Gestational diabetes - Pregnancy Complications

Gestational diabetes mellitus occurs with the onset of pregnancy and is characterized by the inability of the pregnant patient to tolerate glucose. Patients who develop gestational diabetes may develop diabetes later in life.

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However, gestational diabetes often resolves after delivery. The cause of gestational diabetes is largely unknown. However, it is believed that as the fetus grows, glucose demands increase for the pregnant patient. In addition, the “insulin-antagonistic” properties of placental hormones affect the patient by causing insulin resistance.

As a result, the pregnant patient is unable to process glucose in the body and hyperglycemia occurs.

Incidence and Risk Factors

According to the American Diabetes Association (2013), gestational diabetes affects 18% of pregnancies. Factors that place patients at risk for developing gestational diabetes mellitus include:

Maternal obesity
Advanced maternal age
Member of a minority population
GDM in previous pregnancies
Presence of glycosuria
History of a macrosomic infant(s) (birthweight>4500 g)
History of spontaneous abortion or fetal demise
Family history of diabetes mellitus or GDM.

Symptoms of gestational diabetes

Gestational diabetes often doesn’t cause any symptoms. This means you may be screened for the condition at your first antenatal appointment by a venous glucose sample, at around weeks 8-12 of pregnancy. If women are at increased risk of gestational diabetes they will be offered a full test, which takes place during weeks 24-28 of pregnancy.

High blood glucose (hyperglycaemia) can cause some symptoms, including:

a dry mouth with increased thirst
needing to urinate frequently, especially at night
tiredness
recurrent infections, such as thrush (a yeast infection)
blurred vision.

Diagnosis

Screening identifies otherwise healthy people who may be at increased risk of a condition, such as diabetes.

a) Screening

Women may be screened for gestational diabetes at first antenatal appointment with doctor which takes place around weeks 8-12 of pregnancy. At this time, doctor will find out if women are at increased risk of gestational diabetes. They will ask about any known risk factors for gestational diabetes, such as whether they have a family history of diabetes. This may also include a glucose tolerance test (GTT).

b) Glucose tolerance test (GTT)

A GTT takes place during weeks 24-28 of pregnancy. This involves a morning blood test, before you have eaten breakfast. If women had gestational diabetes in a previous pregnancy, the GTT will be carried out at weeks 16-18 of pregnancy – or sooner, if indicated by the first blood glucose sample.

Medical Treatment

Pregnant patients are routinely screened for gestational diabetes mellitus between 24 and 29 weeks’ gestation. In order to diagnose gestational diabetes, patients drink 50 grams of oral glucose solution.

After one hour, a blood sample is obtained and tested for glucose tolerance. A glucose level of 140 mg/dL or higher is considered a positive screen and further investigation is warranted. A 3-hour glucose tolerance test is then typically performed.

Most patients with gestational diabetes are treated through diet. They are encouraged to consume a proper diet and obtain adequate exercise. Patients with gestational diabetes should consume a diet that provides 30 kcal/kg/day.

Furthermore, patients with a body mass index greater than 30 kg/m2 may benefit from a 30%–33% caloric restriction.Besides proper diet and exercise, some patients may require insulin or oral hypoglycemia agents to manage gestational diabetes mellitus. Resistance exercise can help overweight patients with gestational diabetes avoid insulin therapy.

Complications of gestational diabetes

Most women with gestational diabetes go on to have normal pregnancies with healthy babies.
The risk of complications is reduced if gestational diabetes is diagnosed and managed properly throughout pregnancy.
This involves monitoring and controlling the level of glucose in blood during pregnancy.

Maternal and Fetal Complications

A variety of maternal and fetal complications are associated with gestational diabetes mellitus. Patients have a significant chance of delivering via cesarean section due to the large size of infants born to patients with gestational diabetes.

Patients also have an increased frequency of hypertension. Infants born to patients with gestational diabetes mellitus are usually macrosomic (birthweight>4.5 kg). This occurs due to fetal hyperinsulinemia as a result of maternal hyperglycemia, which stimulates excessive growth. These large infants may have difficulty maneuvering the birth canal, and a cesarean section may be required.

If vaginal delivery is attempted, the infant is at risk for shoulder dystocia or other birth injuries. After delivery, the newborn infant’s blood glucose must be monitored regularly due to the sharp decrease in available glucose after the umbilical cord is cut.

The newborn’s pancreas continues to produce insulin after delivery despite the decrease in serum glucose. This adds to the potential instability of the infant’s blood glucose. Infants are also at risk for hypocalcemia, hyperbilirubinemia, and respiratory distress syndrome as a result of gestational diabetes.

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