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Gestational diabetes is diabetes that occurs during pregnancy or is first diagnosed during pregnancy. A woman who has not had diabetes before may also be diagnosed with this condition during pregnancy. Gestational diabetes usually disappears after pregnancy ends.
Diabetes, or diabetes mellitus, is a condition where the pancreas either does not produce insulin at all or produces insufficient insulin.
We have compiled the most frequently asked questions about gestational diabetes to help you.
Who Is at Risk?
Those who have a family history of diabetes, high blood pressure, high cholesterol, and obesity are at higher risk. Gestational diabetes occurs in nearly 3% of all pregnancies.
How Does Gestational Diabetes Occur?
During pregnancy, the placenta grows and the hormones it produces increase. This can make insulin less effective and cause blood sugar levels to rise. This effect typically increases around the 20th to 24th week of pregnancy.
However, in women who were overweight before pregnancy, blood sugar may rise even earlier, starting in the first months of pregnancy. Once the placenta is expelled during birth, these hormones disappear, and in most cases, diabetes also resolves. Approximately 90% of cases resolve after pregnancy, but in 10% of cases, diabetes remains permanent.
What is Diabetes?
Without insulin in the body, the sugar and other nutrients from food cannot enter the cells that need them. As a result, while the cells are deprived of sugar, it builds up in the blood, causing high blood sugar levels.
Diabetes can be classified into Type 1 and Type 2. Type 1 diabetes is caused by the pancreas not producing enough insulin. Insulin is used for treatment in Type 1 diabetes. Type 2 diabetes is also known as insulin-independent diabetes. It can particularly be seen in women with polycystic ovary syndrome.
How is Gestational Diabetes Diagnosed?
Gestational diabetes often has no symptoms. Therefore, all pregnant women must be tested. Your doctor will perform a glucose tolerance test. This test is done between the 24th and 28th week of pregnancy. Based on the results, your doctor will guide you further.
Can Diabetes and Hypertension Cause Infertility?
Chronic conditions like hypertension and diabetes are not direct causes of infertility, but they are health conditions that can contribute to infertility. More importantly, it is how blood sugar and blood pressure levels are managed after conception.
In the early months, when blood sugar is well controlled, the need for insulin or medication may decrease. However, as the baby grows, this balance may shift, requiring more insulin, dietary monitoring, and exercise. Before pregnancy, hypertension and diabetes should always be reviewed as part of the infertility evaluation. It is crucial not to skip doctor check-ups during this period.
Who is at Risk for Gestational Diabetes?
- Those with a family history of diabetes
- Overweight women
- Women who had large babies (>4 kg) in previous pregnancies
- Women who have had a miscarriage
- Women older than 30 years of age
- Women who had high blood sugar in a previous pregnancy
- Women with sugar in their urine
What Should Women at Risk Do?
Women at risk should undergo a glucose tolerance test in the early months of pregnancy. If no diabetes is diagnosed, the test should be repeated between the 20th and 24th week of pregnancy.
How Does Gestational Diabetes Affect the Baby?
Gestational diabetes usually develops around the 24th week of pregnancy, so it typically does not cause any abnormalities in the baby. However, if this condition is detected in the first trimester, extra care is required.
Women who have diabetes before pregnancy can still have a healthy baby. However, it is extremely important for these women to monitor their blood sugar levels throughout their pregnancy.
Gestational diabetes can cause the baby to be born larger than average. Due to the high blood sugar in the mother, the baby’s pancreas also produces more insulin, which leads to increased fat storage in the baby, resulting in a larger size. In this case, a cesarean delivery may be necessary. After birth, the baby may experience low blood sugar levels. Hypoglycemia and convulsions are common in such babies, and their blood sugar should be regularly monitored. Additionally, calcium and magnesium levels should be checked as they may be low in these babies.
What to Consider in Gestational Diabetes Follow-Up?
Gestational diabetes follow-up is twofold: First, managing the mother’s blood sugar, and second, monitoring the development of the baby by the obstetrician. The most crucial aspect of diabetes management is ensuring that blood sugar levels remain within normal limits.
Blood sugar levels should be monitored regularly, and the target range should be between 60-120mg/l. Blood sugar measurements should be taken on an empty stomach, 1 hour after meals, and 2 hours after meals.
In addition, blood sugar should be checked before dinner and at 10:30 PM (sometimes at 03:00-04:00 AM). The target values for blood sugar measurements are: Fasting blood sugar <95 mg/dl, 1-hour post-meal blood sugar <140 mg/dl, and 2-hour post-meal blood sugar <120 mg/dl. Urinary ketone measurement should also be conducted periodically as it is an important indicator for diabetes.
What Should Diabetic Women Pay Attention to During Pregnancy?
For women diagnosed with diabetes, pre-pregnancy evaluations are crucial. If you are overweight or obese, it is important to lose weight and control your blood sugar before pregnancy. This will make your pregnancy more comfortable and ease the delivery process.
Balanced nutrition and exercise are essential during pregnancy. We recommend that pregnant women walk 4-5 days a week. Regular exercise helps lower blood sugar levels and balances blood pressure.
How Should Gestational Diabetes Be Monitored and Managed?
Gestational diabetes can be categorized into two groups: women who were already diagnosed with diabetes and those diagnosed with gestational diabetes between the 24th and 28th weeks. Both groups require careful diagnosis and management during pregnancy.
In women with pre-existing diabetes, controlling blood sugar levels in the first three months is crucial. In women diagnosed with gestational diabetes during pregnancy, it is important to control the blood sugar levels, as this may lead to excessive fetal growth, excessive amniotic fluid, and premature birth.
Moreover, babies born to mothers with pre-existing diabetes may experience significant drops in blood sugar immediately after birth. This can pose a life-threatening risk to the baby, making it essential to manage and monitor diabetes carefully throughout pregnancy.
Gestational Diabetes and Blood Sugar Control
- Post-meal blood sugar levels
- Post-meal blood sugar should be <120 mg/dl 2 hours after eating.
- Fasting blood sugar during pregnancy
- Fasting blood sugar should be <90 mg/dl before breakfast, and <105 mg/dl before lunch and dinner.
Nutrition and Exercise in Gestational Diabetes
Gaining 9-12 kg during pregnancy is considered appropriate. If the pregnancy begins with excess weight, gaining 7-8 kg is recommended, and if the pregnancy begins with a very low weight, gaining 15-17 kg is considered normal.
Exercise and an active lifestyle are very important for all diabetics. Exercise can help lower blood sugar and is important for maintaining blood sugar control.
We recommend pregnant women walk 4-5 days a week. Aerobic exercises can also be performed for 45 minutes every day.
During pregnancy, nutrition is very important, but it is even more critical for those with diabetes. A diet rich in vegetables, whole grains, legumes, and fiber-rich foods is recommended. Olive oil, whole wheat bread, low-fat yogurt, and low-fat milk should be preferred. Margarine should be avoided, and carbohydrate intake should be limited to no more than 40% of total daily calories.
Another crucial point is blood pressure values. Regular monitoring and control of blood pressure are necessary. If systolic blood pressure exceeds 140 or diastolic exceeds 90, consult your doctor.
When and How is Insulin Treatment Administered in Gestational Diabetes?
If fasting blood sugar exceeds 105mg/dl despite diet, and post-meal blood sugar exceeds 120mg/dl, insulin therapy may be required. Women who start insulin therapy should monitor their blood sugar at home. Insulin may be administered once or up to four times a day, depending on the doctor’s recommendation.
What Risks Does Gestational Diabetes Pose to Mother and Baby?
Gestational diabetes occurs in about 3% of pregnancies, and 10% of these women may develop diabetes later in life. However, gestational diabetes does not cause diabetes in the baby. The risk of developing diabetes in the mother is higher in the first 10-15 years after pregnancy. Therefore, fasting and post-meal blood sugar levels should be checked every 6 months.
Risks Gestational Diabetes Poses to the Baby
- If HbA1c is above 8 in the first months of pregnancy, the risk of miscarriage is 3 times higher.
- Babies born to diabetic women have a disability rate of 8-13%, while the rate for women without diabetes is 2-4%. The higher the HbA1c, the higher the disability rate.
- Blood sugar > 250mg/dl increases the risk of preterm birth.
- In the second half of pregnancy, high blood sugar causes large babies, breathing difficulties, hypoglycemia, jaundice, polycythemia, low calcium, and congenital heart problems.
Birth and After
Women diagnosed with gestational diabetes can have a normal delivery, but the baby’s condition influences this decision. Birth typically occurs at the 38th week, and if blood sugar is high during delivery, insulin is administered via an intravenous line. Regular monitoring and follow-ups ensure the safe delivery of healthy babies.
After birth, the mother’s diet should continue as it was during pregnancy. If blood sugar levels return to normal, insulin therapy can be stopped. Regular blood sugar measurements should continue after birth, and another check should be done 1-2 months after birth.
Women whose blood sugar rose during pregnancy have a higher risk of developing diabetes later in life (10%). Therefore, regular exercise, weight control, and healthy eating are essential. Additionally, it is advisable to measure fasting and post-meal blood sugar levels every 6 months. If they plan to become pregnant again, prior monitoring and follow-ups are crucial.
Another important factor, as much as weight, is where the fat is accumulated in the body. Even women with a normal weight who have a waist circumference over 88 cm are at high risk. Women with a waist circumference over 80 cm should be more cautious. Personalized weight control, balanced nutrition, and exercise, along with lifestyle changes, can help control diabetes.
