While pregnant, women who have never had diabetes before but then develop high blood glucose levels may be diagnosed as having gestational diabetes, according to the American Diabetes Association.

It’s when the blood glucose level (blood sugar) of the mother stays high (hyperglycemia) because she is unable to make and use all the insulin needed to support the demands of the pregnancy. About 18% of women may experience gestational diabetes while pregnant but only 7% of those pregnancies will face complications.

Having an elevated blood glucose level, or glucose intolerance, while pregnant raises concerns not only for the mother but also can cause long-term problems for the baby. Hence it must be treated seriously. In recent years, doctors are vigilant about checking for gestational diabetes so that it is identified and effectively managed early.

Warning Signs of Gestational Diabetes

1. Sugar in the urine
2. Unusual thirst
3. Frequent urination
4. Fatigue
5. Nausea
6. Blurred vision
7. Vaginal, bladder, and skin infections

There are several risk factors in gestational diabetes

1. Age:

   Women who become pregnant after the age of 25 years are more likely to get gestational diabetes.

2. Weight: 

   Women who are overweight (have a body mass index (BMI) > 24) are more at risk for gestational diabetes.

3. Family history:

   If someone else in the family has or had diabetes (type 1, type 2, or gestational diabetes), the pregnant woman is at higher risk.

4. Prediabetes:

   This is a diagnosis of warning for future diabetes. It means that the mother's blood glucose levels are higher than normal, but they aren’t high enough to be considered diabetes yet. If she has been told that she has prediabetes, she should be more vigilant about having her blood sugar checked regularly and often, to check for the onset of gestational diabetes.

5. Previous pregnancies with gestational diabetes:

   If the pregnant woman developed gestational diabetes during a prior pregnancy, she is more at risk for developing it in future pregnancies.

Medical Nutrition Therapy (MNT)

1. General Principles:

   All women with GDM should receive nutritional counseling. The meal pattern should provide adequate calories and nutrients to meet the needs of pregnancy. The expected weight gain during pregnancy is 300 to 400 gm/week and the total weight gain is 10 to 12 kg by term. Hence the meal plan aims to provide sufficient calories to sustain adequate nutrition for the mother and fetus and to avoid excess weight gain and postprandial hyperglycemia. Calorie requirement depends on age, activity, pre-pregnancy weight and stage of pregnancy. Approximately 30 to 40 Kcal/kg ideal body weight or an increment of 300 kcal/day above the basal requirement is needed in the 2nd and 3rd trimesters. Pregnancy is not the ideal time for obesity correction. Underweight subjects or those not gaining weight as expected, particularly in the third trimester, require admission to ensure adequate nutrition to prevent low birth weight infants.

2. Calorie Counting:

   As a part of the medical nutrition therapy, pregnant diabetic women are advised to wisely distribute their calorie consumption especially breakfast. This implies splitting the usual breakfast into two halves and consuming the portions with a two-hour gap in between. By this, the undue peak in plasma glucose levels after ingestion of the total quantity of breakfast at one time is avoided. For example, if 4 idlis / chappathi / slices of bread (applies to all types of breakfast menu) is taken for breakfast at 8 am and two hours plasma glucose at 10 am is 140 mg/dl: the same quantity divided into two equal portions i.e., one portion at 8 am and the remaining after 10 am, the two hours postprandial plasma glucose at 10.00 am falls by 20 – 30 mg/dl.

3. Explanatory Note:

   This advice, of splitting the breakfast into two portions, has a scientific basis as the peaking of plasma glucose is high with breakfast (due to the dawn phenomenon) than with lunch and dinner. In a normal person, insulin secretion is higher with breakfast then with lunch or dinner [53], whereas, GDM mothers have a deficiency in the first phase insulin secretion and to match this insulin deficiency the challenge of the quantity of food at one time should also be less.

4. Medications/Insulin:

   Most people are able to control blood glucose levels through adjustments in diet and exercise. However, if the pregnant woman needs a little extra help, the doctor may prescribe insulin or another medication to assist her body in regulating her blood glucose level. These medications will not have any negative effects on your baby. Remember, the most important goal is to keep her blood sugar in the target range to give her and her baby the best health in the long term.