Understanding Gestational Diabetes

Receiving a diagnosis of gestational diabetes during pregnancy can be concerning, but it’s important to remember that this condition is common and often manageable. Far from being caused by eating too much sugar, gestational diabetes occurs when your body struggles to regulate blood sugar levels effectively during pregnancy. Pharmacist Zeinab Ardeshir from PillSorted explains the science behind this condition, including why it happens, how it’s screened, and practical steps to manage it for a healthier pregnancy journey for both mother and baby.

What is Gestational Diabetes?

Gestational diabetes is a condition where blood sugar levels become too high during pregnancy. It typically develops around the second or third trimester. The primary cause isn’t what you eat directly, but rather the crucial role of a new organ in your body: the placenta.

The placenta is responsible for nourishing your baby, providing a steady and regular supply of energy and glucose. To achieve this, the placenta produces hormones that cause a natural process called insulin resistance in the mother’s body. Insulin is a hormone produced by the pancreas that helps move glucose (sugar) from your bloodstream into your cells for energy. During pregnancy, these placental hormones essentially block the mother’s insulin, making more glucose available for the growing baby.

However, if the mother’s pancreas cannot produce enough extra insulin to overcome this resistance, or if there’s a significant spike in sugar levels, then too much sugar will remain in the mother’s bloodstream. This excess sugar can pose risks for both the mother and the baby.

Risk Factors for Gestational Diabetes

While gestational diabetes can affect anyone, certain factors can increase your susceptibility. Healthcare professionals will often monitor you more carefully if you have any of the following risk factors:

• Family History of Diabetes: If there’s a history of diabetes in your family, you may have a higher genetic predisposition.
• Previous Gestational Diabetes: If you experienced gestational diabetes in a prior pregnancy, your risk of developing it again is significantly higher.
• Higher Body Mass Index (BMI): Being overweight or having obesity before or during pregnancy increases insulin resistance, making it harder for your body to regulate blood sugar.
• Pre-existing Insulin Resistance: Conditions like Polycystic Ovary Syndrome (PCOS) already involve insulin resistance, which can increase the likelihood of gestational diabetes.
• Ethnicity: Women of South Asian, Black Caribbean, or Middle Eastern descent have a higher risk.
• Age: Being over 35 years old.

If you have any of these risk factors, your healthcare team will likely discuss monitoring strategies with you as part of your comprehensive women’s health care plan.

Screening for Gestational Diabetes

The primary screening test for gestational diabetes in the UK is the Oral Glucose Tolerance Test (OGTT), usually performed between weeks 24 and 28 of pregnancy. The test helps your healthcare provider understand how your body handles glucose.

Here’s how the OGTT typically works:

1. Fasting Blood Sample: You’ll be asked to fast for 8 to 12 hours (usually overnight) before the test. A blood sample is taken to measure your baseline fasting glucose level.
2. Sugary Drink: You’ll then drink a specific glucose solution.
3. Follow-up Blood Samples: Blood samples are taken again at one and/or two-hour intervals after you finish the drink to see how your body processes the sugar.

The goal is to observe how much your glucose levels spike. For a healthy pregnancy, healthcare professionals generally look for a fasting glucose level of less than 5.6 mmol/L, with levels one hour after the glucose drink of less than 10.0 mmol/L and two hours after of less than 8.5 mmol/L. If your blood sugar levels consistently go higher than these targets, it can be a sign of gestational diabetes, and further management will be discussed.

Why Managing Gestational Diabetes Matters

Maintaining steady blood sugar levels throughout your pregnancy is incredibly important for your baby’s healthy growth and development. Consistently high blood sugar levels can be dangerous for both you and your baby. For the baby, it can lead to excessive growth (macrosomia), increasing the risk of difficult birth, premature birth, and breathing problems. For the mother, there’s an increased risk of pre-eclampsia and future development of type 2 diabetes.

The good news is that gestational diabetes is often very manageable. By taking proactive steps, you can significantly reduce these risks and ensure the best possible outcome for your pregnancy.

Practical Steps to Manage Gestational Diabetes

Managing gestational diabetes often involves a combination of lifestyle adjustments. Here are three key practical steps you can take:

1. Measure Your Blood Glucose Regularly: Your healthcare team will likely provide you with a device to check your blood sugar levels. Regular monitoring, typically early in the morning when you wake up and after meals, helps you and your care team understand how different foods and activities affect your blood sugar throughout the day. This information is crucial for making informed dietary and lifestyle choices.
2. Pair Carbohydrates with Protein and Fibre: This is one of the most important dietary strategies. When you consume carbohydrates, pairing them with protein or fibre helps slow down the absorption of glucose into your bloodstream, preventing sharp spikes. For example:
   • Have banana with peanut butter.
   • Pair yoghurts with berries.
   • Eat oatcakes with cheese.

   Another helpful tip is to try and eat your carbohydrates towards the end of your meal. So, if you’re having a main meal, eat your vegetables and protein first, then consume your rice, pasta, or bread.

3. Keep Moving: Regular physical activity plays a vital role in regulating blood sugar levels. Even just 10-15 minutes of movement after meals can make a significant difference. This doesn’t mean strenuous exercise; gentle walks, pregnancy yoga, or light resistance exercises (always consult your doctor or midwife before starting any new exercise routine during pregnancy) can all be beneficial. Incorporating healthy living habits like regular movement is not only good for managing gestational diabetes but also for your overall general health during pregnancy.

Life After Gestational Diabetes

For most women, gestational diabetes resolves once the baby is born and the placenta is delivered. After labour, your blood sugar levels usually return to normal as your body’s hormone balance shifts back. However, having gestational diabetes does mean you have an increased risk of developing type 2 diabetes later in life.

Therefore, it’s a good idea to continue monitoring your blood sugars periodically, especially around 6 to 12 weeks after birth, and then every couple of months as advised by your doctor. This helps to ensure your blood sugar levels are returning to normal and allows for early detection if type 2 diabetes begins to develop. Your healthcare provider can guide you on long-term monitoring and preventative measures, including maintaining a healthy weight and staying active, to reduce your risk.

Disclaimer: This blog post is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before making changes to your health routine.