Gestational Diabetes Mellitus (GDM) is a condition where pregnant women exhibit high blood sugar levels without previously diagnosed diabetes. It is caused by improper insulin responses. Good news is, it should go away as soon as the baby is delivered and will not pose fatal problems to the baby.
Diabetes basically means that there is too much sugar (glucose) in the blood. Whilst the body relies on glucose for energy, too much of it is obviously not favorable. Ideally, the blood sugar level in our body has to stay at a level that is not too high or too low. Insulin, which is produced by pancreas, functions like a key to each and every one of your cells. It opens the lock to your cells and lets sugar enter them.
What happens is that as the pregnancy progresses, the body undergoes many changes to provide the most favorable conditions for the growing baby. The placenta makes hormones, some of which cause the body tissues to become resistant to insulin. In order to overcome this resistance, the pancreas has to produce extra insulin. If the pancreas fails to produce the extra insulin, pregnant women will develop GDM.
Left untreated, GDM may cause problems during the pregnancy or for the baby.
It was diagnosed usually at the end of the second trimester of pregnancy at around 28 weeks. It is not done earlier because women do not usually develop GDM before that.
The diagnosis was done through Glucose Tolerance Test to assess how well your body responds to high glucose. After fasting for 8 hours, your blood gets withdrawn first to check for your fasting blood sugar level. And then, you are to gulp down a sugary drink and wait for an hour to get your blood sugar tested. Lastly, you wait another hour to get your blood sugar level tested again. It was not a pleasant experience as you cannot eat until the test is done.
The result will show three figures of blood sugar levels. First was the fasting, then the one and two-hour levels. The cut-off values for GDM are as follows:
Fasting glucose >= 5.1 mmol/L
One-hour glucose >= 10.0 mmol/L
Two-hour glucose >= 8.5 mmol/L
Approximately 5-12% of pregnant women will develop GDM during their pregnancy. There are risk factors, stated below, that contribute to the diagnosis:
- Maternal age greater than 35 years
- Family history of diabetes
- Ethnicity (certain races are more susceptible to diabetes)
- History of having large babies
- PCOS (which causes insulin resistance)
- Maternal weight
- Previous GDM
- Certain medications
- Multiple pregnancies
Sometimes, there are no obvious reasons for developing GDM, which is why screening is recommended for all pregnant women.
Effects on mother
The most obvious effect of GDM for pregnant women is high blood sugar levels in the body. High amount of sugar in the blood causes several symptoms such as extreme thirst, frequent and very copious urination (this differs from frequent urination due to pregnancy), fatigue, and snoring. These symptoms are hard to notice as some of them are similar to pregnancy symptoms.
Effects on baby
- Big baby (which may make labor difficult)
- Low blood sugar
- Pre-term birth
- Temporary breathing problems
- Higher chance of obesity and diabetes in the future
These effects are significantly lowered with controlled blood sugar during pregnancy. In my case, my baby did not suffer any of them. He was born perfectly healthy and well.
I had to do the GTT twice because the result from Jakarta was not valid in Sydney. From my experience, the test done in Jakarta could be less accurate for the following reasons:
- The sugary drink was prepared by the nurse in a glass using plain water mixed with 75g of sugar. While in Sydney, the drink was prepackaged and sealed in a bottle.
- The second and third blood sugar level check was done using the blood glucose meter instead of drawing the blood from your veins again.
- I was allowed to drink any amount of water whilst in Sydney I was only allowed to drink as much water as the sugary drink.
- The nurse in Jakarta did not use a timer to time the one and two-hour mark.
As for the results, my blood sugar levels came out normal in Jakarta while in Sydney I was diagnosed with GDM. I was then referred to an endocrinologist. She told me to watch my carbohydrate intake and take a 30-minute walk every day.
The symptom that I noticed was extreme thirst at the beginning of third trimester. I would feel extremely thirsty throughout the day (worse in the morning after waking up) which did not go away by drinking water. It was quite uncomfortable. Thankfully, after a couple of weeks of decreasing my carbohydrate intake and exercising, I found that the thirst went away.
To control my blood sugar, I was to take blood sugar readings every morning before breakfast and an hour after each meal throughout the day. The morning readings had to be below 5 mmol/L while the ones after meals should be under 7.4 mmol/L. Most of my readings were well under control with a few spikes if I had eaten certain high-carb foods. The highest ever was after dimsum (10.1 mmol/L).
I was also advised to start massaging the breasts for 5 minutes each day and try to express some colostrum. I had read that some women are able to get some colostrum before the baby arrives. It did not happen for me though. The expressed colostrum is to be given to the baby in case my milk was not enough for the baby to maintain normal blood sugar level after birth.
I am thankful that it all went well. My baby and I was well after the delivery. He was checked for blood sugar and it came out fine. He also did not experience the possible effects at all. In my case it was probably just a mild case of gestational diabetes. Plus, I was carefully managing what I ate. I think it is important to be aware of this especially if you are overweight. If not, most probably it will be just fine.