Gestational Diabetes is a condition in which a woman without diabetes develops high blood sugar levels during pregnancy. Gestational diabetes generally results in few symptoms, however, it does increase the risk of pre-eclampsia, depression and requiring a Cesarean section. Babies born to mothers with poorly treated gestational diabetes are at increased risk of being too large, having low blood sugar after birth, and jaundice. If untreated, it can also result in a stillbirth. Long term, children are at higher risk of being overweight and developing diabetes type 2.
Gestational diabetes is caused by not enough insulin in the setting of insulin resistance. Risk factors include being overweight, previously having gestational diabetes, a family history of diabetes type 2, and having polycystic ovary syndrome. Diagnosis is by blood test. For those at normal risk screening is recommended between 24 and 28 weeks gestation. For those at high risk testing may occur at the first prenatal visit.
Prevention is by maintaining a healthy weight and exercising before pregnancy. Gestational diabetes is a treated with a diabetic diet, exercise and insulin injections. Most woman are able to manage their blood sugar with a diet and exercise. Blood sugar testing among those who are affected is often recommended four times a day. Breastfeeding is recommended as soon as possible after birth.
Gestational diabetes affects 3-9% of pregnancies, depending on the population studied. It is especially common during the last three months of pregnancy. It effects 1% of those under the age of 20 and 13% of those over the age of 44. A number of ethnic including Asians, American, Indians, Indigenous Australians and Pacific Islanders are at higher risk. In 90% of people with gestational diabetes will resolve after the baby is born. Women are at an increased risk of developing diabetes type 2.
Classical risk factors for gestational diabetes are:
1. Polycystic Ovary Syndrome
2. A previous diagnosis of gestational diabetes or pre-diabetes, impaired glucose tolerance, or impaired fasting glycemia.
3. Family history revealing a first-degree relative with diabetes type 2.
4. Age, a woman’s risk factor increases as she gets older (especially for women over 35 years of age).
5. Ethnicity (those with higher risk factors include African-Americans, Afro-Caribbeans, Native Americans, Hispanics, Pacific Islanders and people originated from South Asia).
6. Being overweight, obese or severely obese increases the risk of gestational diabetes
7. A previous pregnancy which resulted in a child with a macrosomia
8. Previous poor obstetric history.
9. Other genetic risk factors: There are at least 10 genes where certain polymorphism are associated with an increased risk of gestational diabetes.