Gestational diabetes mellitus (GDM) is a condition of abnormally raised blood sugar levels that may occur in the second part of the pregnancy and goes away once the baby is born.
Some women with gestational diabetes may need no treatment, some need a strict diet and others may need insulin injections.
Testing for gestational diabetes
All women are screened for gestational diabetes at their 24 to 28 week routine check up. Women who are at higher risk may be tested more often. You are at higher risk of developing gestational diabetes if you:
• are overweight
• over the age of 25 years
• a family history of type 2 diabetes
• come from an Aboriginal and Torres Strait Islander or some Asian backgrounds
• have had gestational diabetes before
• have previously had polycystic ovary syndrome
• have had a large baby before.
Who Gets Gestational Diabetes, And Why Do I Have To Be Tested?
Approximately 2-5% of pregnant women develop gestational diabetes; this number may increase to 7-9% of mothers who are more likely to have risk factors. The screening for this disease usually takes place between your 24th and 28th week of pregnancy.
Doctors test for gestational diabetes during this time because the placenta is producing large amounts of hormones that may cause insulin resistance. If the results indicate elevated levels, further testing would be done to confirm a gestational diabetes diagnosis.
The tests available for gestational diabetes are:
Glucose challenge test
There is no fasting required and you are given a 50g glucose drink (equivalent to 10 teaspoons of sugar) with a blood test taken one hour after. This is a screening test only and if the result is above a certain level, you will be advised to have a glucose tolerance test.
Glucose tolerance test
This is a diagnostic test. It requires fasting for 10 hours (generally overnight, missing breakfast). A blood test is taken, followed by a 75g glucose drink and further blood tests at one and two hours later. You will be required to remain at the laboratory for the two-hour duration of the test.
Treatment for gestational diabetes
A healthy low-fat, low-sugar diet and regular exercise, such as walking or swimming, can help reduce blood sugar levels.
A nutritionist may be helpful in designing a meal plan that takes into account individual schedules and preferences.
Eating a variety of foods is recommended, and it is better to eat smaller portions throughout the day (e.g. 3 small to moderate meals and 2-4 snacks) rather than just a few large meals.
Many women with gestational diabetes will be advised to eat fewer carbohydrates than in their normal diet and to eat complex carbohydrates that contain fiber. It’s important to limit consumption of foods containing large amounts of simple sugars.
High-fiber foods like fresh fruits and vegetables, as well as whole-grain products, are not only nutritious but also effective in keeping blood sugar levels stable.
Skipping meals is not recommended because this leads to undesirable fluctuations in blood sugar levels.
You may be referred to an obstetrician and dietitian and may need more frequent antenatal appointments and regular monitoring of your blood sugar levels. If your blood sugar levels remain high despite changes to your diet and an exercise regime, then medication, usually in the form of insulin, will be recommended to lower the blood sugar levels into the normal range.
Is There Anything I Should Be Afraid Of?
If gestational diabetes is diagnosed and treated effectively, there is little risk of complications. In such cases, women with gestational diabetes can have healthy babies, and the diabetes should disappear after delivery.
However, if gestational diabetes is not treated, effects on the mother and baby can include:
• Large birth weight
• Premature delivery
• Increased chance of cesarean delivery
• Slightly increased risk of fetal and neonatal death
Can gestational diabetes be prevented?
Gestational diabetes cannot always be prevented; however, obesity is a prime determinant for developing the disease. Maintaining a healthy weight and following a good nutritional plan both before and during pregnancy can decrease your chances of developing gestational diabetes. Maintaining a healthy weight can also decrease your chances of developing type 2 diabetes following pregnancy.
Does Exercise and Physiotherapy help during Gestational Diabetes?
It is necessary for pregnant women to be cognizant of both their diet and physical activity.
Aim for 30 minutes of activity: How much exercise is necessary to reap all the benefits? For women who were inactive before pregnancy, starting with 15 minutes of continuous exercise three times a week, gradually increasing to 30-minute sessions four days a week is recommended. (Always check with your doctor before starting any workout program.)
If you’re having a rough first trimester—with extreme fatigue, nausea or vomiting—you may want to wait until the second trimester to start a workout routine. Highly fit women needn’t reduce how much they exercise during pregnancy, but they should listen to their bodies and stick with what’s comfortable.
How hard should you push yourself during pregnancy? Not too hard! Experts agree that the “talk test” is a good gauge for how tough your workout should be: “If you can carry on a conversation, that’s fine,”. If you’re too winded to chat, take it down a notch.
Safety comes first: Obviously, pregnancy isn’t the time for activities that carry a high risk of falling, such as skiing or in-line skating. But there’s no shortage of safe aerobic activities during pregnancy, including walking, the elliptical trainer and swimming. If you’re a runner, jogging is OK if you feel up to it, but most runners switch to walking at some point because the pounding takes a toll on their hips, knees and feet.
Little research has been conducted on prenatal strength training, but experts believe it’s safe and beneficial, as long as you don’t overexert yourself. Pilates and yoga are also excellent ways to maintain your muscle tone during pregnancy.
Though the importance of prenatal exercise is well known among researchers, even some OB-GYNs are still unaware of all the benefits, and there’s a good bet the word hasn’t trickled down to your mom 😅 So if you hear comments like “Stop! You’re going to boil your baby!” rest assured that you’re doing what’s best for both of you.
Written and compiled by
Dr Divya Gaur
Senior Physio
Physioheal Clinics