestational diabetes does not cause birth defects, because it appears after the organs have formed.
Diet is the first and often the only treatment. About seven to eight out of ten women achieve control without medication. The goal is not to cut out carbohydrates, but to spread them correctly throughout the day.
Breakfast needs attention: insulin resistance is higher in the morning. Choose an egg with a slice of whole wheat bread or yogurt with nuts instead of cereal and juice. A small protein snack before bed helps your morning fasting blood sugar.
You will find general ideas for balanced meals in the article on the best foods for pregnancy. Your exact meal plan is set by a dietitian or your doctor, based on your weight and your readings.
Exercise: a 15 to 20 minute walk after main meals noticeably lowers post-meal blood sugar. Overall, aim for 150 minutes of moderate activity per week, as long as there is no obstetric contraindication.
Self-monitoring: you will measure your blood sugar at home, usually four times a day: in the morning while fasting and after the three main meals. The usual targets are:
Insulin: if after one to two weeks of a proper diet your values remain above target, insulin is added. It does not cross the placenta and is completely safe for the fetus. Needing insulin does not mean you did something wrong: it means the placenta is producing many hormones that raise blood sugar.
With well-controlled diabetes and a normal fetal weight, delivery can be vaginal and close to the due date. In the third trimester, fetal growth is monitored by ultrasound and, when needed, by non-stress test (NST).
After delivery, blood sugar usually returns to normal right away. However, you will need:
Women with a history of gestational diabetes have a significantly higher chance of developing type 2 diabetes in the years that follow, and breastfeeding, a healthy weight and exercise reduce this risk.
When diet and exercise are not enough, the choice of medication is individualized. Insulin remains the reference treatment, because it does not cross the placenta. Metformin tablets are used in some countries as the first drug option, mainly when the problem is fasting blood sugar or the woman struggles with injections. It does cross the placenta, and although the data on children so far are generally reassuring, long-term follow-up is limited. The decision is made together with your doctor.
With insulin, there is a chance your blood sugar will drop below 70 mg/dl. The symptoms are shakiness, sweating, rapid heartbeat, intense hunger, dizziness or confusion.
If hypoglycemia keeps recurring or comes with confusion, tell your doctor right away so the dose can be adjusted.
Gestational diabetes slightly changes the schedule of visits in the third trimester. The main tool is obstetric ultrasound growth scans, which show whether the baby is growing too fast, mainly in abdominal circumference, and whether the amniotic fluid is increasing.
When blood sugar is controlled by diet alone and everything is normal, guidelines recommend that delivery not go beyond 40 weeks and 6 days. With insulin or metformin, delivery is often scheduled between 39 and 40 weeks. Earlier delivery is considered only when control is poor or there are complications. During labor, blood sugar is measured regularly and, if needed, insulin is given intravenously.
In the womb, the baby's pancreas got used to producing more insulin. After birth, when the sugar supply from the mother stops, the baby's blood sugar may drop for a few hours. That’s why:
The breastfeeding of the newborn is ideal, because colostrum stabilizes its blood sugar. In agreement with your doctor, you may collect colostrum by hand from 36 weeks and store it frozen in small syringes, so it is available in the first hours.
Gestational diabetes often comes back in a later pregnancy, in some studies in up to one in two women. The likelihood drops with what you do before the next conception:
If you are planning another pregnancy, the guide on how to get pregnant also covers the general preparation steps.
Fasting blood sugar below 92 mg/dl, below 180 mg/dl at one hour and below 153 mg/dl at two hours. If even one value is equal or higher, gestational diabetes is diagnosed.
Between the 24th and 28th week of pregnancy. In women at higher risk, testing may be done earlier, from the first trimester.
Usually not, that’s why all pregnant women are tested. When symptoms occur, they are intense thirst, frequent urination, fatigue and frequent urinary tract infections or vaginitis.
In most women, yes. However, a follow-up glucose tolerance test 6 to 12 weeks after the birth and regular monitoring are needed, because the risk of type 2 diabetes is higher.
Yes, when blood sugar is well controlled and the baby's estimated weight is normal. The method and timing of delivery are decided on an individual basis.
If your reading is below 70 mg/dl or you have shakiness, sweating and dizziness, take 15 grams of fast-acting sugar, such as half a glass of juice, and measure again after 15 minutes. Tell your doctor so your insulin dose can be adjusted.
The likelihood is higher, but it is not certain. Weight loss, exercise and early blood sugar testing in the next pregnancy reduce the risk and allow timely treatment.
Yes. After delivery, insulin is usually stopped right away. Breastfeeding is encouraged, because it stabilizes the newborn's blood sugar and lowers the mother's future risk of type 2 diabetes.
Children of mothers with gestational diabetes have a somewhat higher chance of obesity and metabolic problems later in life. Good control during pregnancy, breastfeeding and a healthy family lifestyle reduce this risk.
