Gestational Diabetes

Gestational Diabetes

The condition in which a woman has diabetes and get pregnant, while diabetes existed before the pregnancy, is called ‘pregestational diabetes.’ On the other hand, the condition where diabetes appears during pregnancy, but blood sugar levels were normal before pregnancy, is called ‘gestational diabetes.’
Gestational diabetes occurs due to hormonal changes in the placenta and usually disappears after childbirth in most cases.

Complications include

• Early miscarriage
• Difficult birth
• Stillbirth (fetal death in the womb)
• Congenital anomalies of the fetus
• Increased fetal weight
• Necessity of a cesarean section due to the large size of the fetus

Before Pregnancy

• If you are “pregestational diabetic women” visit a doctor to plan your pregnancy, in line with general health guidelines.
• Address any health issues, control blood sugar levels within the normal range (120–70 mg/dl), and keep the hemoglobin HBA1c level below %6.
• Maintain an ideal weight, follow a healthy diet, and engage in regular exercise.
• Your treatment plan might change, such as switching from Oral Hypoglycemic Agents medications to insulin injections, as OHA can cross the placenta and cause problems for the fetus. Additionally, insulin doses may need to be increased during pregnancy, as the placenta produces hormones that make the body resistant to insulin.
• There may also be changes in medications used to treat other conditions like blood pressure and cholesterol.

During Pregnancy

1. Monitor and control blood sugar levels as follows:
   • Fasting blood sugar: Less than 95 mg/dL
   • Postprandial blood sugar (after 1 hour): Less than 130 mg/dL
   • Postprandial blood sugar (after 2 hours): Less than 120 mg/dL
   • Hemoglobin A1c: Less than %6
2. Consume 3 main meals and 3 snacks according to dietary guidelines to maintain stable blood sugar levels and avoid hypoglycemic episodes that could affect the fetus. Always carry sugar cubes or juice to consume if you experience symptoms of low blood sugar, and ensure you and those around you know how to administer glucagon in emergencies.
3. Perform blood sugar tests 6–7 times daily if using insulin.
4. Pay attention to testing for ketones in the blood through blood or urine tests.
5. Perform retinal and kidney function tests as per the treating physician’s guidelines. Regularly consult a diabetes specialist every two weeks.

Treatment

• Dietary management and maintain regular exercise (under medical supervision).
• If optimal control is not achieved, insulin injections may be required.

After Birth

“In most cases, blood sugar levels return to normal after childbirth, but the following precautions should be observed:”

• Engage in regular moderate exercise, such as walking, after consulting with your doctor.
• Follow a suitable diet during the breastfeeding period and then adhere to a plan to manage your weight, especially if you have obesity, to maintain an ideal weight. Consult with your doctor and a nutritionist.
• Conduct blood tests six weeks postpartum and once a year to monitor blood sugar levels, or as directed by your doctor.
• Ensure to practice breastfeeding.
• Regularly follow up with your doctor.