All about Gestational Diabetes - Diagnosis and Treatment

About Gestational Diabetes

Gestational diabetes is a common condition affecting approximately 4–10% of pregnant women. If not properly managed, it can significantly impact fetal development. Poorly controlled gestational diabetes early in pregnancy may lead to severe birth defects and an increased risk of miscarriage. Later in pregnancy, it can cause excessive fetal growth, leading to complications during and after childbirth.

Gestational diabetes also raises the risk of respiratory issues in newborns, premature birth, jaundice, low calcium levels, and other health concerns.

Screening for Gestational Diabetes

Between weeks 24–28 of pregnancy, a 50-gram glucose challenge test (GCT) is recommended as a screening tool to assess the likelihood of gestational diabetes.

Types of Diabetes in Pregnancy

There are two types of diabetes that can occur during pregnancy:

Gestational Diabetes – Diabetes first diagnosed during pregnancy.
Pre-Gestational Diabetes – Diabetes that existed before pregnancy.

Why Is It Important to Treat Gestational Diabetes?

Women with diabetes during pregnancy face a higher risk of maternal and fetal complications.
These risks continue during labor, delivery, and the postpartum period.
About 50% of women who develop gestational diabetes will later develop type 2 diabetes.

How Is Gestational Diabetes Diagnosed?

Gestational diabetes is diagnosed through a screening test followed by a confirmatory test if needed:

50-gram Glucose Challenge Test (GCT)

This is a screening test that does not require fasting.
You will drink a solution containing 50 grams of glucose, and your blood sugar level will be measured one hour later.
If your blood glucose level is 140 mg/dL or higher, you will be referred for a 100-gram glucose tolerance test (OGTT) for confirmation.
Some providers use a threshold of 130 mg/dL to determine the need for further testing.

100-gram Oral Glucose Tolerance Test (OGTT)

This is a diagnostic test requiring fasting for at least 8 hours before the test.
Your fasting blood sugar level is measured, and then you will drink a glucose solution containing 100 grams of glucose.
Blood sugar levels will be tested at 1, 2, and 3 hours after drinking the solution.

Normal values:

• Fasting: Up to 95 mg/dL
• 1 hour: Up to 180 mg/dL
• 2 hours: Up to 155 mg/dL
• 3 hours: Up to 140 mg/dL

If at least two values exceed the normal range, gestational diabetes is diagnosed.
If only one value is abnormal, further monitoring may be required.

Automatic Referral for the 100-gram OGTT

Certain conditions may warrant immediate referral for a 100-gram OGTT, even if the 50-gram test results are normal:

• History of gestational diabetes in a current or previous pregnancy.
• Prior birth of a baby weighing more than 4 kg (8.8 lbs).
• Excess amniotic fluid (polyhydramnios).
• Significant weight gain during pregnancy.
• High blood sugar levels in routine pregnancy tests.
• If 50-gram test results exceed 200 mg/dL, gestational diabetes is diagnosed without further testing.

What Happens After a Diagnosis of Gestational Diabetes?

Upon diagnosis, the woman will be referred to a high-risk pregnancy clinic for specialized care. The goal is to ensure the well-being of both mother and baby throughout pregnancy, delivery, and the postpartum period.

First Visit:

• A nurse intake assessment.
• Referral for a blood sugar monitor.
• A personalized meal plan from a specialized dietitian.
• Clear instructions on dietary and lifestyle changes.

Ongoing Monitoring:

• Blood sugar levels, urine protein levels, and blood pressure will be regularly checked.
• Nutritional counseling and adjustments based on glucose levels.
• Additional medical interventions if needed, such as insulin therapy if blood sugar levels remain high.

The frequency of visits with healthcare professionals (nutritionist, doctor, nurse) will depend on individual needs and the stability of blood sugar levels.

Preparing for Delivery

Women with gestational diabetes are typically advised to deliver between 38–39 weeks to reduce the risk of complications.
If blood sugar levels are well-controlled, pregnancy progression is generally similar to a normal pregnancy.

Postpartum Care and Future Risk

Most women return to normal blood sugar levels after delivery. However, gestational diabetes increases the risk of developing type 2 diabetes later in life. To reduce this risk:

• Maintain a healthy diet.
• Engage in regular physical activity.
• Continue monitoring blood sugar levels as recommended by your doctor.

Regular follow-up is essential to ensure long-term health and prevent future complications.