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Monday, September 20, 2021

Why soon-to-be-mothers should take gestational diabetes seriously

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A 2018 study showed the overall prevalence of GDM among 2000 participants was 21.5%— so here’s how to keep yourself safe

Gestational diabetes mellitus (GDM) is a medical condition where blood glucose levels become too high during pregnancy. Generally, GDM does not occur until the later stages of the pregnancy, when the placenta begins producing more of the hormones that interfere with the levels of insulin in the mother’s body.

As such, screening for GDM is typically scheduled later on during the course of the pregnancy. However, in some cases, when women are considered “high risk”, they are likely to be tested for GDM much earlier in the pregnancy. 

It is estimated that GDM affects between 7-10% of all pregnant women worldwide. However, this is largely dependent on the associated risk factors of any given population such as maternal age, prevalence of diabetes, obesity, and ethnicity. The Middle East and North Africa region have the highest prevalence of GDM in the world that ranges between 8.4- 24.5%, with a median estimate of 12.9%.

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In Qatar, according to a study published in 2018, the overall prevalence of GDM among 2000 participants in the study was 21.5%. This was similar amongst different ethnic groups.  

What causes gestational diabetes?

GDM, like other types of diabetes, makes a person resistant to insulin. Although the mother’s body still produces insulin, that insulin becomes less effective at reducing the body’s blood sugar levels.

Scientists don’t yet know why some women get GDM whilst others don’t, although several factors related to body weight and lifestyle often play a role.

During pregnancy, hormones released by the placenta begin to interfere with insulin’s ability to store glucose in fat and muscle cells. As a result, the level of glucose in the blood rises.

To some extent, all pregnant women experience some insulin resistance during pregnancy. Whilst in most cases they are able to produce additional insulin to compensate for insulin resistance, in the case of women with GDM, they do not produce enough to overcome this state.

How is GDM diagnosed?

Physicians will generally test for GDM between the 24th and 28th week of pregnancy. This is done through blood tests to measure the blood glucose levels. The tests may involve either a one or two step glucose tolerance test. 

For the one-step glucose tolerance test, the individual is required to fast overnight before the blood test the next morning in order to get a baseline reading. The pregnant mother is then given a drink that contains a high level of glucose, and blood is drawn again an hour later, and a third time an hour after that.

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The two-step glucose tolerance test does not require fasting overnight. Instead, the individual consumes a concentrated glucose drink, and the doctor draws blood an hour later.

Should the reading be abnormal, then the person might need to do a 3-hour glucose tolerance test that requires fasting, drinking a high-glucose dose drink, and having their blood tested every hour for three hours after the dose.

What precautions are women with GDM supposed to take?

Managing blood glucose levels is the main goal of the treatments for GDM. While this is usually achieved through changes in lifestyle (physical activity and diet), in some cases when these changes are ineffective, doctors may prescribe medications to keep the mother’s blood glucose levels under control. These could include insulin. 

Typically, women diagnosed with GDM, will be asked to monitor their blood glucose levels throughout pregnancy. If the mother is prescribed insulin, she may need to measure blood glucose levels more frequently in order to ensure the prescribed dose is effective and remains to be throughout the pregnancy.

GDM that is not carefully monitored and managed can result in high blood sugars. This can cause problems for both the mother and baby. Therefore, it is extremely important to take GDM seriously and follow the treatment plan recommended by your physician.

What are the consequences of unmanaged GDM?

GDM can have a negative impact on both the baby and the expecting mother. 

Women with GDM may also be at an increased risk of:

  • High blood pressure and preeclampsia
  • Delivering through C-section
  • Having diabetes again in a future pregnancy, as well as a higher risk of type 2 diabetes later on in life.

In addition, babies with mothers who have GDM are at a higher risk for:

  • Excessive birth weight
  • Early (preterm) birth
  • Serious breathing difficulties
  • Low blood sugar (hypoglycemia)
  • Obesity and type 2 diabetes later in life
  • Stillbirth

What makes you a high risk for GDM?

Being overweight or obese is a risk factor for gestational diabetes. If a woman gains too much weight during her pregnancy, she also increases her risk for GDM later on in her pregnancy. 

Other risk factors for GDM include:

  • Family history of diabetes 
  • Having a baby at or after the age of 25
  • Being pre-diabetic
  • Previously giving birth to a baby that was 4 kilos or more
  • Having GDM in previous pregnancies increases your risk for GDM in coming pregnancies
  • Having polycystic ovarian syndrome

What are some healthy habits that can help prevent GDM or reduce the risk of it occurring again in future pregnancies?

  • Eating healthy. Monitoring your diet and choosing foods that are high in fiber content and low in fat and calories is key. The focus should be on vegetables, whole grains and fruits that are low in sugar. Eating a variety of foods is also recommended so that nutrition and taste are not compromised. 
  • Remain physically active unless advised otherwise. Exercising before and throughout the pregnancy helps protect against GDM. Engaging in 30 minutes of moderate activity on most days of the week is extremely effective in keeping you healthy throughout the course of your pregnancy. Walking, biking, swimming and yoga are all great activities to help keep the body active. 
  • Starting pregnancy at a healthy weight and gaining weight at the recommended pace for your body during pregnancy. If you are planning a pregnancy and are overweight, it may help to lose the extra weight beforehand if possible. This will help make for a healthier overall pregnancy. This weight management and change in diet and lifestyle should be maintained throughout the pregnancy, as gaining too much weight too quickly increases your risk for GDM. It is important to consult with your doctor on the amount of weight gain that is considered reasonable for you and your body.

Maha El Akoum, MPH, is a public health professional currently working as Head of Content at World Innovation Summit for Health [WISH]. 


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