Diabetes During Pregnancy: How to Cope with the Disease?

Pregnancy can be accompanied by different chronic illnesses or signs of previously unknown problems. Diabetes during pregnancy is on the list of such problems.

What is Gestational Diabetes?

Diabetes mellitus during pregnancy, or gestational diabetes, is a disease of carbohydrate metabolism that causes elevated blood sugar levels and is first detected during pregnancy. Diabetes during pregnancy is a special type of diabetes mellitus that does not correspond to either the first or second type of diabetes or other types of the disease.

Gestational diabetes mellitus, which is characterized by elevated sugar levels, i.e. hyperglycemia, is one of the most frequent complications during pregnancy. In 17% of all future mothers, blood sugar levels are elevated during pregnancy, and 83% there develop diabetes.

The frequency of this disease is related to the fact that many women of reproductive age experience changes in the metabolism of sugar or carbohydrates, and the incidence of obesity and type 2 diabetes increases. It is important to note that diabetes mellitus is diagnosed in younger women even before pregnancy. Also, nowadays there are more and more women who are at risk of gestational diabetes before pregnancy. It increases the likelihood of the development of diabetes during pregnancy.

Risk Factors for Gestational Diabetes

• Obese women
• Women over 35 years old
• Type 2 diabetes among first-degree relatives
• More than one childbirth
• Multiple pregnancies (twins, triplets)
• Medical fertilization
• Diabetes mellitus during a previous pregnancy
• Excessive weight gain during a previous pregnancy
• During a previous pregnancy, the weight of the baby was above 4.5 kg
• Complications during a previous pregnancy (for example, abortion, premature birth, a stillborn child for an unknown reason)
• Polycystic ovary syndrome
• Pre-eclampsia

About half of women with gestational diabetes have at least one risk factor, so it is very important to determine the presence of diabetes in a future mother at 24–28 weeks of gestation.

Consequences of Gestational Diabetes

Gestational diabetes mellitus increases the risk of adverse pregnancy outcomes for both the mother (for example, miscarriage, premature birth, and birth trauma) and for the child (for example, congenital anomalies, increased weight of the child, macrosomia, etc.). Diabetes during pregnancy also increases the likelihood that many years later the child will have obesity and diabetes. In a woman with gestational diabetes during pregnancy (the next 8–10 years) the risk of diabetes mellitus type 2 is increased. Also, there are a risk of early (already after 45 years) diseases of the cardiovascular system. The risk of diabetes mellitus during the next pregnancy increases to 30–50%.

Diagnosis of Gestational Diabetes

All future mothers need to be tested for diabetes at 24–28 weeks of gestation. To diagnose gestational diabetes mellitus, a stress test with 75 g of glucose is performed. The glucose tolerance test should be done in the morning on an empty stomach. This means that 8 hours before the test one cannot eat. It is also better not to have anything to drink in the morning. First, the level of fasting blood glucose is determined. Then the patient drinks 75 g of glucose dissolved in 150–200 ml of water within 3–10 minutes. The level of glucose is again determined after an hour and two hours after drinking the glucose. The test indicates gestational diabetes if at least one of the indicators meets the following criteria:

• Fasting blood sugar ≥ 5.1–6.9 mmol /l
• Blood sugar an hour after the test ≥ 10 mmol /l
• The level of blood sugar 2 hours after the test is ≥ 8.5–11 mmol /l

Blood Sugar Control During Pregnancy

Complications for mother and child depend on how well the mother controls her blood sugar levels. The main advice in treatment is self-control of the sugar level in the morning on an empty stomach (there was no food intake for at least 8 hours) and three times an hour after eating (breakfast, lunch, and dinner). Blood sugar can be monitored at home, every day or 3-5 times a week, by determining the sugar level with the help of a glucometer and test strips.

By determining the level of sugar in the blood regularly, with the help of proper nutrition and exercise, you can achieve normal blood sugar levels and avoid various complications during pregnancy. The target figure on an empty stomach (there was no food for at least 8 hours) is ≤ 5.3 mmol /l, one hour after eating – <7.8 mmol /l, two hours after eating – <6.7 mmol /l.

Treatment of Gestational Diabetes Mellitus – Healthy Nutrition and Exercise

Proper Nutrition, or Diet Treatment

Proper nutrition is one of the main methods of treating gestational diabetes. It provides optimal weight gain and normal blood sugar levels. Proper nutrition is the first and most important step in the treatment of diabetes for all pregnant women.

The most crucial thing is to reduce the consumption of foods rich in carbohydrates (fruits, berries, sweets, etc.). It is advisable to eat foods with a low glycemic index (for example, vegetables, whole grains). By eating foods with a low glycemic index, blood sugar levels rise more slowly and remain even. Carbohydrate intake should be divided into 3-4 small servings per day. The inclusion in the diet of foods rich in fiber also reduces blood sugar levels.

Future mothers with normal weight should consume an average of 2050 kilocalories per day – this amount helps to maintain a normal weight and sugar level.

Women with Gestational Diabetes are Recommended

• Together with the doctor (family doctor, gynecologist, or endocrinologist) make a nutrition plan corresponding to the body mass index, taking into account its amount before pregnancy, the desired weight gain during pregnancy, the level of physical activity, wishes, and dietary habits
• Ensure with your doctor regular adaptation of the diet plan throughout pregnancy in order to achieve the goal of treatment – normal weight and normal blood sugar level
• Regularly discuss with your doctor your weight, proper nutrition, prevention of lowering blood sugar levels, i.e. hypoglycemia, and exercise

Physical Exercise

Physical activities during pregnancy help future mothers to lower blood sugar levels, the risk of gestational diabetes mellitus, and the risk of type 2 diabetes in the future. All patients with gestational diabetes are recommended physical activity:

• 30 minutes of any physical activity every day
• 10 minutes of walking with quick steps or hand exercises after each meal
• Women who were physically active before pregnancy are advised to continue to be physically active

If it is not possible to reduce the level of sugar in the blood with the help of proper nutrition and physical exertion, then after 1–2 weeks it is necessary to begin taking antidiabetic drugs. However, it must be remembered that the most important steps in treatment are proper nutrition and physical exercise. Keep in mind that you can start taking antidiabetic drugs only on the instructions of your endocrinologist.

Young mothers who had gestational diabetes during pregnancy had a higher risk of type 2 diabetes and cardiovascular disease after delivery. Therefore, all women who have diabetes during pregnancy should repeat the glucose tolerance test 1-3 months after delivery. If the results are normal, then the test should be repeated every 1–3 years. If the results indicate a violation of carbohydrate metabolism, the test should be done every year.