What is gestational diabetes? What to be careful of if it is detected during a health check [Doctor-supervised]

Introduction

In recent years, gestational diabetes has been increasing due to the trend of later marriage and later childbirth. When combining pregnant women who already have diabetes and those who develop gestational diabetes, approximately 15% of all pregnant women are dealing with diabetes during pregnancy.

If blood sugar levels in gestational diabetes can be properly controlled, there will be no complications, and the baby will be able to give birth normally, and it is said that blood sugar levels will return to normal after birth. However, if control is not successful, various problems can occur.

When a pregnant woman finds out she is pregnant, she undergoes various tests during her prenatal checkups. Many women wonder if it is okay to have so much blood drawn. One of the tests performed during prenatal checkups is a blood sugar test. This is where the gestational diabetes screening test is performed.

Optional tests include maternal serum marker testing and NIPT (non-invasive prenatal testing) .

* NIPT (non-invasive prenatal testing) is a test that involves taking a blood sample from the mother and testing it to check for chromosomal abnormalities in the fetus.

Today we will be talking about gestational diabetes .

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What is Gestational Diabetes?

Gestational diabetes is a sugar metabolism disorder that is first detected and developed during pregnancy. Even if there were no abnormalities before pregnancy, blood sugar levels may rise due to changes in hormone secretion after pregnancy.

Unlike regular diabetes, gestational diabetes usually returns to normal after delivery. However, gestational diabetes can affect both the mother and the fetus, so caution is required .

What causes gestational diabetes?

During pregnancy, hormones that make insulin less effective are secreted, such as hormones secreted from the placenta (progesterone, prolactin, cortisol). In addition, proteins called cytokines that suppress the action of insulin are secreted from fat tissue. Therefore, during pregnancy, blood sugar levels tend to be higher than usual and are difficult to stabilize .

In many cases, blood sugar levels can be controlled by increasing the production of a hormone called insulin from the pancreas, but blood sugar levels can sometimes become high due to genetics, lifestyle, and constitution.

These hormonal changes occur because the baby receives nutrients through the umbilical cord, so they are good for the baby’s development, but if the balance is lost , it can have a negative effect on both the mother and the baby.

Factors that may lead to gestational diabetes

1. Have a family member with diabetes
2. Obesity (BMI 25kg/m2 or above)
3. Giving birth at an advanced age (over 35 years old)
4. Have a history of giving birth to a large baby
5. Pregnancy-induced hypertension group, with a history
6. Polyhydramnios
7. Have a history of unexplained habitual miscarriage or premature birth
8. Have a history of giving birth to a child with a congenital malformation
9. Severely positive urine sugar or repeated positive urine sugar two or more times

If any of the above applies to you, you may be at increased risk of developing gestational diabetes.

How to test for gestational diabetes?

During early prenatal checkups, blood sugar levels will be measured at random (regular blood sugar tests).

If your random blood sugar level is high, a glucose tolerance test is performed.

A glucose tolerance test is a method of testing your blood sugar level by drinking a test juice that contains sugar (75g of glucose) .

Even if you had no problems in the early stages of pregnancy, your blood sugar may become high in the middle and late stages of pregnancy. For this reason, you will be tested again in the middle of your pregnancy.

Random blood glucose

This is a regular blood glucose test. Your blood glucose will be measured after your usual breakfast and lunch.

fasting blood sugar

This is a blood glucose test without eating any food. The test is performed after skipping breakfast and lunch.

Glucose tolerance test

After drinking the sugary juice, blood samples are taken one and two hours later to check your blood sugar levels.

Gestational diabetes test results

fasting blood sugar	92 mg/dL or more
Random blood glucose level	100㎎/dl or more
Glucose tolerance test	Blood sugar after 1 hour: 180 mg/dl or more
Blood sugar after 2 hours	153㎎/dl or more

*A doctor will make a comprehensive assessment of the test results for the above items to determine whether or not you have gestational diabetes.

What are the symptoms of gestational diabetes?

There are almost no symptoms of gestational diabetes. Since blood sugar levels can be high without you realizing it, it is important to have regular prenatal checkups .

When a mother’s blood sugar level becomes high, the baby’s blood sugar level also becomes high, which can cause various problems such as the following:

Maternal

Pregnancy-induced hypertension, polyhydramnios, retinopathy, nephropathy, shoulder dystocia (the baby’s shoulder gets stuck in the birth canal during childbirth)

Fetus

Miscarriage, fetal macrosomia, cardiac hypertrophy, hypoglycemia, polycythemia, electrolyte abnormalities, jaundice, fetal death

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What is the treatment for gestational diabetes?

Since active exercise therapy is not possible during pregnancy, dietary therapy is first attempted, and if that does not work, insulin therapy is then used.

The difference between dietary treatments for regular diabetes and gestational diabetes is the target blood sugar range.

For gestational diabetes, the target blood sugar level is less than 100 mg/dl before meals and less than 120 mg/dl two hours after meals.

During pregnancy, you need to take in the energy and nutrients necessary for your baby, so rather than simply restricting your diet, you need to consume a balanced diet that contains the right nutrients in the right amounts.

Therefore, the amount of food consumed on a gestational diabetes diet is greater than that on a regular diabetic diet. However, the target intake amount varies depending on the state of gestational diabetes and the stage of pregnancy, so you must follow your doctor’s instructions.

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Another thing that must be kept in mind when dieting is to ensure that the mother and baby are properly nourished, avoid postprandial hyperglycemia, and avoid increased production of ketone bodies during fasting.

When fasting, the sugar in the mother’s blood is used as the baby’s energy source. Meanwhile, the mother uses fat as an energy source. When fat is used as energy, a substance called ketone bodies is produced. If too many ketone bodies are produced, it can trigger a disease called diabetic ketoacidosis , and the risk of this disease increases during pregnancy.

Diabetic ketoacidosis is a life-threatening disease for both mothers and babies. Excessive energy restriction causes excessive production of ketone bodies in the body. In particular, excessive energy restriction in obese pregnant women requires caution.

The standard diet for pregnant women with gestational diabetes is said to be about 30% less than the normal diet for pregnant women, and any further reduction should be avoided.

What is diabetic ketoacidosis?

The breakdown of fat causes an increase in substances called ketone bodies in the blood, which makes the blood acidic and leads to severe dehydration. Symptoms include sudden thirst, drinking a lot of water, urinating a lot, and feeling fatigued all over. Stomach pain and nausea may also occur, so if these symptoms occur, caution is advised. In severe cases, the patient may lose consciousness.

If blood sugar control is insufficient even with dietary therapy, insulin therapy will be used. In the case of diabetes, oral hypoglycemic drugs can be taken orally, but in the case of gestational diabetes, these cannot be used, so insulin injections, which are safe for the baby, are used.

In the case of gestational diabetes, strict management of blood sugar levels is very important. The goal is to keep blood sugar levels below 100 mg/dl before meals and below 120 mg/dl two hours after meals. As pregnancy progresses, the amount of insulin used increases, which worries many pregnant women, but in most cases, insulin can be discontinued after delivery, so there is no need to worry.

Diet and prevention of gestational diabetes

Although moderate exercise is necessary during pregnancy, it is best to avoid too much intense exercise, so in order to prevent gestational diabetes, we recommend that you first pay attention to your diet.

In dietary therapy for gestational diabetes, it is necessary to avoid taking in a lot of energy at once, which can lead to high blood sugar levels. For this reason, it is common to reduce the amount of food eaten at one time and eat snacks between meals . By eating a total of six meals a day, blood sugar levels will stabilize.

Dietary precautions

• Regularly
• Well balanced
• Choose foods that cause a mild rise in blood sugar

Establish a regular rhythm in your life and keep the intervals between meals constant. Skipping meals or eating at irregular times can cause blood sugar levels to become unstable. Working pregnant women in particular tend to skip breakfast, and even if they eat regularly during the week, their meal times tend to become irregular on weekends. Make sure to eat regular meals at the same times every day.

Divide your daily energy intake into 3 to 6 equal parts (breakfast, lunch, dinner, and snacks between meals) and eat accordingly. Eating too much or too little in one sitting will not stabilize your blood sugar. Avoid eating too much at once as this can cause a sudden rise in blood sugar.

Proper daily energy allocation

• Carbohydrates: 50-60%
• Protein 15-20%
• Fat 20-25%

Ideally, a dinner table should have what is commonly referred to as a staple food, main dish, and side dish.

By consuming a balanced amount of carbohydrates, proteins, lipids, vitamins, and minerals, your metabolism will circulate and you will be able to burn energy efficiently.

The key to choosing snacks is to be careful not to eat anything that is high in carbohydrates or sugar.

Foods that contain a balanced amount of protein and lipids, such as yogurt (unsweetened), small fish, and almonds, cause a gradual rise in blood sugar.

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What to be careful of after giving birth if you have gestational diabetes?

During your postpartum checkup, you will need to undergo a glucose tolerance test to see if your gestational diabetes has been cured. Even if you have been cured, if you have had gestational diabetes, you are more likely to have gestational diabetes in your next pregnancy, and are seven times more likely to develop diabetes in the future, so we recommend regular checkups.

It is said that breastfeeding reduces the risk of developing diabetes in both mothers and babies in the future, so try to breastfeed your baby.

Conclusion

Gestational diabetes is one of the diseases to worry about during pregnancy. By having correct knowledge about the disease, you can reduce your worries and make your pregnancy life more comfortable.

Gestational diabetes is also related to future diabetes and metabolic syndrome in the mother and baby, so it is important to be careful about your lifestyle.

【References】

• Japan Society of Obstetrics and Gynecology – Gestational diabetes
• Japan Diabetes and Pregnancy Society – Gestational diabetes
• Japan Endocrine Society – Gestational diabetes
• Medical Notes – Gestational Diabetes
• |National Center for Child Health and Development – ​​Pregnancy and gestational diabetes