What is Gestational Diabetes?
It is a form of diabetes that occurs during pregnancy, usually in the second trimester. It is characterized by elevated blood sugar levels and usually the levels return to normal levels after delivery.
What are the causes?
Insulin is a hormone produced by the β-cells of the pancreas, with the main action of transporting glucose into the cells in order to regulate euglycemia (normal blood glucose). Diabetes therefore occurs when the body cannot effectively use the insulin that is produced or the insulin that is produced is not sufficient for the body’s needs. During pregnancy, the placenta produces hormones that help the fetus grow. However, these hormones make it more difficult for insulin to work, resulting in an increase in the mother’s blood sugar levels.
Therefore, gestational diabetes occurs when the mother’s pancreatic beta cells are unable to respond to the normally increased insulin needs. It is one of the most common complications of pregnancy, occurring in 5-18% of pregnant women.
What are the risk factors?
Women at increased risk for Gestational Diabetes are:
- Women over 25 years of age
- Women with excess body weight (Overweight – Obese)
- Reduced Physical Activity — Sedentary Life
- Prediabetes
- History of diabetes in a previous pregnancy
- Polycystic ovary syndrome
- Family history of diabetes
- History of macrosomia in a previous pregnancy (i.e. birth weight over 4 kg)
How is the diagnosis made?
The diagnosis is made with the glucose tolerance test (sugar curve), which is performed after taking 75 grams of anhydrous glucose. The test is usually recommended at 24-28 weeks of pregnancy. Blood sugar is measured before taking the solution, at 60 minutes and at 120 minutes. The test must be done in the morning after an 8-14 hour fast and we must follow a normal standard diet for at least the 3 previous days.
The test is considered normal when fasting sugar values are below 92 mg/dl, at one hour <180 mg/dl and at two hours <153 mg/dl. If even one value is above these limits, then gestational diabetes is diagnosed
What is the treatment?
Through Nutrition
A diet with a controlled and constant amount of carbohydrates daily is recommended. Our goal is to consume carbohydrates with a low glycemic index. The glycemic index (GI) is a classification system for foods containing carbohydrates and shows us how much blood sugar levels increase 2 hours after consuming them.
The GI value varies from food to food and the higher it is in a food, the more blood sugar increases once we consume it. The classification scale ranges from 0 to 100.
- Low GD: <55
- Moderate GD: 56-69
- High GD: >70
- Maximum GD value: 100 (glucose)
In addition, the diet we will follow will aim to avoid excessive weight gain. Weight gain should be gradual with most of the weight being gained during the last 3 months. During the first half of pregnancy, the increase we want to be moderate, After the 5th month, the weight increases more, as then the growth and development of the fetus and placenta is greater. Of course, this also depends on the weight we have at the beginning of pregnancy.
According to the weight before pregnancy, we calculate the kilos that we want to gain during this period.
Find your BMI here https://co-metabolism.gr/en/ypologismos-bmi-rmr/
Through Exercise
The recommendations also mention how important daily exercise is. Even a 20-minute walk after a meal can significantly help reduce blood sugar levels. Of course, this should be done in consultation with your doctor about the type of exercise, its frequency and intensity. In addition, he should also inform you in which month of pregnancy he allows it.
By Self-Testing
Recording blood sugar values as well as the food consumed is very helpful in seeing how the body reacts depending on the previous meal. 4 measurements per day are usually recommended, every morning fasting and one hour after each main meal.
Usually the goals are:
- In the morning before breakfast: <95 mg/dl
- One hour after meals: <130 mg/dl
Of course, these goals are individualized depending on the case.
Insulin Administration
If diet and exercise are not enough, then insulin may need to be administered exogenously. The use of insulin in most cases stresses pregnant women. However, it should be emphasized that it is a simple, painless and completely safe procedure, both for the mother and the fetus. In addition, it is administered exclusively during pregnancy and its use is discontinued after childbirth.
What is needed after childbirth?
For the first 2-3 days after childbirth, monitoring of blood sugar levels is required without any special diet. After 6 – 8 weeks, it is recommended to repeat the blood sugar curve to confirm that there is no remaining disorder in glucose metabolism. If the curve is normal, then fasting blood sugar should be checked at 6 months and then repeated every 1 year as recommended in the general population.
In conclusion
Gestational diabetes refers to a disorder in glucose metabolism, which appears for the first time during pregnancy. In the majority of cases, a balanced nutritional program is needed along with regular physical activity to maintain euglycemia and the safe development of the fetus.
