Gestational diabetes

Diagnosis

During the second trimester of pregnancy, the mother who is at average risk of gestational diabetes will be recommended to undergo screening test.

The mother who is at high risk of diabetes, the test for diabetes will be recommended during the first prenatal visit.

After delivery, it is recommended that 6–12 weeks after giving birth, women with GDM should be checked for persistent diabetes. In additionally, it is advised that women with a history of GDM will be required to take a lifelong screening for diabetes or prediabetes, ideally every three years.

Depending on the health care provider, screening tests could vary, but typically include:

• Initial glucose challenge test: the patient will consume a glucose solution then the blood sugar will be measured after an hour of glucose solution consumption.
  • Below 140 mg/dL (7.8 mmol/L) is the normal range on a glucose challenge test.
  • 190 milligrams per deciliter (mg/dL), or 10.6 millimoles per liter (mmol/L), indicates gestational diabetes.

A second glucose tolerance test will be required to determine the presence of gestational diabetes if the blood sugar level is greater than expected, but this may vary depending on the laboratory or clinic.

• Glucose tolerance testing: the patient blood sugar will be tested hourly for three hours after the consumption of sweeter glucose solution. The patient may be considered to have gestational diabetes if at least two of their blood sugar levels are higher than normal.

Treatment

The goal of treatment for gestational diabetes is to maintain normal blood glucose levels. Maintaining good blood sugar levels benefits both the mother and the child. They can avoid complications throughout pregnancy and delivery with close supervision.
Gestational diabetes treatment may include:

• Lifestyle changes: healthy diet and regular physical activity (as recommended) will help maintain the blood sugar level within the normal range. Healthcare providers will assist the patient in developing a meal plan for the healthy diet based on the present weight of the patient.
  • Healthy diet: Fruits, vegetables, whole grains, and lean protein are the mainstays of a healthy diet, which also restricts overly refined carbs, such as sweets. These foods are also high in nutrition and fiber and low in fat and calories.
  • Physical activity: Before, during, and after pregnancy, regular physical activity is an important factor for wellness. If the patient is not physically active, diabetes could develop. Pregnancy-friendly options include cycling, swimming, and walking. Housework and gardening are examples of everyday activities that are included.

The blood sugar usually decreases after physical activity. Also, regular exercise can assist in reducing a number of pregnancy-related discomforts, including back pain, cramping, swelling, constipation, and difficulties sleeping.

• Daily blood sugar monitoring: to ensure that the blood sugar level remains within the normal range while the patient is pregnant, the healthcare provider will recommend that the patient monitor the blood sugar level four times a day or more times, preferably upon waking up at the morning and after meals.
• Medication: Blood sugar levels may need to be lowered with insulin injections if healthy diet and physical exercise are insufficient to control the blood sugar. Prescription of oral medication or injectable will be discussed with the healthcare provider to properly manage the gestational diabetes. Some pregnant women with gestational diabetes require insulin to achieve the normal range of blood sugar.
• Monitoring before delivery: Close monitoring of the baby is important. Healthcare provider will perform an ultrasound and other tests to monitor the growth and development of the infant. The healthcare provider may induce the labor if the patient does not start labor by their due date. The mother and the baby have a higher risk of developing complications if the labor is after the due date.
• Monitoring after delivery: Blood sugar level will be check after the delivery and within 6 to 12 weeks, this is to ensure that the blood sugar level is within the normal range. If the blood sugar is within the normal range then the patient may have a follow up for at least every three years for assessment for any prediabetic risk. If the patient developed type 2 diabetes or prediabetes, then consultation with the healthcare provider will be discussing on the treatment options to manage the blood sugar level within the normal range.