Gestational Diabetes - Signs and Symptoms, Causes, Diet, Treatment
October 20, 2021
iMumz Expert Panel
Gestational diabetes, to put it simply, is a condition when the sugar (glucose) in your blood during pregnancy exceeds acceptable limits.
Your blood sugar levels can go up when your body isn’t producing enough of a hormone called insulin. Insulin helps:
- the muscles and tissues in your body to use blood sugar for energy
- your body to store any blood sugar that isn’t needed
While you’re expecting, your body has to make extra insulin, especially from Week 20 onwards. You need extra insulin because your placenta’s hormones are making your body respond less effectively to the current levels of insulin. Your body works hard to make that extra insulin. But, if it fails to, your blood sugar levels rise. That results in gestational diabetes.
Gestational diabetes is common, affecting as many as one in six mums-to-be.
The good news is that gestational diabetes usually goes away after your baby is born. It’s different from type 1 diabetes or type 2 diabetes, which last a lifetime.
But it can affect your baby’s health, and it raises your risk of getting type 2 diabetes later in life. You can take steps so you and your baby stay healthy.
Women with gestational diabetes have a 40–60% risk of developing diabetes mellitus over 5–10 years after pregnancy.
Also, children born in gestational diabetes pregnancies face an increased risk for obesity and type 2 diabetes.
Although gestational diabetes -associated mortality is rare, maternal and foetal mortality can occur when glucose levels are poorly controlled.
Pre-diabetes and diabetes (combined) affect approximately six million births in India alone, of which 90% are due to gestational diabetes.
What are the symptoms of Gestational Diabetes?
The important thing to note is that most pregnant women don’t report any signs of gestational diabetes. That’s why a mandatory screening for it is done, usually between the 24th and 28th weeks of pregnancy. The test checks the blood glucose (blood sugar) levels after drinking a glucose solution.
Also, you should watch out for these symptoms which could be an indicator for gestational diabetes:
- Increased thirst: Even after drinking more water than normal, still feeling thirsty.
- Fatigue: While most pregnant women report feeling tired, gestational diabetes tends to make one even more tired.
- Dry mouth: A parched mouth, dryness inside the oral cavity.
- Increased urination
- Getting infections such as thrush again and again.
- Noticing a blurred vision.
What are the causes of Gestational Diabetes?
Gestational diabetes occurs when your body can’t make the extra insulin needed during pregnancy. Insulin, a hormone made in your pancreas, helps your body use glucose for energy and helps control your blood glucose levels.
During pregnancy, your body makes special hormones and goes through other changes, such as weight gain. Because of these changes, your body’s cells don’t use insulin well. This condition is called insulin resistance. Most pregnant women can produce enough insulin to overcome insulin resistance, but some cannot. These women develop gestational diabetes.
What are the risk factors for Gestational Diabetes?
You may be more likely to develop gestational diabetes if:
- You are overweight with a body mass index (BMI) of 25 or more.
- You have already given birth to a large baby weighing 4.5kg or more.
- You’ve had gestational diabetes in an earlier pregnancy.
- Some ethnicities are more susceptible to getting gestational diabetes. South Asians (including Indians) are among those. Check if there is a history of gestational diabetes in your family: if a close relative has had it.
What are the tests done for diagnosis of Gestational Diabetes?
Currently, the Diabetes in Pregnancy Study Group of India advocates for universal screening using a single nonfasting 2-h 75 g glucose challenge test, with 2 h value > 140 mg/dL being diagnostic of gestational diabetes mellitus (GDM).
Because the symptoms are so hard to pick up on, the best way to know if you have gestational diabetes is by testing your sugar levels.
Urine tests are a standard part of your doctor visits. One element that is looked at in a urine test is the amount of sugar in the urine. If this level is higher than it should be, it might be an indication that you have gestational diabetes.
If your doctor thinks you have only a low risk of developing gestational diabetes she might ask you to take a fasting plasma glucose test. For this test, your blood sample will be taken once on an empty stomach first thing in the morning.
If your urine shows elevated sugar levels, your doctor will ask you to take the glucose tolerance test (GTT). This is usually done between 24 weeks and 28 weeks of pregnancy. The glucose tolerance test is done routinely at many diagnostic centres as a screening technique.
What are the treatments for Gestational Diabetes?
Treatment for gestational diabetes aims to keep blood glucose levels equal to those of pregnant women who don't have gestational diabetes. The treatment always includes targeted meal plans and scheduled physical activity, and it may also include daily blood glucose testing and insulin injections.
Here are 5 ways to stay healthy with gestational diabetes:
- Follow diet plans with discipline.
- Eat 6 small meals in place of 3 regular meals.
- Take walks, do Yoga
- Listen to soothing music to de-stress
- Don't miss doctor's visits.
What are Target Blood Sugar Levels for Women During Pregnancy?
Here are the blood sugar levels that are normal for women during pregnancy:
- Before a meal: 95 mg/dL or less
- An hour after a meal: 140 mg/dL or less
- Two hours after a meal: 120 mg/dL or less
Can I reverse gestational diabetes with diet?
In some cases, it is possible to reverse gestational diabetes just by following a strict diet. Your doctor will recommend a diet plan based on your unique situation and the requirement is that you stick to it with complete discipline.
While choosing foods, make sure you choose nutrient-dense foods like home made yoghurt (dahi) boiled and nicely-seasoned sprouts, vegetable dalia, vegetable poha, idli, vegetable uttapam or besan cheela with less oil.
Also, don’t skip meals. Your full-time job now is to keep regulating your blood sugar levels so aim to eat a healthy snack or meal every 3 hours or so. Eating nutrient-dense foods regularly can help keep you satiated and stabilize blood sugar levels.
What is the right Diet and Exercise for Gestational Diabetes?
Take these simple steps to stay healthy:
Eat a healthy, low-sugar diet. Talk to your doctor to be sure you’re getting the nutrition you need. Follow a meal plan made for someone with diabetes:
- Get rid of sugary snacks like mithai, toffees, and ice cream for natural sugars like fruits, carrots, and raisins. Add vegetables and whole grains, and watch your portion sizes.
- Have three small meals along with two or three snacks. Keep your meal timings SAME everyday.
- Get 40% of your daily calories from carbs and 20% from protein. Fifty percent of the carbs should be complex, high-fiber carbs, with fat being between 25% and 30%.
- Aim for 20-35 grams of fiber a day. Foods such as whole-grain breads, cereals, and pasta; brown or wild rice; oatmeal; and vegetables and fruits will help get you there.
- Limit your total fat to less than 40% of your daily calories. Saturated fat should be less than 10% of all the fat you eat.
- Eat a variety of foods to make sure you get enough vitamins and minerals.
The iMumz App has Yoga suggestions and Webinars to help manage gestational diabetes. Click here to download the App!
Can I eat pizza with gestational diabetes?
High-fat foods can make your blood sugar stay up for longer. So, it’s not a good idea to have pizzas, unless a teeny-weeny bite will address your pizza-craving!
You could make your own pizza base using almond flour instead of all-purpose flour to bake. Unlike wheat flour, almond flour is low in carbs and has a very low glycemic index, which makes it particularly adapted to a diabetes-friendly diet. It’s got healthy nutrients and tastes good, too!
Top it with sautéed mushrooms, capsicum, onions, olives and broccoli. A thin layer of low-fat cheese is fine.
How can I prevent Gestational Diabetes?
While the bad news is that gestational diabetes prevention is not always possible in many cases, it definitely is possible in few. So, every woman, whether high risk or not, should, first and foremost, aim for a BMI of 24 or below. A 2018 study looked at 10 years of data on gestational diabetes and concluded that being overweight was a significant risk factor.
The good news is that in the same research, it was found that making dietary changes reduced the risk. Here are the dietary changes that worked wonders:
- Consciously reducing the portion sizes
- Deleting processed foods from the diet
- Having only fruits to meet sugar craving.
- Eating protein to stay fuller longer: lentils, tofu, soya
- Increasing fiber intake by eating plenty of vegetables and whole grains
- Replacing juices, dairy-laden drinks, and sodas with herbal tea and lemon juice
Do mothers with gestational diabetes deliver early?
The complications caused by elevated blood sugar levels can increase the risk of premature birth. Studies show that the risk of premature delivery due to gestational diabetes is greater if a mother develops diabetes before the 24th week of pregnancy. 2 After the 24th week, the chances of preterm birth go down.
You're more likely to have a C-section if you have gestational diabetes and if the baby’s weight increases too much. Large babies (more than 4.5 kgs) are more likely to get stuck in the birth canal leading to birth injuries, hence a c-section is needed.
The Baby Care Program on the iMumz gives mums-to-be access to regular webinars and ‘Ask Me Anything’ sessions with experts. Click here to download the App!
How can I treat gestational diabetes naturally?
Are you more than 20% over your ideal body weight? The first target for you should be to keep your weight in check. Make healthy food choices by eating a variety of foods including fresh fruits and vegetables, limiting fat intake to 30% or less of daily calories and watching your portion sizes.
Keep active! Regular exercise allows your body to use glucose without extra insulin. This helps combat insulin resistance and is what makes exercise helpful to people with diabetes. However, it is important to check with your doctor before starting an exercise program.
What are some good exercises for managing gestational diabetes?
It is a good idea to keep exercising before and during pregnancy. Not only is it overall beneficial, it can help prevent gestational diabetes.
What exercise does is that it trains the body to become more sensitive to the insulin that the pancreas creates, which helps regulate blood sugar levels.
Here is a tip: get active EVEN before becoming pregnant. For anyone with a sedentary lifestyle, steps that may help include:
- Cycling in the park
- Walking in the marketplace
- Taking the stairs
- Doing active leisure activities, such as hiking, gardening, or playing with children outdoors
- Making a walking pact with friends
Are there any good Yoga Asanas to manage Gestational Diabetes?
Yoga can help with gestational diabetes by regulating hormones that affect blood sugar levels, cortisol and adrenaline levels, and emotional well being by stimulating the relaxation response in the body. Yoga also brings the practitioner into deeper awareness of her body so that she accurately monitors her energy level, blood sugar level, and appetite.
Yoga, done with pranayama significantly decreases blood glucose level .
Here are some Yoga asanas that you should definitely incorporate in your daily workouts:
- Tadasana - the palm tree pose
- Paschimottanasana- seated forward bend
- Balasana- the child’s pose
- Marjariasana- the cat stretch pose
- Konasana- side bending
- Virabhadrasana- the warrior pose
- Trikonasana- the triangle pose
If any of the following warning signs occur, it is advised that exercise should be terminated: vaginal bleeding, dizziness, headache, chest pain, muscle weakness, preterm labour, decreased foetal movement, amniotic fluid leakage, calf pain or swelling and dyspnoea without exertion.
Will Gestational Diabetes Affect My Baby?
Most women with gestational diabetes have healthy babies because the condition is easily spotted and can be managed.
If your diabetes is not controlled and you have too much sugar in your blood, it will cross the placenta to your baby. This can make your baby grow big. A big baby can make labour and birth more difficult, increasing the risk of a complicated birth. Rarely, it can even lead to a baby being stillborn. That’s why your doctor will work with you to keep your blood sugar at a healthy level.
Uncontrolled diabetes can also result in too much water, or amniotic fluid, developing around your baby, a condition known as polyhydramnios.
Early labour is a risk factor so monitor yourself closely. Choose a hospital that isn’t too far from your home!
Depending on how your pregnancy is going, and on how big your baby has grown, your labour might be induced or your doctor might suggest a caesarean section between 38 weeks and 40 weeks.
If your doctor thinks you and your baby are doing well, she might just ask you to get frequent scans after 38 weeks as you wait for labour to start on its own. These scans will check how your baby is doing and check the blood supply from the placenta.
When you go into your labour, you and your baby will need continuous monitoring. If your doctor suspects that it will be difficult for your baby to come out, or if your baby appears distressed, she will suggest a caesarean birth.
Will I get Type 2 Diabetes? Will this continue after birth?
After the delivery, the doctor will check your sugar-levels once more. This test will be repeated at your six-week postnatal check. For most women, gestational diabetes goes away after birth.
One study reports that one in five mums diagnosed with gestational diabetes actually already had type 2 diabetes before they conceived, without realising it. If this was your case, the diabetes will not go away after birth. But all the lifestyle changes you made during pregnancy will help you to manage your diabetes after birth.
Many women who have gestational diabetes go on to develop type 2 diabetes years later. There seems to be a link between the tendency to have gestational diabetes and type 2 diabetes since both involve insulin resistance. Again, if you stick to the lifestyle changes, it will really help in preventing diabetes after gestational diabetes.
What are some Ayurveda Tips to Manage Gestational Diabetes?
1. Chankramana (walking) - Walking for 10 minutes after each main meal will help those whose glucose levels are not in control even after taking medicine. This exercise helps muscles absorb blood sugar preventing it from building up in the bloodstream. You are also keeping yourself safe against gaining excess weight.
2. Satvavajay Chikitsa - Practice mindfulness meditation. The iMumz App has well-researched mindful meditation activities that you can check out.
3. Manasik Swasthya - Remain absolutely conscious about managing your mental stress in day-to-day life. The stress hormone cortisol has a direct impact on high blood sugar! Make sure to get 7-8 hours of sleep and 2 hours of afternoon rest. The iMumz App has soothing ragas that work wonderfully on reducing stress.
4. Nidana Parivartan - Avoid excessive sleeping, excessive consumption of curd, excessive consumption of jaggery products, new cereals, sheeta (cool) and snigdha (soft) drinks and other kapha-increasing edibles. Stay away from foods that are sour, salty, sweet, or oily.
A nice herbal tea for removing Kapha dosha:
- Boil 4-5 cups of water in a pan.
- Add ½ inch of ginger and let it simmer for 2-3 minutes.
- Take the pan off the heat and steep 5 mint leaves and a pinch of cinnamon.
- Strain and store in a flask.
- Drink it throughout the day as part of your everyday kapha diet.
What is the best thing to eat before bed for those who have gestational diabetes?
It’s actually good to eat a small balanced snack before bed. Its important to know why. Here are the two reasons:
The Dawn phenomenon: Between roughly 3:00 a.m. and 8:00 a.m., blood sugar levels surge as your body prepares to wake up. This causes high blood sugar levels in the morning.
The Somogyi effect: Glucose levels drop significantly between 2:00 a.m. and 3:00 a.m. The body responds by releasing hormones that raise blood sugar levels again. It can release too much of these hormones, leading to high blood sugar levels in the morning.
Eating a bedtime snack can prevent blood glucose levels from dropping very low during the night and lessen the Somogyi effect.
NO fruit or milk before bed, mind you! Not eating a snack will prevent the liver from releasing sugar into the bloodstream while you sleep which can lead to high sugar numbers before breakfast the next day. What are some snack ideas?
- A handful of nuts.
- A sliced apple
- Avocado on toast
- Wheat biscuits
- Carrot or cucumber slices.
- Celery sticks with hummus.
- Roasted chickpeas.
- Roasted chivda with peanuts
What are some Indian Vegetarian Diet Plans to manage Gestational Diabetes?
Vegetarian Diet Plan for Gestational diabetes diet - Option 1
Early morning (between 6am - 7am)
- 1 glass warm water with 15 ml aloe vera juice
- Soaked nuts and seeds- 2 almonds, 1 fig, 1 dry date, 1 tsp flax seeds and pumpkin seeds, 1 walnut
Breakfast (between 8am - 9am)
- Oats upma with lots of vegetables
- Sprouts bhel with chopped vegetables
- 1 medium-sized seasonal fruit (apple, pear, orange, sweet lime)
- 1 glass spiced buttermilk (chhachh) - add mint leaves, coriander leaves, cumin seeds, saindhav salt and asafoetida
Lunch (between 1pm - 1.30pm)
- Salad (tomatoes, spring onion, cucumber, beetroot, flax seeds, lemon juice)
- 1 large bowl of stir-fried okra (bhindi)
- 1 bowl of dal with fenugreek (methi) leaves
- Lemon pickle and flax seeds chutney (powder)
- 2 medium-sized millet rotis
- Lemonade (nimbu pani)
Evening snack (6pm)
- Makhana with peanuts
- Green leafy vegetables and dal (dill leaves, fenugreek leaves, amaranth leaves, moringa leaves, spinach )
- 1 bowl of mixed vegetables
- 1 katori khichdi (soyabean, barley, mix dal, paneer)
- 2 cheelas
- 1 cup turmeric milk
Vegetarian Diet Plan for Gestational diabetes diet - Option 2
Early morning (between 6am - 7am)
- 1 tsp soaked methi seeds with one glass warm water
- 1 piece of dry coconut , soaked nuts - 2 almonds , 1 fig , 1 walnut , 2 cashews, 2 pistachios
Breakfast (between 8am - 9am)
- 1multigrain methi thepla with ghee
- 1 bowl soya chunk bhel with chopped vegetables
- 1 medium-sized seasonal fruit (pear , apple , orange , sweet lime , strawberries , blackberries )
- 1 glass tender coconut water
Lunch (between 1pm - 1.30pm)
- Beetroot , carrot , raddish , cucumber with flax seeds salad
- 1 large bowl of bitter gourd vegetable
- 1 bowl of dal with spinach leaves
- 1 cup cucumber raita
- 2 medium-sized millet rotis
- Peanut chutney
- Barley soup / moong soup
Evening snack (6pm)
- Murmura bhel with chopped vegetables
- Green leafy vegetables and dal
- 1 bowl of salad
- 1 katori khichdi ( mix vegetables)
- 2 moong chelas
- 1 cup saffron milk