Gestational Diabetes: How Dangerous Is It for Mother and Baby?

Gestational diabetes – two to five percent of expectant mothers develop this metabolic disorder. Gestational diabetes causes hardly any symptoms and is therefore often not recognized. Untreated, however, it can be dangerous for mother and baby.

What is gestational diabetes?

Gestational diabetes is a form of diabetes. It only occurs during pregnancy. In the case of so-called gestational diabetes, the pregnant woman’s body cannot regulate the blood sugar level sufficiently. Women with this disorder therefore have elevated blood sugar levels. Your body does not have enough insulin available. The hormone insulin ensures that the sugar is transported from the blood into the cells and thus supplies the body with energy. The disease is also known as type 4 diabetes or gestational diabetes mellitus (GDM) or colloquially abbreviated as SS diabetes.
Gestational diabetes is one of the most common diseases during pregnancy. The WHO estimates that seven to eight percent of expectant mothers are affected. In Germany, the figure is slightly lower at around 3.4 percent. This corresponds to 22,000 women per year. Older and overweight pregnant women carry an increased risk. Both risk factors have been increasing for years. Only 10 percent are correctly diagnosed with the disorder.

How does gestational diabetes develop?

Gestational diabetes can develop in two ways: Increased insulin demand or increased insulin resistance.

The pregnant woman increasingly needs more energy. In return the body releases more glucose. In order to transport it into the cells, the body also needs more insulin. In some pregnant women, the pancreas, as the insulin producer, cannot perform this extra work. The consequence of the insulin deficiency is a high blood sugar level. In this case we speak of a real insulin deficiency.
With a so-called relative insulin deficiency, the situation is different. In the first trimester of pregnancy, certain pregnancy hormones (e.g. HCG) ensure that the cells react more sensitively to the insulin stimulus. However, as the composition of the hormones changes in the 2nd and 3rd trimester, the cells develop insulin resistance. Although there is sufficient insulin available, the blood sugar level cannot be reduced. This happens around the 20th week of pregnancy. In women who do not eat a balanced diet or who were already overweight before pregnancy, the disorder occurs relatively more frequently.

Who is affected?

The female organism generally copes well with the new challenges. But there are risk groups that are more often diagnosed with gestational diabetes.
In addition to older (over 35) and overweight pregnant women (BMI over 30), the risk group also includes women who have relatives who suffer from type 2 diabetes. Mothers who have already given birth to a child with a high birth weight (over 4500 grams), who have had more than three miscarriages or who have had gestational diabetes in a previous pregnancy also carry a higher risk. Such high-risk patients should undergo a test as early as the 13th week of pregnancy.

How is gestational diabetes different from normal diabetes?

In the case of diabetes that existed before pregnancy, the disorder develops differently. In these cases either the insulin production in the pancreas is disturbed (diabetes mellitus type 1) or the hormone does not act on the organs (type 2).

By the way: a slightly elevated blood sugar level is quite normal during pregnancy. The transition from a harmless increase in sugar levels to gestational diabetes is fluid and must be assessed by a doctor.

What are the consequences for mother and baby?

If the metabolic disorder is not diagnosed, the development of the fetus is at risk. Untreated gestational diabetes does not necessarily have negative effects. But the risk of a number of complications increases. This is because the increased sugar in the mother’s blood reaches the child via the placenta and umbilical cord. The excess sugar is deposited in fat deposits in the baby. The birth weight is often over 4500 grams (macrosomia).

The consequences of undiagnosed gestational diabetes for the baby:

• The baby grows disproportionately fast.
• However, its internal organs (especially the lungs) cannot mature sufficiently.
• Malformations of the lungs and heart problems can occur. The risk of premature birth increases with very large and heavy children.
• After birth, the children suffer from massive hypoglycaemia.
• Often the children become overweight later. There is also a higher probability of developing diabetes later in life.

The consequences of undiagnosed gestational diabetes for the mother:

• The risk of an episiotomy increases. In gestational diabetics, a caesarean section is more often necessary due to the size of the child.
• At birth, suction cups or forceps must be used relatively more often.
• There is a higher risk of urinary tract infections.
• Gestation also occurs more frequently and can be a possible trigger for premature birth.
• Mothers also have a higher risk of developing permanent diabetes after pregnancy.
• Later in pregnancy, there is a higher risk of developing gestational diabetes again.

What are the symptoms of gestational diabetes?

Pregnant women usually do not feel that something is wrong. Because pregnancy diabetes itself does not cause alarming complaints, pain or typical symptoms. Therefore, the disorder is often not diagnosed. Frequent cystitis could be an indication, as sugar is a good breeding ground for the bacteria that cause such infections. If the ultrasound examination shows that your unborn child is very large or if a lot of amniotic fluid is visible, this could be an indication of a disturbed sugar metabolism.

How can gestational diabetes be diagnosed?

Conventional urine test sticks, which are supposed to indicate sugar levels, are too imprecise to diagnose gestational diabetes reliably. Today, your gynaecologist can reliably diagnose gestational diabetes with a sugar stress test (oral glucose tolerance test) in the doctor’s office. The screening test is paid for by the statutory health insurance companies as part of prenatal care. It is best to do the glucose tolerance test between the 24th and 28th week of pregnancy. In practice, your blood sugar is measured first. Then you are given a glucose solution (50 grams of glucose) to drink and after one hour your blood is taken. If the blood sugar level is normal, the test is complete. If your blood sugar level is 135 mg/dl or higher, your doctor will usually carry out a second test, in which you must be fasting. This is also a benefit paid by the health insurance companies today. This time you drink a solution containing 75 grams of glucose. When you are fasting and one and two hours after drinking, your blood is taken and your sugar level is determined. If the fasting blood sugar value is above 91 mg/dl, the value after one hour is above 179 mg/dl and the value after two hours is above 152 mg/dl, then according to the guidelines of the German Diabetes Society, pregnancy diabetes is present.

What does the treatment look like?

There are many things you can do to protect yourself and your child from the consequences of gestational diabetes. Through a change in diet, diet and more exercise, 90 percent of women can achieve good sugar levels. Insulin therapy is only necessary for 10 percent.

The best way to change your diet is to get professional support. Because in this case, a diet is not necessarily about eating less, but the right food. Your internist or a diabetes doctor will be happy to advise you. Today, there are also small measuring devices with which you can check your values yourself. If changing your diet and taking more exercise is not enough, you will need insulin injections until the end of your pregnancy. You can administer these to yourself with a handy pen. However, insulin administration must be closely monitored by your gynaecologist. Too high a dose can also lead to hypoglycaemia. In this situation it is therefore important for you to always have something in your pocket to quickly raise your sugar level again. Dextrose is the best way to do this.

Your gynaecologist will perform several ultrasound examinations in the last trimester of pregnancy. He will use these to check the baby’s growth. If you are expecting a very large baby, it may be necessary to give birth earlier or to plan a Caesarean section. The sugar level usually returns to normal after the birth. However, you now have an increased risk of developing diabetes later. Regular monitoring of your sugar levels therefore makes sense in any case.

Nutrition for diabetics

The increased sugar levels in the blood can be reduced very well by a balanced diet. Here we have only compiled a few important tips. If you have gestational diabetes, a medical nutritional consultation will help you. According to recent studies, the glycemic index is particularly important. It measures how the different carbohydrates in food affect your blood sugar level. Foods with a high glycemic index drive up blood sugar levels quickly and should be eaten in moderation by people with diabetes. More of this please:

• Low fat dairy products
• Fresh fruit and vegetables
• Food with a low glycaemic index

And less of that:

• Quickly digestible carbohydrates (sweets, jam, syrup, sugary drinks, honey, white flour products)
• Greasy food

And besides: Several small meals help to keep the blood sugar under control. Four to five meals a day is better than three. Exercise against high blood sugar In addition to a balanced diet, regular physical activity also has a direct influence on blood sugar. Exercise burns energy. Sugar levels fall. Sports that are particularly suitable for pregnant women are swimming, cycling, yoga, long walks, aqua gymnastics and cross-country skiing.

Less recommended are squash, tennis or horse riding. No matter what kind of exercise you choose. The important thing is that you stay on the ball.