Gestational Diabetes: Protecting Both Mother and Baby

Pregnancy may tend to change many things — how hungry you feel, how much energy you have, even how your body handles food. Most of these shifts may be expected, but there’s one that often comes as a surprise: Gestational Diabetes Mellitus (GDM).

GDM is the name given when higher blood sugar is first picked up during pregnancy. The tricky part is that it may not cause obvious symptoms. Many women who develop it have never had diabetes before. That’s why health professionals often encourage screening as a routine part of antenatal care.

The numbers suggest this should not be taken lightly. Globally, about 14.7% of pregnancies may be affected by high blood sugar. In South-East Asia, it could be closer to one in four. In India, studies vary — some rural areas of central and western India show rates of 1.9% and 12.7% respectively, while in urban centres, the figure has been reported as high as 6.6-27.2%. And since about 85–90% of diabetes detected in pregnancy is gestational, most of the guidelines now recommend that all pregnant women be offered screening, not just those seen as “high risk.”¹

How High Blood Sugar Can Affect Mothers and Babies

For Mothers
So why does GDM matter? High blood sugar during pregnancy may raise the chance of certain complications. Women with GDM may be more likely to develop high blood pressure or pre-eclampsia, both of which can affect both mother and baby. Other issues may include too much amniotic fluid, a longer or more difficult labour, or sometimes the need for a caesarean delivery.

Even after delivery, risks don’t always disappear right away. Some women may face problems such as the uterus not contracting properly, heavier bleeding, or infections. And looking beyond pregnancy, research shows that women who’ve had GDM carry a higher risk¹ of developing type 2 diabetes within five to ten years¹, as well as a possible increase in cardiovascular problems later in life.

For Babies
Babies, too, may be affected if maternal blood sugar stays high. Glucose crosses the placenta, and the baby may respond by producing extra insulin. This can sometimes lead to macrosomia (a larger-than-average baby), which makes labour more complicated and increases the chances of birth injury.

Right after birth, some newborns may develop low blood sugar, jaundice, or breathing problems. And later in life, children exposed to high maternal blood sugar during pregnancy may face a greater chance of obesity, diabetes, or other health concerns, including cardiovascular and neurological problems. This is often described as a transgenerational effect, where risks can pass from one generation to the next.

Why Testing Every Mother Is Now Advised

Not too long ago, only women seen as “at risk” i.e. older mothers, those who were overweight, or those with a family history of diabetes, were tested for GDM. But with the growing prevalence of diabetes worldwide, and a significant number of live births being caused due to GDM, it is necessary to conduct timely screening of all women, even in the absence of symptoms.¹

The DIPSI (Diabetes in Pregnancy Study Group of India) method may be an apt solution to address this. The test is simple: a pregnant woman is given 75 grams of oral glucose, and her blood sugar is measured two hours later. If the reading is 140 mg/dL or higher, it may indicate GDM.

One of the main advantages is convenience. The test doesn’t require fasting and can be done during a routine antenatal visit. Guidelines generally suggest testing at the first antenatal appointment, ideally before 12 weeks. If results are normal (negative), the test may be repeated at 24-28 weeks, with a gap of at least 4 weeks between the two tests. Detecting GDM early gives families and doctors more time to manage it.

Managing Gestational Diabetes: What May Help

1. Nutrition First¹

Diet usually plays a central role in managing blood sugar. The aim is not to eat less but to strike a healthy balance so that both mother and baby get the nutrients they need.

A simple “plate method” is often suggested by healthcare providers:
* Half the plate with vegetables (green leafy vegetables, vegetables with high water content, other traditional vegetables, and a variety of beans)
* One quarter with protein (such as pulses, dhal, or lean meats)
* One quarter with grains, cereals, or millets
* Additional – 200ml curd for all three meals and snacks (roasted bengal gram/sprouts/salads)

General guidelines also recommend around 175g of carbohydrates, 71g of protein, and 28g of fibre per day.¹ Micronutrients like iron, calcium, zinc, folic acid, vitamin C & B12, and iodine are important too. Healthy fats are encouraged, while saturated and trans fats are best kept low. 2.3l of water is recommended per day, caffeine is often limited to under 200mg per day, and alcohol avoided altogether.¹

Calorie needs usually rise during pregnancy — about 1,800 kcal/day in the first trimester, 2,200 kcal in the second, and 2,400 kcal in the third. That said, every woman’s needs are different, so it’s best to follow a plan worked out with a doctor or dietitian.

Staying Active

Being active, within safe limits, may help the body use insulin more effectively. Walking, light aerobics, or yoga designed for pregnancy are common suggestions. But the right activity level depends on individual health, so it’s always best to check with a healthcare professional first.

Monitoring Sugar Levels

Keeping an eye on blood sugar can make a big difference during pregnancy. The DIPSI 2023 guideline notes that regular checks may help both mothers and doctors see how well blood sugar is being managed and adjust plans when needed.

Women who are on insulin may be asked to do a seven-point test – before and two hours after each meal, and again before bedtime. For most others, four checks a day, i.e. one before breakfast and one two hours after every main meal, usually give enough information. This helps the care team, especially if insulin is needed, to adjust treatment for optimal glycemic control.

If sugars stay steady with dietary changes and more frequent testing isn’t possible, a weekly fasting and post-meal test may be enough, as long as it’s done under medical advice. Where available, for a more comprehensive insight into glucose trends, some healthcare professionals may advise the use of continuous glucose monitoring (CGM).

Many women now use mobile apps that record these readings and share them securely with their doctors. This makes it easier for care teams to follow progress and decide when any change in treatment is needed.

The general goal is to keep readings around 90 mg/dL before meals and about 120 mg/dL two hours after eating. These levels, recommended by DIPSI and the American College of Obstetricians and Gynecologists (ACOG), are linked to healthier outcomes for both mother and baby.

When Lifestyle Changes Aren’t Enough

For many women, adjustments to food and activity may be enough. But if blood sugar stays high, doctors may suggest insulin therapy. The treating physician will advise on the best approach, which may include specific types of insulin that are approved and considered safe for use during pregnancy. The exact medication and dose are tailored to each woman and will be adjusted by the treating doctor as the pregnancy progresses.

Pregnancy and Delivery: What to Expect

Because GDM is usually treated as a high-risk condition, women may be advised to attend more antenatal visits, have at least three ultrasound scans, and undergo closer, frequent monitoring of blood pressure, blood glucose levels and the baby’s growth.

Most women can still plan for a vaginal delivery, but if the baby is very large or if complications may be in sight, a caesarean may be recommended by the treating doctor after assessments. Early delivery before 39 weeks is generally avoided unless there is a clear medical indication. During labour, blood sugar is closely monitored, and insulin doses may be adjusted if needed.

After Birth: Why Follow-Up Matters

For the Newborn
Babies born to mothers with GDM often need extra attention in their first hours. Their blood sugar is usually checked within the first hour and then every four hours until the readings are in the targeted range as advised by the treating physician. Exclusive breastfeeding is strongly encouraged, as it may help regulate glucose and support healthy growth.

For the Mother
For mothers, the journey doesn’t always end with delivery. Having had GDM may be considered one of the predictors of type 2 diabetes later in life. That’s why a glucose tolerance test at around six weeks postpartum is generally recommended, followed by annual checks. Postnatal counselling may also include advice on healthy eating, regular exercise, weight management, and family planning. These lifestyle choices can be important in lowering future risks.

Breaking the Cycle

If left unchecked, gestational diabetes can set up a cycle in which both mother and child face higher risks for years to come. But with early screening, proper management, and regular follow-up, that cycle may be broken.

Gestational diabetes doesn’t always cause obvious symptoms, but its effects may be far-reaching. The condition may increase the risk of complications during pregnancy and may also raise the likelihood of diabetes for both mother and child in the years ahead. The reassuring fact is that early and even universal testing, combined with timely management and regular follow-up, may make a meaningful difference.

Reference:
https://www.ijddc.org/doc/mPW1fkSM-13410_2023_1222_PrintPDF.pdf

(Note to the Reader: This article has been created by HT Brand Studio on behalf of Roche Diabetes Care India Pvt. Ltd. The information provided is intended solely for informational purposes and does not constitute medical advice or endorsement. Please consult a registered medical practitioner for personalized medical advice or before making any decisions regarding your health conditions or treatment options.)