A disorder that develops during pregnancy, in which the pregnant parent's blood sugar levels increase.
This article is pending medical review.
Contributors
Written by Julian Zeegers
Reviewed by Britte Megens
Edited by Juliëtte Gossens
The prevalence of gestational diabetes in the United States is rather high: 2 to 10% of recognized pregnancies in the US involve gestational diabetes (1). This number has significantly increased over the years, likely because the number of people with obesity has risen (2).
Pregnant people with gestational diabetes have higher-than-desired blood glucose - the body's sugar - levels compared to healthy people. This is due to an increased insensitivity of the body to insulin, also known as insulin resistance. During pregnancy, insulin levels are generally increased due to a moderate enlargement of the insulin-producing parts of the pancreas. Insulin is the hormone responsible for the uptake of glucose from the blood into the cells, therefore decreasing the blood glucose concentration. Although insulin levels are markedly increased during pregnancy, certain hormones that are secreted by the placenta cause insulin resistance. As a result, they disable insulin from exerting its action. Thus, blood glucose levels remain higher than normal (2).
Consequences of Gestational Diabetes
The short-term consequences of gestational diabetes may include larger-than-average newborn (macrosomia), pre-eclampsia, and neonatal diseases among others. Another important short-term consequence is neonatal hypoglycemia. In this condition, the new-born's (neonatal) blood sugar level is lower than normal. Accordingly, extensive monitoring of the new-born’s blood glucose concentration is mandatory. Long-term consequences involve increased risk of the baby developing childhood obesity later on in life, decreased glucose tolerance, and metabolic syndrome (a combination of diabetes, high blood pressure, and obesity). The pregnant person themselves are also more prone to develop type II diabetes later in life after having experienced gestational diabetes (2).
Clinical care
Most prospective parents affected by gestational diabetes are treated by adjusting their lifestyle, most commonly including nutrition therapy and increased physical exercise. A key feature of nutrition therapy involves distributing calories gradually over the day. This way, the blood glucose level right after a meal does not rise out of proportion, which is a condition known as postprandial hyperglycemia (too high blood glucose level right after a meal) (3).
For patients who don’t improve with lifestyle adjustments, insulin therapy might be a solution. Insulin works very rapidly to reduce blood glucose levels. Due to the increased insulin resistance, rather high doses of insulin should be considered by caregivers (3).
References
Gestational Diabetes Centers for Disease Control and Prevention 2021 [updated August 10, 2021. Available from: https://www.cdc.gov/diabetes/basics/gestational.html ]
Lynn R, Tomich P. Gestational Diabetes: Diagnosis, Classification, and Clinical Care. Obstet Gynecol Clin North Am. 2017;44(2):207-17. DOI: 10.1016/j.ogc.2017.02.002
Alfadhli EM. Gestational diabetes mellitus. Saudi Med J. 2015;36(4):399-406. DOI: 10.15537/smj.2015.4.10307
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