Gestational Diabetes----Definition, Types, Symptoms, Risk Factors and Treatment

 What is  Gestational Diabetes?

Gestational diabetes or diabetes in pregnancy is a type of diabetes that affects women during pregnancy. Diabetes is a condition where the amount of glucose (sugar) in the blood is too high.

Normally the amount of glucose in the blood is controlled by a hormone called insulin. However, during pregnancy, some women have higher than normal blood glucose levels and their body may not produce enough insulin to deliver blood to all those cells. This means that the level of glucose in the blood rises. It is important for you to know about gestational diabetes.

Types of Gestational Diabetes

There are two main types of gestational diabetes:

Type 1 diabetes - when the body does not produce insulin at all (often referred to as juvenile diabetes or early diabetes)

Type 2 diabetes - when the body does not produce enough insulin and/or the body's cells do not respond to insulin (insulin resistance)

For women who have diabetes before becoming pregnant, see the relevant link.

Point of view

Gestational diabetes or diabetes in pregnancy can be controlled by our diet and exercise. However, some women with gestational diabetes will need medication to control blood sugar levels. Read more about how gestational diabetes is treated.

If gestational diabetes is not detected and controlled, it can increase the risk of birth complications. As babies are larger than their gestational age (macrosomia).

In most cases, gestational diabetes develops in the third trimester (after 28 weeks) and usually disappears after childbirth. However, women who develop gestational diabetes are more likely to develop type 2 diabetes later in life.

Symptoms of Gestational Diabetes

Gestational diabetes is often diagnosed during routine screening. It sometimes doesn't cause any symptoms.

However, high blood sugar (hyperglycaemia) can cause some symptoms, including:

• excessive thirst

• dry mouth

• Frequent urination

•      Tiredness

• Frequent infections, such as thrush (a yeast infection)

• Blurred vision

Diabetes is a condition where there is too much glucose (sugar) in the blood.

Diabetes is either caused by insufficient insulin production, or the body becomes resistant to insulin, which means that insulin does not work properly.

The amount of glucose in your blood is controlled by a hormone called insulin, which is produced by the pancreas, a gland behind the stomach.


When you eat, your digestive system breaks down the food into pieces and the nutrients are absorbed into your bloodstream. Normally, insulin is produced to move any glucose from your blood into your cells. The glucose in your cells is then broken down for energy production.

Diabetes in pregnancy

During pregnancy, your body produces several hormones (chemicals), such as estrogen, progesterone, and human placental lactogen (HPL). These hormones make your body resistant to insulin, which causes This means that your cells respond less to insulin and your blood glucose levels remain higher.

The purpose of the effect of this hormone is to transport extra glucose and nutrients in your blood to the foetus (unborn baby) so that the foetus can develop.

To cope with the increased amount of glucose in your blood, your body must produce more insulin. However, some women may not produce enough insulin in pregnancy to deliver glucose to cells, or their body's cells are more resistant to insulin. This condition is known as gestational diabetes.

Risk Factors of Gestational Diabetes

You may be at increased risk of gestational diabetes if:

• Your body mass index (BMI) is 30 or higher

• Your first child has a birth weight of 4.5kg (10lbs) or more - babies who weigh more than 4kg (8.8lbs) are called macrosomic.

• You had gestational diabetes in a previous pregnancy

• You have a family history of diabetes - one of your parents or siblings has had diabetes

• Your family's origin is South Asian (specifically India, Pakistan or Bangladesh), Black Caribbean or Middle Eastern (specifically Saudi Arabia, United Arab Emirates, Iraq, Jordan, Syria, Oman, Qatar, Kuwait, Lebanon or Egypt) Is

Gestational Diabetes’ test

Every pregnant woman with one or more risk factors should be offered a screening test for gestational diabetes.

Screening usually identifies healthy people who may be at increased risk of conditions such as diabetes. You may then be offered information and further tests to determine what condition you have.


You can do this by booking a test for gestational diabetes. This happens in the first prenatal consultation with your nurse or doctor, which is around 8-12 weeks of your pregnancy.

At this time, your doctor or midwife will know if you are at risk for gestational diabetes. They will ask about any risk factors that may affect you, such as whether you have a family history of diabetes.

Read about the causes of gestational diabetes for a complete list of the risk factors you may need.

If any of these risk factors apply to you, you will be offered a test for gestational diabetes.


Gestational diabetes is usually diagnosed at 24-28 weeks using an oral glucose tolerance test (OGTT). For the OGTT, a sample of your blood will be tested, then you will be given a glucose drink. Another sample of blood will be taken two hours later to see how your body is reacting to the glucose.

If you have had gestational diabetes in a previous pregnancy, the OGTT will be performed at 16-18 weeks, followed by a repeat OGTT at 28 weeks if the first test is normal.

Gestational Diabetes Treatment

If you have gestational diabetes, you will be given advice on how to monitor and control your blood sugar (sugar) levels.

For many women, changing diet and getting more exercise will be enough to control your gestational diabetes. Some women will need medication.

In addition, you will be taught how to monitor blood sugar, and your unborn baby will be closely monitored.

Blood Glucose Monitoring

Your doctor will discuss with you how to test your blood glucose levels. They'll also explain how blood glucose is measured, and what level you should aim for.

Blood glucose levels are usually measured in terms of the amount of millimoles of glucose in one liter of blood. Millimole is a measurement that defines the concentration of glucose in your blood. The measurement is expressed as millimoles per liter.

Your individual millimole per liter target will be set for you. This might include a goal for you:

• Blood glucose during fasting (after you have been hungry for eight hours)

• Glucose in the blood after a meal (one hour after you eat)

You will be advised when and how often you need to test your blood glucose. You may need to test blood glucose after every meal during pregnancy and blood glucose during fasting. If your diabetes is being treated with insulin (see below under Medications), you may need to test your blood glucose before sleeping at night.


You may be advised to change your diet to control your gestational diabetes. You should be referred to a dietitian (a professional who specializes in nutrition) for advice on a special diet.

 Treatment of Gestational Diabetes

Eat Regularly

Don't skip meals. By eating regular, balanced meals that include a starchy carbohydrate with a low glycemic index (GI), you can absorb carbohydrates more slowly, keeping your blood sugar levels stable between meals.

Choose from pasta, basmati or easy cook rice, grainy breads such as granary, pumpernickel and rye, new potatoes, sweet potatoes and yams, oatmeal oats, all-bran and natural muesli. High fiber varieties of starchy foods will help your digestive system and prevent constipation.

GI Foods

The GI rank of a food is based on the level of sugar in the blood. Light GI foods are slowly absorbed into the bloodstream, and high GI foods are quickly absorbed, causing blood sugar levels to rise.

Don't rely solely on GI ratings. Aim for a balanced and attractive diet, which you can maintain for a long time. Think about variety to get the full benefits of low GI foods.

Eat more fruits and vegetables

Aim for at least five portions a day to take in vitamins, minerals and fiber, but keep to one portion of fruit at all times. And try to include beans and lentils such as kidney beans, butter beans, chickpeas or red and green pulses.

Limit sugar and sugary foods

You don't have to eat a sugar-free diet. Sugar can be used in baking in foods and as part of a healthy diet, but use it sparingly. You can reduce the sugar level in your diet by drinking sugar-free, added sugar or diet colas or squash instead of sugary drinks.

You may also be advised to choose a lean (fat-free) protein, such as fish. Eat two portions of fish a week, one of which should be oily fish, such as sardines or mackerel. There are some fish you should avoid, for example, eating a lot of tuna.

Unsaturated fats

Aim to eat a balance of polyunsaturated and monounsaturated fats. Small amounts of unsaturated fat will keep your immune system (the body's defense system) healthy and may lower cholesterol levels (cholesterol is a fatty substance that can build up in your blood and seriously affect your health). Is).

Foods high in unsaturated fat include:

• Nuts and Seeds

• Avocado

Sunflower, olive and vegetable oils



If your body mass index (BMI) is greater than 27 before you became pregnant, you may be advised to reduce the amount of calories in your diet.

Your doctor, nurse or diabetes team will give you advice on how many calories you should eat in a day, and the safest way to work calories into your diet.

Work out

Physical activity lowers the level of glucose in your blood, so regular exercise can prove to be an effective way to treat gestational diabetes. The doctor, nurse or diabetes team will advise about the safest way to exercise during pregnancy.

If your body mass index (BMI) was greater than 27 before you became pregnant, you may be advised to get at least 150 minutes (2 hours and 30 minutes) of moderate exercise each week. It can be any activity that can slightly increase your breathing and heart rate, such as bicycling or brisk walking.


If diet and exercise haven't effectively controlled your gestational diabetes after about one to two weeks, you may be given medication. The timing may vary depending on your glucose level.

There are many different types of medications available, and the choice will depend on:

• What will most effectively control your blood sugar

• What is acceptable to you

Possible drugs include:

• Insulin Tablet

• Metformin and Glibenclamide in tablet form

These are explained in more detail below. These medicines will be stopped soon after your baby is born.

Insulin Injection

If you are insulin resistant (your body doesn't respond to insulin), you may need insulin injections to make sure your body has enough insulin to lower your blood sugar levels.

Insulin must be given by injection because if you swallow it, enzymes (proteins that speed up and control chemical reactions in the body) in your stomach digest it like food and it will not be effective. If you need insulin injections, you will be shown:

• How and when to inject yourself

• How to store your insulin and destroy your needles


Insulin has many different uses. You may be advised to:

• Quick-acting insulin analogues (aspart or lispro) - these are usually given before or after a meal; These work quickly but don't last long

• Basal insulin (insulatard or lantus) - these are usually injected at bedtime or upon waking; They provide the necessary background to keep blood sugar levels stable between meals.

These are safe to use during pregnancy. However, you will need to check your blood sugar closely. If you are being treated with insulin, you will need to check your:

• Blood glucose during fasting (after about eight hours of starvation)

• Glucose in the blood, one hour after each meal

• Blood glucose at other times (eg if you feel unwell or are having attacks of hypoglycaemia - low blood glucose)

If you have too little of it in your blood, you may have hypoglycemia.

Oral Hypoglycaemic Agents

In some cases, you may be advised to take oral hypoglycaemic agents with or instead of insulin. These are medicines that are ingested to lower the level of glucose in your blood. Both of these can be used during pregnancy:

- metformin

- Glibenclamide (from the 11th week of pregnancy)

Both metformin and glibenclamide can cause side effects, including:

• Nausea or boredom

•      Vomit

• Diarrhea (loose, watery stools)

Along with insulin, if you are using glibenclamide, you may be at risk of hypoglycaemia. This does not usually happen with metformin unless it is used in combination with insulin or glibenclamide.

For a full list of additional side effects, see the information leaflet that comes with the medicine.

monitoring your unborn baby

If you have Gestational Diabetes

your unborn baby may be at risk of complications, such as growing in size for the time of pregnancy. Because of this, you may be offered additional antenatal appointments so that your baby can be closely watched throughout your pregnancy.

Your consultation talks include:

• An ultrasound scan around 18-20 weeks of your pregnancy to check for any signs of abnormalities in your unborn baby's heart (if you are diagnosed with gestational diabetes late in your pregnancy, you may not get this scan) can be suggested)

• Ultrasound scans to monitor your baby's growth and the amount of amniotic fluid (the fluid that surrounds them in the womb) at weeks 28, 32, 36 of pregnancy and at regular checkups from week 38




If you have gestational diabetes and your baby is growing at a normal rate, you may be given the chance to start labour after the 38th week of pregnancy.

This can be done by inducing labour pain. This is when labour pains are triggered artificially by inserting a pessary (tablet) or gel into your vagina or injecting a hormone into your arm.

As long as your blood sugar is within normal levels, your baby's ultrasound scan is normal, and there are no other pregnancy problems, you can naturally wait for labour pains to begin.

If your baby is larger than expected for his gestational age (macrosomic), your doctor should discuss birth options with you.

Normal delivery is usually still possible but it will depend on the size of the baby.

You should give birth in a hospital where healthcare professionals trained in reviving new-borns are available 24 hours a day.

During labour and birth, the glucose in your blood will be measured every hour and will be kept between 4 and 7 millimoles per liter. If you are taking insulin during pregnancy, you will be advised to have an intravenous drip of insulin and glucose during labour pains, to carefully control your blood sugar levels.

About two to four hours after birth, your new-born baby's blood sugar will also be measured, usually before the baby's second feed.

Complications associated with gestational diabetes

If gestational diabetes is detected, or it is not managed effectively, it can cause problems for both you and your baby.

Controlling the level of glucose in your blood during pregnancy reduces the risk of complications.

Gestational diabetes can increase the risk of:

• Placental abruption - The placenta (the organ that connects a pregnant woman's blood supply to her unborn baby) begins to break away from the wall of the womb (uterus). This can lead to vaginal bleeding and/or persistent abdominal pain.

• Need to induce labour pain - when medication is used to artificially initiate pain

•      premature birth

• Macrosomia

• Trauma during birth - to yourself and your baby

• Neonatal hypoglycaemia – your newborn has low blood sugar, which can make the diet work, cause blue skin and irritability

• Perinatal death - the death of your baby around the time of birth

• Development of obesity and/or diabetes later in the child's life

Premature birth

Gestational diabetes can lead to premature birth (your baby is born before the 37th week of pregnancy). This can cause further complications for your baby, such as:

• Respiratory distress syndrome - your baby's lungs are not fully developed and cannot provide enough oxygen to the rest of their body

• Jaundice - Your baby's skin turns yellow when a waste product called bilirubin builds up in the blood.


Gestational diabetes increases the risk of your baby becoming older than gestational age, ie weighing more than 4kg (8.8 grams). This is known as macrosomia.

Macrosomia occurs during pregnancy because excess glucose from the mother's blood passes into the foetus (unborn baby). This causes the foetus to produce insulin (a hormone) that allows glucose to enter the cells, resulting in growth.

Delivery time Shoulder dystocia



Macrosomia can cause a condition called shoulder dystocia. This is when your baby's head passes through your vagina, but your baby's shoulder is stuck behind your pelvic bone (the ring of bone that supports your upper body, also called the hip bone) .

Shoulder dystocia can be dangerous because the child may have trouble breathing when the child is trapped. It is estimated to affect 1 in 200.

Future position


After having gestational diabetes, you are about seven times more likely to develop type 2 diabetes than women with normal pregnancies.

Type 2 diabetes is when your body doesn't produce enough insulin, or the body's cells don't respond to insulin (insulin resistance).

Therefore, it is essential to monitor your blood sugar after birth to check whether it is normal or not.


Your child may be at higher risk of developing these conditions in the future:

•      Diabetes

•      obesity

future pregnancies

Having gestational diabetes, you have an increased risk of developing gestational diabetes in future pregnancies.

If you are planning a second pregnancy, it is very important to talk to your doctor. They may arrange to monitor your own blood glucose from early in your pregnancy.

Diabetic blood test

You can monitor your own blood sugar levels using a simple finger prick test or urine test.

finger prick test

You will need to do this independently:

• blood test strips

• Blood Glucose Meter

• Finger Prick

• Lancets

• Diary to monitor blood sugar

• Sharps box to throw sharps

These can be provided by your doctor or hospital.


• Before performing a finger prick test, make sure you have all of your equipment in a clean dry place.

• Wash your hands and clean them thoroughly with warm water (dirty hands can contaminate the blood sample and give false results).

• Select your finger and massage the finger to improve blood circulation.

• Pricking the fleshy part of your finger can result in injury. Instead, prick the finger away from the thumb. Gently squeeze your finger to get a drop of blood.

• Take a drop of blood on the test strip. The meter will automatically give the result.

• Note the result in your diary.