Key Takeaways

• Gestational diabetes is a problem with blood sugar control that’s diagnosed during pregnancy.

• It occurs because of hormonal changes during pregnancy that causes insulin resistance.

• Gestational diabetes can cause complications during delivery, and poses serious risks to the health of both mother and baby.

• All pregnant women should be screened for gestational diabetes during the second trimester of pregnancy.

• Treatment begins with lifestyle changes. If this is not enough to keep blood sugar under control, then insulin therapy or oral medications may be used.

• Women with gestational diabetes are at an increased risk for developing type 2 diabetes later in life, and should receive regular screening.

What is gestational diabetes?

Gestational diabetes is a problem with blood sugar control that’s diagnosed during pregnancy. It’s sometimes known as gestational diabetes mellitus, or GDM. If a mother has diabetes before she gets pregnant, this would not be considered gestational diabetes, but rather type 1 or type 2 diabetes.

Gestational diabetes is very common. In Singapore, about 15 to 20% of all pregnant women have gestational diabetes. Previous research indicated that the numbers were lower, but programs that screen all pregnant women for gestational diabetes have found that this condition is more common than previously believed.

It’s essential to detect gestational diabetes as early as possible. With early diabetes detection, treatments can be used to help improve blood sugar control and reduce the risk of major complications. When left untreated, gestational diabetes poses a significant risk to the health of both the mother and baby.

Causes of gestational diabetes

During pregnancy, there are a number of hormonal changes. Some of these hormones tend to make the mother’s body more resistant to insulin. These include certain hormones produced by the placenta, such as human placental lactogen (hPL) and human placental growth hormone (hPGH), as well as hormones that are produced by the mother’s body at higher levels during pregnancy, including cortisol, estrogen, and progesterone.

Insulin resistance occurs to some extent during every pregnancy. However, in most cases, the mother’s body produces more insulin to compensate for the insulin resistance, and her blood sugar control remains normal. However, in some women, insulin resistance is more severe, resulting in gestational diabetes. 

In general, gestational diabetes first becomes apparent during the second trimester of pregnancy, as the placenta produces higher levels of the hormones that cause insulin resistance. It generally becomes more severe during the third trimester.

Who is at risk of developing gestational diabetes?

It’s still not clear why some women develop gestational diabetes and others do not. However, there are certain risk factors that make it more likely that a woman will develop GDM during her pregnancy. These include:

• Lack of physical activity

• Family history of diabetes

• Having had gestational diabetes during a previous pregnancy

• Being over 35 years old

• Being overweight

Even if you don’t have any of these risk factors, it’s still possible that you could develop gestational diabetes. It’s recommended that all pregnant women receive screening for GDM. Early gestational diabetes detection is crucial, because treatment of this condition can reduce the risk of complications with the pregnancy. 

Screening and diagnosis

In Singapore, it’s recommended that all pregnant women be screened for gestational diabetes between 24 and 28 weeks of pregnancy. This involves an oral glucose tolerance test (OGTT). For this test, your blood glucose is first checked while you haven’t eaten overnight. You then consume a drink containing a precise amount of glucose. Your blood glucose is checked again one, two, and three hours later, to evaluate how well your body is able to process the glucose in the drink.

In women who are at a higher risk for diabetes, screening is also recommended in the first trimester. Although this is too early for gestational diabetes to develop, it allows diabetes detection in women who already had diabetes but had not been previously diagnosed. This screening may involve a fasting glucose, hemoglobin A1c, or OGTT. 

Risks and complications

If left untreated, gestational diabetes can create complications for both mother and baby. The increased glucose levels in the mother’s blood tend to cause the baby to grow faster. If the baby is too large, then vaginal delivery can be difficult, and injury to the baby is more likely. As a result, a cesarean section may be necessary to safely deliver the baby.

Mothers with gestational diabetes are also at an increased risk for preeclampsia, a potentially dangerous condition in which the mother’s blood pressure is too high. This can cause damage to a variety of organs, including the brain, kidneys, and liver.

In addition, babies born to mothers with gestational diabetes are at an increased risk for serious health problems, including trouble breathing, jaundice, and low blood sugar. They’re more likely to need care in the neonatal intensive care unit (NICU). The effects of gestational diabetes may also impact the child later in life. As adults, people whose mothers had gestational diabetes while pregnant with them have a higher risk for developing conditions like obesity, heart disease, and diabetes.

Management and treatment

For women with gestational diabetes, it’s important to keep a close eye on blood sugar. It’s recommended that blood glucose levels be tested regularly. A fasting blood glucose level should be checked each morning, and the level should also be checked one to two hours after eating. Treatment will focus on keeping glucose levels as close to the normal range as possible, which helps to reduce the risk of complications.

To check blood glucose levels as recommended, a pregnant woman will need a glucose sensor. This could be a traditional glucometer that uses fingerpricks to check glucose levels, or a continuous glucose monitor (CGM) could be used for more convenience.

Lifestyle changes are usually the first line of treatment. This includes increased physical activity, a healthy diet, and managing weight gain to keep it in the normal range. While weight gain during pregnancy is definitely normal, it’s important to ensure that you don’t gain too much weight, because this can increase the risk of conditions like gestational diabetes.

Developing and sticking with a healthy lifestyle plan can be very challenging for anyone, and it’s even more difficult when you’re pregnant. Having the support of a team can make a huge difference. 

For those whose blood glucose levels are still not within the normal range after making lifestyle changes, then additional treatments are needed to help with blood sugar control. This may involve insulin therapy, or oral medications like metformin. It’s important to keep blood glucose from rising too high, but it’s also important to avoid episodes of low blood sugar, which can be dangerous. Your care team should provide you with education in how to recognize the signs of low blood sugar and take action.

Collaborative care and support

To best support the health of both mother and baby, it’s best for a woman with gestational diabetes to receive medical care from a multidisciplinary team of specialists. Medical care in pregnancy is complex, particularly when the pregnancy is complicated by a condition like gestational diabetes, so it’s best to have a team of experts to ensure that nothing is missed. The team generally includes an endocrinologist (a specialist in hormonal health, including diabetes), an obstetrician (a specialist in pregnancy care), and a nutritionist.

Women with gestational diabetes may need education in how to monitor their blood sugar. They also need advice about developing a healthy lifestyle plan that will be safe during pregnancy and will work well for them, along with support in sticking to this plan. In some cases, women with gestational diabetes also need to learn how to manage insulin therapy. Education and support in all of these areas is crucial in helping to ensure optimal treatment for gestational diabetes and get the best possible outcomes for both mother and baby.

Pregnancy outcomes and postpartum considerations

In most cases, gestational diabetes will go away on its own after the baby is born, and normal blood sugar control will return. However, there are some cases where diabetes persists after the pregnancy is over. At that point, the mother is considered to have type 2 diabetes. To make sure that gestational diabetes has resolved, it’s recommended that the mother have another oral glucose tolerance test (OGTT) about 6 to 12 weeks after the birth.

Although gestational diabetes often resolves, it does result in an increased risk for diabetes. About half of all women with gestational diabetes will go on to develop type 2 diabetes later in their lives. Because of this, if you develop gestational diabetes, it’s important that you continue to receive screening for diabetes throughout your life. It’s recommended that you be screened at least once every three years, and ideally every year.

Prevention

The best way to prevent gestational diabetes is to live a healthy lifestyle before and during pregnancy. Ideally, it’s best to be at a healthy weight before you get pregnant. If you’re thinking of trying to conceive, and you struggle with your weight, then it’s a good idea to get some help in achieving a healthier weight before you start trying to get pregnant. Our NOVI Optimum plan offers support from health coaches and nutritionists, along with our expert endocrinologists, to help you reach your goals. Some people may benefit from certain medications that can help with weight loss; if you’d like to consider this option, it’s included in NOVI Optimum Plus.

If you’re in a group at higher risk for diabetes, then you should also strongly consider getting screened for diabetes before you start trying to conceive. Diabetes detection allows you to get your blood sugar under control before pregnancy, which could improve your fertility as well as helping to support the health of both you and your baby once you get pregnant.

Pregnancy can create intense cravings. Some women also experience mood swings, and it may be tempting to reach for sugary foods for comfort. However, eating a healthy diet during pregnancy is important for the health of both you and your baby. It’s also important to get enough exercise. There are special considerations for ensuring that exercise during pregnancy is safe and comfortable, and support from an expert can be very helpful in developing a safe exercise plan that you’ll be able to stick with. Eating well and exercising throughout your pregnancy will help to reduce your risk of many health complications, including gestational diabetes.

Although women with gestational diabetes have a significant risk of developing type 2 diabetes in the future, you can take actions to significantly reduce your chances of developing diabetes. In fact, one study found that women who had gestational diabetes could reduce their risk of later developing diabetes by 90% by following these five guidelines:

• Maintaining a healthy body weight (BMI between 18.5 and 24.9)

• Eating a healthy diet

• Exercising regularly

• Avoiding smoking

• Keeping alcohol consumption to a moderate level

Again, having support from a team of experts can help you to develop and stick to a healthy lifestyle plan that will work for you. This reduces your risk of developing type 2 diabetes, and the serious and even life-threatening complications that it can cause.