Gestational diabetes is an elevation in blood glucose levels that develops at some point of pregnancy. It results from an inability to meet insulin needs that worsen by decreased effectiveness of that hormone.

Women who have gestational diabetes can help control this condition by adhering to healthy life style. Eating healthy foods, controlling weight and being physically active can be sufficient, but if not, taking insulin may be required.

Gestational diabetes normally gets away after birth. However, women who have been previously affected by it are at higher risk of developing gestational diabetes in subsequent pregnancies and type 2 diabetes later in life.

Gestational diabetes is a type of diabetes that appears only during pregnancy, in which blood glucose levels are slightly elevated beyond the normal. It is a common condition among women who get pregnant and most of the times disappear after delivery. However, it can lead to serious health problems for both the mother and baby if not treated probably.

Gestational diabetes happens as a result of either not producing enough insulin hormone during pregnancy, or with a condition called insulin resistance when the cells are not responding to this hormone properly. These can develop with changes in pregnancy as gaining weight and producing more hormones from the placenta.

• Age: Women older than 25 years are more likely to develop gestational diabetes. The possibility increases with age to reach the summit over the age of 45 years.
• Family or personal history: having prediabetes, gestational diabetes in previous pregnancy, or a first relative with type 2 diabetes make the condition more likely to develop.
• Macrosomia: women who deliver a baby with an excessive birth weight that exceeds 4 kilograms are riskier to have this condition.
• Obesity: a body mass index (BMI) of 30 or higher puts burden also on the risk of gestational diabetes.
• Race: women who are black, Hispanic, American Indian or Asian are more likely to develop gestational diabetes.
• Hormonal imbalances: have a hormonal disorder called polycystic ovary syndrome makes woman at increased risk of having gestational diabetes.

Insulin is a hormone secreted from beta cells in the pancreas into the blood stream. It is crucial for making glucose able to enter the cells in order to be used for energy. Gestational diabetes starts when the body is not able to make and use all the insulin it needs for normal pregnancy.

The pregnant body needs more insulin to cover the increase in its mass. In the other hand, the placenta produces high levels of various hormones, almost all of them impair the action of insulin in the pregnant cells. As the baby grows, the placenta produces more and more insulin-blocking hormones. Without enough and effective insulin, glucose cannot depose from the blood, thus it builds up to high levels.

Expectants with gestational diabetes often have no clear manifestations as blood glucose levels are not high enough to aggravate symptoms and if appeared it may be referred by the pregnant to as usual pregnancy effects. Woman is advised to visit her doctor when she think about getting pregnant in order to evaluate the health status and the risks. Regular follow ups during pregnancy are also recommended.

Gestational diabetes is usually diagnosed in late stage of pregnancy. Every pregnant should get a screening test for gestational diabetes between the 24th and 28th week of pregnancy. This should be conducted earlier for high risk woman. Tests include:

• Glucose Challenge Test (GCT). An elementary screening tests to see how efficient the body in processing sugar. It measures the level of blood glucose after I hour of taking a solution contains 50 grams of sugar. If the result was higher than 140 mg/dl, this might indicate gestational diabetes, thus the woman need to undergo another one called glucose tolerance test to make confirmation.
• Glucose Tolerance Test (GTT): A more determined test that reflects how the body deals with glucose. At first, It Measures blood sugar after at least 8 hours of fasting, then every hour for the next three hours after drinking a syrup with 100 grams of glucose. Gestational diabetes is diagnosed if at least two of the blood sugar readings are higher than normal levels.

          Values of abnormal GTT:

Treating gestational diabetes can help both the pregnant and her baby stay healthy and protected from current or later complications. This condition could be put under control to bypass it with the least losses. Treatment focus on:

• Blood glucose monitoring

The health care provider may ask to check blood sugar for many times during the day to make sure level stays within a healthy range. Although this may look hard and inconvenient, it will get easier and more acceptable with practice. Documenting the results well help the doctor to track the case and evaluate the degree of control over gestational diabetes, which will direct the treatment plan for the best care and outcomes.

The usual times for blood glucose checking and the targeted levels for gestational diabetes women are explained in the following chart:

• Healthy diet

A healthy diet is an essential basis of a healthy lifestyle, which implicate doubling importance during pregnancy as two persons are affected i.e. the mother and the baby. There is no need to handle a special diet for gestational diabetes, but it is important for the affected women to eat well-balanced food every day to get the right amounts of nutrients that you and your baby need.

In general, women with gestational diabetes are advised to

• Increase their intake of foods rich in fibers, like vegetables and fruits.
• Consume whole grains instead of refined forms.
• Limit consumption of meat, sugar and processed foods.

• Weight control

Gaining some extra kilograms is normal process during pregnancy if happened within the targeted goals as explained in the char below. Woman having gestational diabetes may want to consult a registered dietitian or a diabetes educator to create a weight control plan based on her present weight, pregnancy weight gain goals, blood glucose level, exercise habits, food requirements and economic status.

• Physical activity

Exercises can improve insulin sensitivity, which allow glucose to enter the cells and thus decrease blood glucose level. Physical activity burns excess calories and fat that prevent obesity. Regular exercising can also improve blood flow and blood pressure. It also can help relieve some common discomforts of pregnancy like back pain, and make the expectant ready for delivery.

For safe and effective exercising during pregnancy, women with gestational diabetes are advised to:

• •  Consult the doctor before starting exercise regimen to know if there is a need to take special steps before, during, and after workout.
  • Check Blood sugar before and after exercise or as recommended by doctor and document the results.
  • Warm up before starting the exercise, act in moderation during it, then finishing the job gradually.
  • Drink enough amount of water for healthy functioning and compensation of fluid losses.
  • Aim for at least 30 minutes of moderate aerobic exercises, like walking and swimming, most days of the week.
  • Avoid activities in which they can get hit or fall down, such as skating.
  • Stay out of exercising on their back after the first trimester to prevent limitation of blood flow.

• Insulin therapy

If diet and exercise aren't enough to reach blood sugar goals, exogenous insulin may be needed. This hormone is considered safe during pregnancy if taken properly with keeping eyes on glucose levels. Deferent types of insulin are available and may include:

Insulin is mainly given in the subcutaneous tissue - a fatty layer just beneath the skin. A Pre-Mixed type of insulin is available and helpful to reduce number of injections (Types explained in the next chart). People who use insulin are advised to change the site of injection every time they use it In order to protect the skin from the effects of multiple injections. Sites suitable for that include: the abdomen, back of the upper arms, upper buttocks and the outer side of thighs.

Treatment with insulin is carrying the potential to drop blood glucose below normal levels (less than 70 mg/dl). This may take place for skipping a regular meal, having more insulin than usual or doing more physical activity than normal. It is considered a serious condition that need to be corrected by fast-acting carbs like a tablespoon of honey. It can be manifested by: tremor, sweating, headache and fatigue.

• Certain oral hypoglycemic medication

Some doctors may prescribe an oral medication to deal with high blood sugar, while others believe that more research is needed to check safety of oral hypoglycemic drugs for pregnant women. Metformin is a choice that can be given. It makes cells in the body more sensitive to hormone insulin and decreases glucose production in the liver. This drug doesn’t cause hypoglycemia. However, users can complain of GI side effects like diarrhea, which could be tolerated as body used to the drug.

• Monitoring the fetus

Close observation of the baby's growth and development is important part of the treatment plan. The doctor may monitor the baby with repeated ultrasounds than done first around weeks 18-20 of pregnancy, to check fetus heart for any signs of abnormalities. Then, the procedure redone at weeks 28, 32, 36 and regular checks from week 38 to monitor his growth and the amount of amniotic fluid surrounding him.

• Safe delivery

Expectants with gestational diabetes can wait for Natural childbirth as long as blood sugars are under control, the ultrasound of the baby are normal and there is no other problem in pregnancy. If the baby is large for his/her gestational age, then the doctor or midwife will discuss the risks and benefits of a caesarean section. Blood glucose level will be measured hourly during delivery and kept at 70-110 mg/dl. Those who have been on insulin during pregnancy will have an intravenous drip of insulin and glucose during giving birth.

• Caring for the new born

Newborn baby is prone to hypoglycemia as he gets used to elevated amount of glucose during pregnancy and his pancreas habituates to secrete more insulin to deal with excess sugar. His/Her blood glucose level will be measured around two to four hours after delivery, usually before the second feed. If his/her blood glucose still very low, he/she may need to be fed through a tube or given an intravenous fluid.

Most women who have controlled gestational diabetes deliver healthy babies. If the condition is not managed properly, or goes undetected, it could cause a group of serious problems for both pregnant and baby. Possible complications are:

• Preeclampsia. Gestational diabetes increases the risk of this serious complication that causes high blood pressure - usually around 20 weeks of pregnancy - and other symptoms of organ damage, such as proteinuria. This condition can threaten the lives of both mother and baby.
• Type 2 diabetes. Having gestational diabetes put the woman at greater risk of developing diabetes type 2 as get older, especially with unhealthy life style and excess weight. The baby also will carry that risk.
• Macrosomia. Elevated plasma glucose triggers baby's pancreas to make more insulin and store that glucose inside the cells. The baby may grow too large to reach 4 kilograms or more.
• Birth injury. Having too large fetus makes him more likely to get stuck in the birth canal. This can lead to birth injuries such as intracranial hemorrhage, or the pregnant may require a cesarean section.
• Preterm labour. High blood sugar may increase the chances of delivering the baby before the 37th week of pregnancy, either spontaneously or as recommend by doctor. This can affect baby’s maturity and health.
• Respiratory distress syndrome. A condition that causes difficulty in breathing, mainly for preterm births. Babies of mothers with gestational diabetes may experience it even if they're not born early.
• Hypoglycemia. Baby’s pancreas is used to produce increases amount of insulin to treat high glucose levels during pregnancy. This may lead to developing low blood sugar shortly after birth when the source of extra glucose from the mother is denied.
• Miscarriage and stillbirth. Woman with gestational diabetes are at risk of losing her pregnancy during the first 23 weeks. If the baby passed that, he still at risk to die around the time of the birth.

Even sometimes gestational diabetes cannot be prevented, Healthy habits adaptation before and during pregnancy can reduce the risk of having this condition. Commitment to these choices after birth with gestational diabetes may decrease chances of future episodes of it and the development of type 2.

A study led by researchers from many Finnish health institutions, like Helsinki University, found that moderate individualized lifestyle intervention like counseling on diet, physical activity, and weight control had reduced the incidence of gestational diabetes by 39% in high-risk pregnant women.

Women may be able to lower their chances of getting gestational diabetes by:

• Maintaining a healthy weight and not gaining too much during pregnancy. Losing the excess kilograms before getting pregnant may help have a healthier pregnancy and delivery.
• Being physically active before and during pregnancy by targeting 150 minutes of moderate-intensity of aerobic exercises per week. This may require counseling the doctor about the suitable workouts.
• Healthy Eating by having regular, balanced meals that include variety of healthy foods, like fruits, vegetables and whole grains. A need also for reducing amounts of sugar and saturated, trans fats and.
• Early and frequent breastfeeding after delivery, particularly who had gestational diabetes in pregnancy, as it can help prevent or decrease the newborn chances of having hypoglycemia. It also minimizes the risk of developing type 2 diabetes for the mother and the child.

With good self-care and health provider support, women with gestational diabetes can skip the condition safely. The majority of cases will cure form the condition within short period from giving birth. The doctor will check blood sugar after delivery and again in 6 to 12 weeks to make sure that the level has returned to normal. Then diabetes risk will be reassessed at least every three years.

Women who had gestational diabetes are at higher risk to have it again with subsequent pregnancies. This condition is associated with an increased risk of both mother and child to develop type 2 diabetes later in life. Making healthy lifestyle choices such as eating healthy foods and exercising can help reduce that risk. Of those women with a history of gestational diabetes who reach the ideal body weight after delivery, less than 25% of them eventually develops type 2 diabetes.

The International Diabetes Federation (IDF) estimated that 20.9 million, or 1 out of 7 live births in 2015 the women had some form of hyperglycemia in pregnancy. The distribution of these cases was as the following: 85.1% were due to gestational diabetes, 7.4% due to other types of diabetes first detected in pregnancy and 7.5% due to diabetes detected before getting pregnant.

The greater portion of hyperglycemia in pregnancy were in low and middle-income countries accounting for nearly 87.6% of cases. Here, access to health services for the expectants is often limited. There are some regional differences in the prevalence of this condition, with the South-East Asia Region leading the prevalence rates at 24.2% compared to 10.5% in the Africa Region.

The prevalence of hyperglycemia in pregnancy increases rapidly with age to reach the climax over the age of 45, although there are fewer pregnancies in that age group. Indigenous peoples, often have higher prevalence rates than the surrounding population, especially for gestational diabetes. The rates of this condition are 2 times more among some indigenous women, compared to non-indigenous.