Diabetes is an immunological disorder wherein the body cannot process glucose properly as it can’t either make or use insulin properly. Insulin is a pancreatic hormone produced that helps the body convert glucose and allow its use as energy. When the body does not utilize glucose, it builds up in the blood, which leads to hyperglycemia, i.e., increased blood glucose level. Hyperglycemia affects the whole body simultaneously. It can lead to damage to nerves, blood vessels, eyes, kidneys, and the heart. During the first few months of the pregnancy, high blood glucose can even cause congenital disabilities in the baby.
Gestational diabetes is a fairly common condition in which the blood sugar level rises and other diabetic symptoms appear over the course of pregnancy in a woman who had no signs of having the disease before the pregnancy. It is fairly common, occurring in about 3 to 9 women out of every 100. If a woman had been diagnosed with diabetes before pregnancy, it would be called pregestational diabetes.
Pregnancy alters the way a woman’s body uses glucose. During pregnancy, the body develops a placenta to provide nutrients and oxygen to the growing baby. The placenta also has a dual function of producing hormones. During late pregnancy, the body produces many extra hormones such as estrogen, cortisol, and human placental lactogen, which can adversely affect the functioning of insulin in the body. Once these hormones block insulin (also called insulin resistance), glucose cannot enter the body cells and blood glucose levels start rising.
Gestational diabetes is much more common in women who are overweight women, or those who had gestational diabetes during a previous pregnancy, or women who have a family member with type-2 diabetes. Women pregnant with twins or other multiple children are also very likely to develop gestational diabetes.
Gestational diabetes does not have any typical symptoms. Most women do not even realize that they have it unless they get tested. Due to the adverse effects of gestational diabetes on the developing baby, all women should be screened for the condition between 24 to 28 weeks of pregnancy. For diagnosis, a standard glucose screening test is performed.
The treatment of gestational diabetes is a little more complicated as compared to regular diabetes. It depends on the person’s symptoms, age and general health, and the severity or progression of the disease. The treatment focuses on keeping the blood sugar level in check. Most doctors suggest a low carb diet, exercise, blood glucose monitoring, with low-level insulin injections and oral medicines for hypoglycemia.
Though diabetic complications in pregnancy usually occur only in women diagnosed with diabetes before pregnancy but can occur in women with gestational diabetes too. Women may need more insulin injections than usual. Blood glucose can also go so low that it can be life-threatening for both the mother and the child. High blood glucose can also cause
ketoacidosis, which is life-threatening if left untreated. Women with gestational diabetes are more liable to develop type 2 diabetes later in life or gestational diabetes in the subsequent pregnancies, so one should be regularly tested for diabetes even after the conclusion of the pregnancy.
Some of the common complications of gestational diabetes in the fetus are:-
● Stillbirth: Stillbirth, or fetal death, is more likely in women with gestational diabetes because the baby’s development is affected negatively due to high blood pressure and damaged blood vessels due to high blood sugar. Though the exact reason for fetal deaths is not known, the number is relatively high compared in women with gestational diabetes.
● Congenital disabilities: Gestational diabetes can lead to a lot of complications in the fetus, and these congenital disabilities can even be severe enough to cause fetal death. These congenital disabilities usually occur during the first trimester of pregnancy. Babies can develop major defects in the heart and blood vessels, brain and spine, urinary system and kidneys, and digestive system.
● Macrosomia: If a baby’s overall size is larger than usual, then it is called macrosomia. All nutrients for the baby come directly from the mother’s blood via the placenta. If the mother has gestational diabetes, then the baby’s body starts preparing more insulin to battle it. This leads to the enlargement of the baby’s body.
● Birth injury: As mentioned above, gestational diabetes can cause macrosomia, leading to difficulty in childbirth. Both the baby and mother can get injured due to the baby’s large size.
● Hypoglycemia: Right after birth, the baby may have low blood glucose levels, especially if the mother’s blood glucose has been high for too long before delivery, as this increases the amount of insulin in the baby’s body. After birth, the level of glucose drops down, but the level of insulin remains high. If the glucose level is too low, the baby may need a glucose IV to normalize it.
● Respiratory distress: High insulin levels can prevent lung tissue growth in the baby’s body and lead to breathing issues and respiratory distress in the baby. It is more common in babies who are born before 37 weeks of pregnancy.
● Preeclampsia: Women with gestational diabetes are also more liable to develop preeclampsia, i.e., high blood pressure leading to organ damage.
Women with gestational diabetes need to be very closely monitored, especially if they need to take insulin, as they have higher chances of stillbirth. This can be done via tests such as fetal movement counting, ultrasound, non-stress counting, biophysical profile, doppler flow studies, etc. The baby may need to be delivered via C- section in extreme cases.
In conclusion, gestational diabetes is a very serious condition that can have far-reaching effects on both the mother and the baby. It is very important for all prospective parents to be aware of its dangers and be cautioned against them.
At Ovum Women and Child Hospital, we have a maternity and gynaecology team fully staffed with expert high-risk pregnancy doctors in Bangalore. Our team has some of the best gynaecologists in Bangalore for PCOS treatment and for the treatment of other gynaecology and maternity disorders. We work hard to ensure that we retain the spot of the best hospital for normal delivery in Bangalore.