Gestational diabetes is any elevation of blood glucose levels during pregnancy. This type of diabetes is diagnosed for the first time during pregnancy, from the second trimester, and usually disappears after the baby is born. However, this picture could also involve a previously diabetic woman who is diagnosed with this disease just when she is pregnant; in this case, the woman after giving birth continues with elevated blood glucose levels. On this occasion, Dr. Jesús Rocca, an endocrinologist at Clinica Ricardo Palma, give us more information on the subject.

Risk factors

Among the main risk factors that can cause gestational diabetes are:

• Family history of diabetes
• Having had a child who was born weighing more than 4 kg (i.e., a macrosomic child)
• Having had elevated glucose, including prior to pregnancy
• Excess weight (overweight or obesity) in the gestation stage
• Being hypertensive or having fatty liver or high triglycerides before pregnancy

That is why all women with a family history or particular history, such as those mentioned, prior to pregnancy, should undergo a glucose tolerance test within 20 to 24 weeks of gestation.

Complications

The main complications are divided into two:

Complications affecting the mother

• Surgical delivery: The baby can grow a lot in the womb, which can force the delivery to be by cesarean section.
• Preterm labor or post term labor: The baby can be born prematurely or after 42 weeks of gestation.
• Hypertension in pregnancy: Condition that can put the life of the mother and the baby at risk.
• Diabetes in the future: There is a very high future risk of the mother suffering from type 2 diabetes permanently.

Complications affecting the baby

• Fetal macrosomia: Overweight of the baby at birth.
• Hypoglycemia: The baby’s glucose may drop soon after birth.
• Increased risk of postpartum infections.

Treatment

A major change in diet is essential. A significant reduction in calories is not indicated at this stage, since it can have aggravating effects on the baby; However, what should be reduced is the consumption of sugar or foods that contain it and increase the consumption of vegetables. Carbohydrate consumption should also be modified, avoiding those with a high glycemic index and changing them to carbohydrates that are slowly absorbed. All these indications must be provided with the support of a nutritionist.

If a change in diet is not enough to lower blood sugar levels, the endocrinologist will give a treatment with insulin, always checking the levels of glucose and glycosylated hemoglobin in the pregnant woman.

Recommendations

It is recommended that every woman perform a glucose test before and during her pregnancy, and even more so if she has a family history. Likewise, it is ideal that she is at an adequate weight at the time of pregnancy to avoid complications. On the other hand, if she had gestational diabetes, the mother should have a glucose tolerance test one month after her baby was born, in addition to a subsequent follow-up every six months or every year, since as time passes there is a remarkably high risk of developing type 2 diabetes.

Dr. Jesús Rocca
Endocrinologist at Clínica Ricardo Palma