Gestational diabetes in the expectant mother is one of the most common complications during pregnancy. Particularly insidious is that the disease often goes undetected, as it often causes no symptoms. Experts estimate that around five percent of pregnancies are affected. What exactly is gestational diabetes, how can you recognize its symptoms, and what are the consequences and risks for the unborn child? Find out here.
Gestational diabetes – what is it?
Gestational diabetes is also called gestational diabetes (GTD) or gravidity diabetes. This is a special form of diabetes that is diagnosed for the first time during pregnancy – regardless of whether the disease first appeared during pregnancy or existed undiagnosed before. In this case, the mother’s blood glucose level is elevated either permanently or for an unusually long time after meals. In most cases, the condition returns to normal after the end of pregnancy. This sugar tolerance disorder is particularly harmful to the child, as the risk of pregnancy complications, including premature birth and stillbirth, increases considerably. But gestational diabetes can also have consequences for the mother.
Risks for the child
How dangerous is gestational diabetes for the child? In principle, gestational diabetes causes two main problems in the child:
- The increased growth in size during pregnancy, with problems during birth, up to premature birth and stillbirth.
- Health problems of the child after birth
The unborn child reacts to the mother’s excessively high blood sugar level with extreme nutrient absorption. This results in excessive growth of the child in the womb (called macrosomia) with delayed development at the same time – this combination is called diabetic fetopathy. At birth, babies sometimes weigh 4.5 kg or more in the case of untreated gestational diabetes. In addition, the placenta or the organs of the unborn child – especially the lungs – may be affected by maturation disorders, which can lead to respiratory distress syndrome in the affected baby (especially after premature birth). Malformations of the heart can also result if the condition occurs early in pregnancy. Furthermore, too much amniotic fluid is often formed (polyhydraminion), which limits the space for the baby and promotes premature birth. These and other factors put the child at high risk for complications during pregnancy and at and after birth.
Other consequences for the baby
During a normal delivery, large children are more at risk of not being adequately propelled in the birth canal (known as shoulder dystocia); therefore, nerve paralysis in the shoulder-arm area (plexus palsy) is more common as a result. In addition, the body of the unborn child often reacts to the high sugar level by producing more insulin to keep its own sugar level low. After delivery, the infant therefore often suffers from hypoglycemia as soon as the mother’s sugar supply stops. During infancy, metabolic disturbances or shifts in salt balance may occur. If gestational diabetes remains undiagnosed and untreated, children are at increased risk of developing diabetes and obesity in later life.
Risks for the mother
Mothers with gestational diabetes also face complications during and after pregnancy, such as increased blood pressure, increased urinary tract infections, edema, kidney problems, or a tendency to sometimes life-threatening seizures (preeclampsia). The complication of child birth also increases the risk of pelvic floor damage. Another problem is that around 40 to 60 percent of the women affected develop type 2 diabetes mellitus requiring treatment within ten to fifteen years of giving birth – even if the gestational diabetes disappears again immediately after the birth. It is therefore crucial to diagnose gestational diabetes in good time – then the risks of serious consequences for mother and child can be minimized.
Recognizing symptoms in gestational diabetes
Typical symptoms of diabetes such as frequent urination, fatigue and severe thirst usually do not occur in gestational diabetes or are attributed to the pregnancy itself. Thus, pregnant women usually do not notice that they are sick. The following signs may indicate diabetes during pregnancy:
- Frequent urinary tract infections
- Increased inflammation of the vagina
- High blood pressure
- Excessive weight gain or excessive growth of the child
Diagnosis by gestational diabetes test
The simple screening test to detect gestational diabetes is part of routine screening, so the cost of the so-called oral glucose tolerance test (oGTT) is covered by health insurance. The diabetes test is performed between the 24th and 28th week of pregnancy (SSW) and is not dangerous for the baby. The procedure is quite simple: for the test, the woman drinks a sugar solution consisting of 200 ml of water and 50 g of glucose (50-g-oGTT). After one hour, a blood sample is taken to determine whether the sugar level is elevated. If the blood glucose level is elevated (from a value of 135 mg/dl or 7.5 mmol/l), the oGTT is repeated under modified conditions.
Second diabetes test
The second test for gestational diabetes (75-g oGTT) is performed in the morning on an empty stomach and with a higher amount of glucose (75 g). In addition to measuring the blood glucose level twice (after one and after two hours), this time the fasting value is also determined, i.e. blood is taken before the glucose solution is drunk. The relevant values for this test are:
- 92 mg/dl (5.1 mmol/l) fasting.
- Or 180 mg/dl (10.0 mmol/l) after one hour.
- Or 153 mg/dl (8.5 mmol/l) after two hours.
The second test is thus much more meaningful and is recommended by experts even if the first test was negative, but there are symptoms that could indicate the disease. However, the costs are only covered by health insurance if the preliminary test has been carried out beforehand. By the way: to exclude gestational diabetes, the determination of urine sugar is unsuitable.
What to do in case of gestational diabetes?
Often a consistent change in diet already helps, only in rare cases is the injection of insulin necessary. Studies have shown that when blood sugar is well controlled, there are significantly fewer complications at birth and the baby is less likely to be overweight. Therefore, the most important measure immediately after the diagnosis of gestational diabetes is a change in lifestyle. It is important to eat a balanced diet rich in fiber and to avoid sweets and soft drinks as far as possible. You can find more tips on nutrition for gestational diabetes here. In addition, regular – preferably daily – exercise and close monitoring of blood glucose levels are crucial components of treatment.
Causes of diabetes in pregnancy
The exact causes for the development of gestational diabetes have not yet been conclusively clarified. It is likely that a genetic predisposition plays a role in affected women. In addition, there are major changes in the hormone balance during pregnancy. This probably leads to interactions between the female sex hormones (estrogen, progesterone), the placental hormones (HCG, HPL) and the insulin hormone, which regulates blood sugar. These hormones are produced more frequently, especially in the second half of pregnancy. As a result, either the cells respond less well to insulin or its production is impaired. It is also thought that more insulin is broken down in the placenta, which is why sugar levels in the blood rise.
Risk groups for gestational diabetes
There are at-risk groups that are more likely to be affected by gestational diabetes and for whom oGTT is recommended before 24 weeks of pregnancy. Who is at risk?
- Overweight pregnant women, especially if they do not exercise much and smoke
- Pregnant women over the age of 30
- Pregnant women with diabetes in the family
- Pregnant women who have already suffered several miscarriages
- Pregnant women who have already given birth to a child with a birth weight of more than 4,000 g
- Pregnant women who have already had gestational diabetes in a previous pregnancy
Certain medications, such as beta-blockers or cortisone, can also promote the development of gestational diabetes. If you are pregnant and at least one of these risk factors is present in you, talk to your gynecologist. In this case, the screening test can be performed as early as the first trimester and several times during the pregnancy.
Regular checks of blood glucose levels after pregnancy.
Once gestational diabetes has been diagnosed, blood glucose levels are checked following pregnancy and again after two months. Even if these values are normal, a woman should have her glucose levels measured at regular intervals by her primary care physician.
