Diabetes in Pregnancy

Post in Publikationen
by Amelie Hofmann-Werther

What is Gestational Diabetes?

Gestational diabetes mellitus (GDM) is defined as impaired glucose intolerance with onset or first recognition during pregnancy (American Diabetes Association). Diabetes develops when the body can't efficiently produce or utilize insulin, a hormone made by the pancreas that allows cells to turn blood glucose into usable fuel. This definition applies whether insulin or only diet modification is used for treatment and whether or not the condition persists after pregnancy.

According to a 2014 analysis by the Centers for Disease Control and Prevention, the prevalence of gestational diabetes is as high as 9.2%. The prevalence may range from 1 to 14% of all pregnancies, depending on the population studied and the diagnostic tests employed.

Risk factors for developing GDM

  • Maternal age > 25 years old
  • Obesity with BMI > 25
  • Poor physical activity/workout
  • Positive family history for diabetes
  • Status post-delivery of a macrosome baby
  • Smoking
  • PCO-Syndrome (Polycystic Ovarian Syndrome)
  • High blood pressure, metabolic syndrome
  • Ethnical factors

What causes Gestational Diabetes in Pregnancy?

During normal pregnancy, metabolic changes occur in the female body to provide adequate nutrients for the developing fetus. In the first trimester, estrogen and progesterone levels rise, to promote increased pancreatic insulin secretion and increased hepatic glycogen storage. Also peripheral glucose utilization increases. All these changes result in lower fasting glucose levels that can last up to weeks 13 to 15 of pregnancy. During this phase, women have a higher risk of developing hypoglycemia, especially if they’re experiencing morning sickness and vomiting.

As pregnancy progresses into the second and third trimesters, other hormones come into play, including human placental lactogen, cortisol, prolactin, progesterone, and estrogen, and their increasing levels result in an insulin resistance. In compensation for this resistance, insulin secretion is increased two to three times. Women with normal pancreatic function can achieve this, but those who are predisposed to diabetes might show a delayed or insufficient pancreatic insulin secretion, resulting in carbohydrate intolerance and GDM.

How can gestational diabetes be diagnosed?

At 24-28 weeks' gestation, all pregnant women are offered to have an either one-step or two- step glucose testing as per medical guidelines. The pregnancy care taking gynecologist will explain the option of a glucose challenge screening test and a diagnostic glucose tolerance test (one or two-step approach). Patients at increased risk for type 2 diabetes or women presenting with overt signs or symptoms of hyperglycemia such as polyuria, polydipsia, glycosuria, recurrent urinary tract infections should be screened for diabetes at their first antenatal visit. Depending on the results of the plasma glucose measurement fasting and at 1 and 2 hours after glucose exposure, the doctor will define certain goals in blood sugar self-testing the woman needs to restrict herself to.

How can gestational diabetes affect your baby?

Untreated or poorly monitored gestational diabetes can harm mother and baby. In gestational diabetes, the pancreas works overtime to produce insulin, but the insulin does not effectively control blood glucose levels. Although insulin does not cross the placenta, glucose and other nutrients do. High blood glucose levels pass the placenta, overfeeding the baby, which causes the baby's pancreas to produce extra insulin. Since the baby is getting more energy than it needs to grow and develop, the extra energy is stored as additional body fat.

This can lead to macrosomia, a "large" baby. Babies with macrosomia may face health problems, including obstructed labour, injury to their shoulders during birth. Because of the increased excessive insulin production (hyperinsulinemia) by the baby's pancreas, newborns may have very low blood glucose levels at birth and are at higher risk for breathing problems and temperature disregulations.

How Is Gestational Diabetes Managed?

  • Monitoring of blood sugar levels four times per day (before breakfast and 2 hours after meals; monitoring blood sugar before all meals may also become necessary)
  • Switching to a low-calorie sweetener containing sucralose
  • Monitoring of urine for ketones, an acid that indicates your diabetes is not balanced
  • Following of specific dietary guidelines.
  • Moderate physical exercising
  • Monitoring of weight gain
  • Taking insulin if necessary

How can diet influence gestational diabetes?

A diet for pregnant women with GDM should be a healthful and well-balanced eating plan aiming at supporting the pregnancy and promoting blood sugar balance. Consistency in its meal timing needs to be emphasized. In order to motivate and empower patients, diabetes education and nutrition counseling should be sensitive to special patient needs and cultural traditions. A dietitian can determine together with the pregnant lady, how many calories are needed per day and help teaching how to find proper portion size and right amounts of protein, carbohydrates, and fat. If dietary changes aren't sufficient to maintain the blood sugar in a satisfying range, insulin might be required.

Dietary recommendations in gestational diabetes

The 3 components of management for women with GDM are Nutrition education, physical activity, and medications as needed.

If you have gestational diabetes, be aware of a few basic eating tips:

  • Eat 3 small meals and 2-3 little snacks at regular times every day
  • Try not to skip meals or snacks
  • Carbohydrates should ideally be 40%-45% of the total calories
  • Eat small, frequent meals throughout the day and try to avoid fatty, fried, and greasy foods
  • Choose high in fiber foods, such as whole-grain breads, cereals, pasta, rice, fruits, and vegetables. All pregnant women are recommended to eat 20-35 grams of fiber a day
  • Try to have less than 40% of calories in fat, with less than 10% consumed being from saturated fats.
  • Limit sweets and desserts and stay away from added sugars (honey or syrup to your foods)
  • When using sweeteners, make sure they are safe for use during pregnancy, such as sucralose
  • Add vitamins and minerals in your daily diet. Your Gynecologist will recommend a prenatal vitamin and mineral supplement to meet the nutritional needs of your pregnancy

A healthy diet should mainly be based on vegetables, fruits in limited portions, whole grains, foods that are high in nutrition and fiber and low in fat and calories. Carbohydrates turn into blood glucose, the fuel for the body, but its levels need to stay within certain target ranges.

There is no single diet that is right for every woman. A dietitian or a diabetes educator helps to establish a meal plan based on a ladies current weight, pregnancy weight gain, blood sugar level monitoring, exercise and workout preferences and budget.

Exercise & Workout recommendations

Moderate physical activity is of high importance and impact before, during and after pregnancy. Exercise lowers blood sugar; it helps stimulating glucose utilization and increases the cells' sensitivity to insulin. A bit of workout also helps relieve common discomforts of pregnancy, including back pain, muscle cramps, swelling, constipation and trouble sleeping. And more than that it gets in shape for labor and delivery. Walking, cycling and swimming are good choices during pregnancy.