Gestational Diabetes (2)

Risk Factors, Mechanisms, and Management

What hygienic and dietary advice should be followed?

How should blood glucose levels be monitored?

Dr. Claude Allouche, gynecologist, Ahuza Clinic,

Raanana, Israel, 058 726 02 64

Risk Factors for Gestational Diabetes:

• Overweight and Obesity:
  • BMI > 25 kg/m² (overweight)
  • BMI > 30 kg/m² (obesity)
  • Often associated with lack of physical activity.
• Age:
  • Increased risk for women over 35 years old at the start of pregnancy.
• Family History:
  • Type 2 diabetes in first-degree relatives (parents, siblings).
• Previous Gestational Diabetes:
  • Recurrence risk varies between 30 and 84%.
• Macrosomia History:
  • Baby weighing more than 4,000 g at full term during a previous pregnancy.
• Polycystic Ovary Syndrome (PCOS):
  • A hormonal disorder affecting over 5% of women of reproductive age. Symptoms include multiple ovarian cysts, rare ovulation, and excessive hair growth.

Why Does Gestational Diabetes Occur?

During pregnancy, a woman's blood glucose regulation changes:

• Insulin is a hormone produced by the pancreas that allows the body to convert the food we eat into energy, which is stored as sugar or glucose. Insulin allows glucose to enter cells from the bloodstream.
• In diabetic patients, insulin is either completely absent or doesn't function correctly. The body can't absorb the glucose needed for cells to function, leading to an accumulation of glucose in the blood.

During pregnancy:

• First half: Insulin secretion and sensitivity increase, which can lead to hypoglycemia (low blood sugar), especially at night and upon waking.
• Second half: Glucose tolerance decreases. Increased female hormones from the placenta lead to insulin resistance, prompting the pancreas to produce more insulin.
  • If the pancreas can't produce enough insulin, it results in hyperglycemia (high blood sugar) and gestational diabetes.
  • Excess glucose in the mother's blood crosses the placenta and accelerates fetal growth.
  • Babies exposed to gestational diabetes are at risk of:
    • Macrosomia (large body size),
    • Hypoglycemia (low blood sugar),
    • Increased risk of developing type 2 diabetes later in life.

Fortunately, gestational diabetes can be well-managed, and most affected women give birth to healthy babies. It is crucial for women with gestational diabetes to monitor their blood glucose levels, follow a healthy diet, exercise regularly, maintain a reasonable weight, and consult their doctor frequently.

What hygienic and dietary advice should be followed for gestational diabetes?

• A balanced diet and dietary guidelines are essential for controlling blood glucose levels and maintaining well-being during pregnancy.
  • Caloric intake is determined based on:
    • Body Mass Index (BMI),
    • Weight gain during pregnancy,
    • Dietary habits.
  • Recommended caloric intake: 25 to 35 kcal/kg/day.
  • Caloric restriction is advised in cases of obesity but should not drop below 1600 kcal/day.
  • Carbohydrates should make up 40 to 50% of total caloric intake.
  • Low-glycemic index carbohydrates and fiber help control gestational diabetes.
  • Carbohydrate intake should be distributed across three main meals and two to three snacks.
  • A dietitian can help modify and manage daily meals and provide advice on essential nutrients for pregnancy.

Physical Activity During Pregnancy:

• In the absence of pregnancy-related contraindications, regular physical activity is encouraged to help regulate blood sugar. About 30 minutes of activity, 3 to 5 times a week, is recommended.

How Should Blood Glucose Levels Be Monitored?

• Blood glucose monitoring is essential for women with gestational diabetes. Self-monitoring is done using a glucometer and appropriate test strips prescribed by a doctor.
  • The frequency of monitoring varies by individual; it is crucial to follow personalized medical advice.
  • Monitoring is especially important for women treated with insulin.
  • Typically, checks are done fasting and after meals (postprandial). Initially, before and after each meal, and once the diabetes is well-controlled, monitoring may be reduced to fewer meals.

Blood sugar goals:

• Fasting: ≤ 0.95 g/l
• 1 hour after meal: 1.30 to 1.40 g/l
• 2 hours after meal: 1.20 g/l

Sources: Ameli – Gestational Diabetes