Diagnosis of Gestational Diabetes
All pregnant women should be routinely screened for gestational diabetes between 24 and 28 weeks of pregnancy. If you fall in the high-risk category for developing diabetes during pregnancy, you will need to be tested for diabetes as soon as you become pregnant and later again at 24 to 28 weeks.
An oral glucose tolerance test involves drinking 50g of glucose solution and your blood sugar is tested after one hour. If screening is positive, you will need to take another glucose tolerance test. This will be done after you have been advised to take an unlimited carbohydrate diet for 3 days, overnight fasting, and resting for 30 minutes before the test.
Risk Factors
You may be more likely to develop gestational diabetes if you have one or more of these risk factors.
- Over 25 years.
- Obese.
- Family history of diabetes.
- Had gestational diabetes in previous pregnancies.
- Had a ‘big’ baby in your previous pregnancy.
- Have previously given birth to a stillborn baby.
- Fall under certain ethnic groups such as Native American, African American, Asian or Hispanic.
Complications of Diabetes in Pregnancy
Although many pregnant women with gestational diabetes do not have any complications, other cases of gestational diabetes may result in serious complications for both mother and child.
Risk to the Baby
- Increased risk of miscarriage.
- Enhanced rates of congenital malformations (birth defects).
- Large baby, with additional risk of birth injuries, obstructed labor or Cesarean section.
- Pre-term delivery, resulting in a premature baby.
- Respiratory (breathing) difficulties.
- Congestive heart failure.
- Low birth weight.
- Jaundice in the newborn.
- Child can develop hypoglycemia soon after birth.
- Increased risk of stillbirth.
- Greater chance of the baby developing diabetes in later life.
- Risk of obesity as the child grows.
Risks to the Mother
- Risk of developing gestational diabetes in future pregnancies.
- Chances of developing diabetes in later life.
- Birth canal injuries and obstructed labor due to big baby.
- More likely to have a Cesarean section.
- Polyhydramnios (excessive amniotic fluid).
- May increase risk of developing pre-eclampsia.
- Frequent UTI.
Treatment and Management of Diabetes in Pregnancy
Blood sugar control is very important during pregnancy to avoid complications for you and your baby.
- Regular blood sugar monitoring (including home glucose monitoring before each meal) is absolutely necessary throughout pregnancy.
- Diet and exercise.
- Controlling hypertension and obesity.
- Insulin injections – if diet and exercise does not reduce the blood sugar level adequately.
- Avoiding hypoglycemia if on insulin – taking meals on time and in the right quantity.
- Oral hypoglycemic drugs are not used as they can pass through the placenta and may harm the baby.
- Ultrasonography to monitor fetal growth and well-being.
- Regular antenatal checkups.
Women with pregestational diabetes have much to gain if they can maintain a normal blood glucose level before, at the time of conception and during pregnancy. They should pre-plan their pregnancy. Avoiding smoking from the time the pregnancy (Cigarette Smoking in Pregnancy) is planned and folic acid supplements from 3 months before conception can help reduce some of the risks during pregnancy.
Lifestyle alterations can delay or prevent risk of developing diabetes in the future.
