gestational diabetes
Metabolic Health

What is Gestational Diabetes

How to control gestational diabetes is something a lot of people are looking for, but to know that we have to first understand gestational diabetes. Gestational diabetes is one of the types of diabetes that a woman develops during her pregnancy. It is also the first time that diabetes has been diagnosed. Though it is a temporary stage, it is crucial to get tested and treated as it can affect the health of the mother and baby. Like in other diabetes, the blood sugar level shoots up in gestational diabetes. The good news is that the blood sugar level returns to normal after delivering the baby. 

How Is Gestational Diabetes Caused

In any kind of diabetes, the body’s ability to produce insulin is hampered, thus producing lower insulin levels. The pancreas is responsible for producing insulin. Insulin plays a crucial role in allowing blood sugar to enter cells and tissues to produce energy for functional activities. During pregnancy, many changes occur in the mother’s body–physical, mental, emotional, hormonal, etc. Hormonal changes result in weight gain. Due to a larger tissue mass in the body, the insulin produced is not sufficient, and a condition called insulin resistance develops. Most women show signs of insulin resistance around the last trimester. Women who have insulin resistance before getting pregnant have higher chances of developing gestational diabetes right from the early days of pregnancy. Sometimes, gestational diabetes may develop into type 2 diabetes, so it is important to get tested and treated for gestational diabetes. It is generally a good practice to keep checking your blood sugar levels so that if symptoms arise, they can be treated from the initial stages. There are also ways on how to treat gestational diabetes that can be done under the guidance of a doctor

Symptoms and Risk Factors of Gestational Diabetes

Typically, gestational diabetes does not have any specific symptoms. It can vary from person to person, depending on medical history and potential risk factors. Generally, being obese or overweight could be a risk factor for gestational diabetes. If there has been an episode of gestational diabetes during the first pregnancy, it could cause concern for a subsequent pregnancy. A lack of physical activity may trigger gestational diabetes. Genes play an important role–if an immediate family member has had gestational diabetes, one must be aware and watch for signs. If the baby delivered earlier weighed over 4 pounds or 4.1 kg, it is important to get tested for gestational diabetes during the subsequent pregnancy. Premature delivery could also cause gestational diabetes during the next pregnancy. If the mother has had a history of low blood sugar, that is one of the major risk factors. 

The test for gestational diabetes is generally done between the 24th and 28th weeks of pregnancy. If there are other risk factors and higher chances of having gestational diabetes, the doctor advises the test earlier in the pregnancy to avoid complications. Sometimes, during the early stages of pregnancy, if the blood sugar level is higher, it may indicate that instead of gestational diabetes, it could be type 1 or type 2 diabetes. 

Symptoms of gestational diabetes

Usually, gestational diabetes are not associated with any specific symptoms, but pregnant women may experience:

  • Fatigue
  • Increased thirst
  • More frequent urination
  • Blurred vision
  • Vaginal, bladder and skin infections.

Risk factors of gestational diabetes

  • Generally, being obese or overweight could be a risk factor for gestational diabetes.
  •  If there has been an episode of gestational diabetes during the first pregnancy, it could cause concern for a subsequent pregnancy.
  • A lack of physical activity may trigger gestational diabetes.
  • Genes play an important role–if an immediate family member has had gestational diabetes, one must be aware and watch for signs.
  •  If the baby delivered earlier weighed over 4 pounds or 4.1 kg, it is important to get tested for gestational diabetes during the subsequent pregnancy.
  • Premature delivery could also cause gestational diabetes during the next pregnancy phase.
  • If the mother has had a history of low blood sugar, that is one of the major risk factors.
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Who's at risk of gestational diabetes

Any pregnant woman can develop gestational diabetes symptoms, however, several factors put you at higher risk:

  • When you are obese which means your Body Mass Index (BMI) is equal to or greater than 30, this is one of the main causes of gestational diabetes.
  • If you have had gestational diabetes in your previous pregnancy or your previously born baby weighed 4.5 kgs or more.
  •  If you have a family history of diabetes.
  • If you are of South Asian, Black, African-Caribbean, or Middle Eastern descent.

If any of these above factors apply, the mother should get a screening done during the pregnancy for the timely detection and management of gestational diabetes.

Complications of Gestational Diabetes

High blood sugar (glucose) is a symptom of gestational diabetes, which normally goes away after delivery. Although it can occur at any time during pregnancy, it usually occurs in the second or third trimester. If gestational diabetes is not properly managed, it may cause certain complications for both mother and the baby.

Complications that may affect the baby

Unborn babies may become susceptible to the below complications in case you have gestational diabetes:

1. Premature Birth: Mothers with high sugar levels may run into the risk of having early labour and premature birthing.

2. Being overweight at the time of birth: If your blood sugar levels are elevated, it may cause the baby to put on excessive weight. This may cause interference during delivery, like being trapped in the birth canal causing birth injuries, or requiring a c-section.

3. Severe breathing problems:  Babies born prematurely may develop respiratory distress syndrome, which makes breathing challenging.

4. Stillborn: Mothers with untreated gestational diabetes are at a risk of stillbirth, where the baby may pass away either inside the womb or during birth.

5. Risk of type-2 diabetes: Babies may become obese, and are even at the risk of developing type-2 diabetes during the course of their lives.

Complications that may affect the mother

Additionally, gestational diabetes may put mothers at risk of:

1. preeclampsia: Gestational diabetes puts the mother at a risk to develop a critical pregnancy complication called preeclampsia which is characterised by high blood pressure, blurry vision, headaches, swelling, and protein in the urine.

2. C-section delivery: Gestational diabetes causes the baby to put on excessive weight, this reduces the likelihood of normal delivery, and the mother may rather head toward c-section.

3. Diabetes in the future: If a mother has been diagnosed with gestational diabetes, she runs into the risk of developing type 2 diabetes again as she ages.

How to Control Gestational Diabetes

The general preventive measures that can be taken to prevent and control gestational diabetes are to stay physically active. It is important to exercise regularly for overall health. Meals must not be skipped as insulin production is hampered. Before getting pregnant, it is helpful to consult the gynaecologist to understand if there are any risk factors involved and precautions that can be taken to avoid gestational diabetes. It is also important to take prenatal vitamins as prescribed to control the effect of hormonal changes and other risks. 

Ideally, blood sugar levels must be tested every year so that the onset of any kind of diabetes will ensure early detection, diagnosis, and treatment. Follow a balanced diet so that the body gets all the required nutrients in the right quantity. Regular physical activity goes a long way in preventing and controlling gestational diabetes. Activities such as using the stairs, brisk walking, basic exercises, and stretches help keep diabetes at bay. The doctor monitors the baby’s and mother’s health during the pregnancy to prevent complications. 

How Is Gestational Diabetes Diagnosed?

Doctors usually test for this condition at the end of the second trimester or the beginning of the third trimester (24 weeks to 28 weeks), and this is only if you are not at risk.

But if you are someone who has had a previous history of gestational diabetes, is obese, or has a family history of diabetes, then you are at a higher risk of developing this condition, and your doctor may do the screening early in the pregnancy.

One of the most common screening exams for gestational diabetes is:

  • Glucose Challenge Test: In this test, the patient is made to consume a syrupy glucose solution. After an hour the blood test is done to see the body’s response to sugar. According to medical sources, the normal blood glucose level is lower than 140 mg/dL and a blood sugar level of 190 mg/dL or more indicates gestational diabetes.
  • Follow-up Glucose Challenge Test: If your reports have come back with a higher value in the first test, then you will have to undergo the follow-up test. This is also conducted in a similar fashion, where the patient is made to drink a sweeter glucose solution, and then the blood sugar levels are recorded on an hourly basis for three hours.

You will be diagnosed with gestational diabetes if two of these blood tests reveal high blood sugar levels.

Treatment for Gestational Diabetes

Gestational diabetes can be managed with lifestyle changes and some oral medications.

1. Switch to healthy eating: A balanced diet is an integral part of controlling gestational diabetes. Mothers are recommended to opt for food items that have carbohydrates that are more slowly absorbed and less likely to induce a spike in blood sugar. The diet should be balanced with the right amount of fats, carbohydrates, proteins, fibre, vitamins and minerals.

2. Physical activity: Staying physically active is another good way to control gestational diabetes. However, the intensity of your workout should be first discussed with the doctor. Usually, it’s recommended to go on short walks immediately after meals to control the spike in blood sugar levels.  

3. Take medicine regularly: Many times medication is required to control gestational diabetes, lifestyle changes alone don’t help. Your doctor will continue to monitor your blood glucose levels, and if it continues to remain elevated, they may prescribe pregnancy-safe insulin shots or oral medication. The patient must take these medications regularly without missing a dose to keep gestational diabetes in check. 

Nutritional Recommendations For Gestational Diabetes

A balanced diet plays an important role in preventing and controlling all kinds of diabetes. In many cases, gestational diabetes can be controlled with just a proper diet and without medication. Each case of gestational diabetes is unique–some may require medication while some do not. By consuming a balanced diet, blood sugar levels can be checked. When the meal contains the right quantity of carbohydrate and sugar components, blood sugar levels can be easily regulated. Check with a dietician to get a personalized meal plan for best results. 

What to Eat with Gestational Diabetes

What to eat with gestational diabetes is very important to know when you are trying to control gestational diabetes. Here are a few things you should include in your diet.

  • Lean proteins: Lean proteins are the major components required for muscle growth and development of the baby. Lean proteins include lean meats such as chicken, fish, turkey, eggs, and low-fat dairy products. It is important to have proteins with every meal during the day, but the majority of the protein allowance should be consumed with breakfast. It can be helpful to reduce and prevent morning sickness. 
  • Non Starchy vegetables: Non Starchy vegetables are rich in micronutrients, fibre, and roughage. They are also called “freebie foods'' as they satiate hunger without adding much to the calorie count. Some non starchy vegetables are broccoli, cucumber, green beans, onions, peppers, and green salads. 
  • Healthy fats: avocado, nuts, seeds, olive oil, nut butter, etc. 
  • Complex carbohydrates: Beans, whole-wheat bread, berries, sweet potato, brown rice, and yoghurt. 
  • It is best to avoid sugary beverages and processed foods.

Food Items To Limit

Certain food items caused a sudden spike in the blood glucose level, and these should be limited in the gestational diabetes diet. Let’s take a look at these.

  • Items like cake, pastries, candies, cookies, pudding, sweets and other bakery products should be avoided by pregnant mothers with gestational diabetes. These refined and processed food items are high in sugar, fats and empty calories. It can spike blood sugar levels very quickly, and can also become a cause of weight gain.
  • Avoid intaking sugary sodas, and canned fruit juices, as these again have added sugar. If you want to have juice, make it from fresh fruit without adding any sugar. It’s recommended to have whole fruit over juice to consume the maximum fibre content. 
  • Limit the consumption of starchy food items like white bread, pasta, white potatoes, white rice etc.. because they have high content of carbohydrates which may impact your blood sugar levels. Instead switch to sweet potatoes, whole grain bread, and red rice that too in controlled portions.
  • Avoid unhealthy and fried snacks like mixtures, and bhujia. The best snacks for gestational diabetes would be roasted dry fruits like almonds, walnuts and seeds.
  • Consuming fruits and milk in moderation is recommended for mothers with gestational diabetes as these are rich in natural sugar.

Tips for healthy eating with gestational diabetes

  • It’s a good idea to replace white rice with whole grains and millet like finger millet (ragi), pearl millet (bajra), sorghum (jowar), foxtail millet (kangni) in your diet. Whole grains and millets have lower GI and release glucose in the bloodstream slowly and steadily.
  • Fruits in general are packed with antioxidants, vitamins, minerals and fibre. However, they are a good source of natural sugar too. Mothers with gestational diabetes should pick fruits that have low GI and GL like apples, guava, papaya, and pear to name a few. Fruits like bananas and mangos should be consumed in a very limited and controlled portion.
  • Cook your food in ghee or coconut oil rather than regular cooking oil. Both ghee and coconut oil have saturated fats, which are more stable and less easily oxidised during cooking, it makes a better choice over vegetable oil. These also should be consumed in a limited quantity of just 2-3 teaspoons every days.
  • Eat regular, small, frequent meals, and don’t try to skip meals. Leaving long gaps between meals or not eating can make your blood glucose levels unstable.
  • Avoid consuming food items that have simple sugars, like flavoured tea, fizzy drinks, and desserts. These can spike your blood sugar level easily.
  • You can once in a while substitute roti with brown rice.
  • Don’t completely avoid any specific food groups which are generally done in fad diets like keto, GM. Have a healthy, well-balanced and wholesome meal for a healthy pregnancy.

Sample diet plan for gestational diabetes

Your gestational diabetes diet plan needs careful attention and it should be balanced with all the essential food components. Having said that, this doesn’t mean that your meals have to be bland. Even with gestational diabetes, you can enjoy your favourite food, but in controlled portions and moderation.

Let’s take a look at a sample gestational diabetes Indian diet plan for both vegetarians and non-vegetarians.

Gestational diabetes diet plan : Vegetarian

Time Menu
Early morning (between 6 am – 7 am) -          1 cup of regular tea/green tea -          Roasted seeds such as watermelon (tarbooj), cucumber (kheera) and sesame (til) (approx. 25gm)
Breakfast (between 8am - 9am) -          2 slices of wholegrain bread (toasted). -          Bowl of fresh cottage cheese (paneer) (approx. 50gm) with green chutney.
Mid-morning (11 am) -          1 medium-sized seasonal fruit (approx.150 gm).. -          1 glass spiced buttermilk (chhaach).
Lunch (between 1 pm - 1.30 pm) -          Carrot (gajar) and lettuce (salad patta) salad. -          1 large bowl of stir-fried okra (bhindi) -          1 bowl of dal with fenugreek (methi) leaves. -          1 cup tomato (tamatar) raita. -          2 medium-sized millet rotis.
Evening (4 pm) -          Limeade (nimbu pani).
Evening snack (6 pm) -          Upma with peanuts (moongphali).
Dinner (8 pm-8.30 pm) -          Green leafy vegetables and dal. -          1 bowl of mixed vegetables. -          1 katori soya nuggets curry. -          2 rotis.
Bedtime -          1 cup low-fat milk.

Gestational diabetes diet plan: non-vegetarian

Time Menu
Early morning (between 6 am – 7 am) -          1 cup of regular tea/green tea -          Roasted seeds such as watermelon (tarbooj), cucumber (kheera) and sesame (til) (approx. 25gm)
Breakfast (between 8am - 9am) 2 slices of wholegrain bread (toasted). -          Egg bhurji (1 egg) with green chutney.
Mid-morning (11 am) -          1 medium-sized seasonal fruit (approx.150 gm). -          1 glass spiced buttermilk (chhaach).
Lunch (between 1 pm - 1.30 pm) -          Carrot (gajar) and lettuce (salad patta) salad. -          1 large bowl of stir-fried okra (bhindi). - Chicken (75 g) with fenugreek (methi) seeds. -  1 cup tomato (tamatar) raita. -          2 medium-sized millet rotis.
Evening (4 pm) -          Limeade (nimbu pani).
Evening snack (6 pm) -          A bowl of boiled corn (makka)
Dinner (8 pm-8.30 pm) -          Green leafy vegetables and dal. -  Sautéed seasonal vegetables. -          Mint (pudina) raita -          2 rotis.
Bedtime -          1 cup low-fat milk.

How to prevent Gestational Diabetes?

Just like other diabetes types, gestational diabetes also affects how the cells in the body use glucose. High blood sugar levels brought on by gestational diabetes can harm both the mother's and the unborn child's health.

While it is not possible to guarantee that a woman can’t develop gestational diabetes, it can be prevented by adopting certain lifestyle changes.

  • Eating healthy: Eating healthy is definitely number one on the list. Avoid eating junk and switch to food items that are fiber-rich, and low in calories. Add abundant veggies, fruits, and protein-rich food items to the meal plan. Remember to drink enough water. If you consume alcohol, then you must totally stop it.
  • Exercise daily: Staying active, and regularly exercising can help you avoid getting gestational diabetes before, during, and after pregnancy. Try to include a half-hour of moderate exercise in your daily routine. It could be a simple evening walk, dancing to your favourite song, or taking a bike ride. Apart from this, try to stay active throughout the day. Walking your dog, and parking your car far away from the grocery store, are some easy ways to keep you on your feet.
  • Achieve healthy weight before pregnancy: Concentrate on implementing long-lasting dietary and lifestyle adjustments that will help you lose those extra pounds before you start planning a pregnancy. When you start your pregnancy at a healthy weight the chance of developing gestational diabetes becomes significantly lower.

When to see a doctor

If at all feasible, seek medical attention as soon as you begin to consider attempting to conceive so that your doctor can assess both your general health and your risk of gestational diabetes. Once you become pregnant, your doctor will continue to monitor your blood sugar levels as part of the prenatal checkups.

Bottomline

Gestational diabetes is a common occurrence during pregnancy. In any kind of diabetes, the body’s ability to produce insulin is hampered, thus producing lower insulin levels. The pancreas is responsible for producing insulin. Insulin plays a crucial role in allowing blood sugar to enter cells and tissues to produce energy for functional activities. There are various risk factors involved. The most common risk factors are obesity, prior diabetic symptoms, physical inactivity, etc. Being active, exercising frequently, and having a balanced gestational diet help prevent and control gestational diabetes. Consume a balanced diet rich in lean proteins, non starchy vegetables, healthy fats, complex carbohydrates. Also read how diabetes insipidus causes.

In general, you should eat:

  • Consume lot of whole fruits and vegetables
  • Include of lean proteins and healthy fats in your diet
  • Considerable amounts of whole grains, such as bread, cereal, pasta, and rice, plus starchy vegetables, such as corn and peas
  • Limit consumption of foods that have a lot of sugar, such as soft drinks, fruit juices, and pastries

FAQs

What triggers gestational diabetes?

When a woman is pregnant her body undergoes many physical, emotional, and hormonal changes. The changes in hormones cause weight gain. This triggers disruption in the insulin production of the body. As Insulin has an important role in producing energy in the body, due to an increased weight sufficient the produced insulin of the body is not sufficient eventually leading to insulin resistance that triggers gestational diabetes. 

How will gestational diabetes affect the baby?

Having fluctuating blood sugar levels due to gestational diabetes can make your pregnancy risky. If your blood sugar levels are high during your pregnancy then due to low insulin levels the pancreas works extra to meet the insulin requirement of the body. This causes the increased glucose levels to reach the baby through the placenta which results in the baby receiving energy that is more than required. Eventually, the extra energy is stored as fat which results in the baby being born overweight. Such babies are prone to macrosomia, breathing problems, obesity in adulthood, etc.  

Can you have a healthy baby with gestational diabetes? 

 If a woman with gestational diabetes manages to control her sugar levels then there are higher chances that she will experience healthy childbirth. For having a healthy baby irrespective of getting diagnosed with gestational diabetes, a woman needs to be psychically active and follow a strict diet. It is okay for a woman with gestational diabetes to have multiple meals instead of having everything at once which causes blood sugar levels to spike. Sticking to a proper routine and diet can make your baby a healthy one irrespective of gestational diabetes.

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