Introduction:
Gestational diabetes (GD) is a type of diabetes that usually occurs during pregnancy. GD is considered a common complication of pregnancy. In recent years, the number of GD cases has been increasing worldwide. This condition is linked with poor maternal-fetal outcomes.
What Is Gestational Diabetes?
Gestational diabetes is a common problem among pregnant women. It is estimated that about 5 % of all pregnancies are affected by GD. This means almost 2,00,000 cases are to be seen every year. If this condition is not appropriately addressed, both mother and baby will end up with health issues.
GD can be treated if identified early. There are a few things to be done to keep the pregnancy healthy. To control GD is the key point for health during pregnancy. Gestation means “during pregnancy.”. Hence, GD is considered to occur only among pregnant women.
Diabetes means high blood sugar in the blood. It is a disease related to metabolism. Metabolism means how the body utilizes food for energy and growth. Glucose is the main source of energy. Glucose is produced in the body when the stomach and intestine break down food. After being digested, the glucose formed enters the bloodstream. From the blood, it has to enter the cells to be utilized. This process requires insulin, a hormone released by the body. Insulin helps open the cell for the entry of glucose.
When the metabolism is normal, the body can produce enough insulin, and all the glucose can be absorbed by cells in the bloodstream. In the case of a diabetic condition, the body does not produce sufficient insulin. Hence, cells cannot use all the glucose present in the blood. There is a buildup of glucose or sugar in the blood.
GD can only be seen in pregnant women. During pregnancy, the body of a woman undergoes different changes. Because of this, insulin cannot work properly. The placenta, which is responsible for the baby's growth and functions to send nutrients and water to the baby, tends to produce certain hormones. These hormones also play a role in affecting insulin function. This creates insulin resistance. Because of this, the body must make three times the amount of insulin it needs.
Extra insulin produced among a few pregnant women is sufficient to keep their sugar levels in the normal range. 5 % of women may suffer from GD, as the extra insulin cannot be made up to keep the blood sugar levels normal.
How Does Gestational Diabetes Affect Delivery?
Women with GD may not have any changes with delivery. Many of them with well-controlled GD may have full-term deliveries. According to the experts, there is no particular timing for the delivery of women with GD.
Some women with GD may face complications. Among such individuals, the timing of delivery may vary. In some cases, the delivery may be advised a few weeks earlier. This is done for both the parent's and the child’s safety.
Some may be advised to have cesarean delivery as a larger fetus may create problems during vaginal delivery. Women with GD contain high levels of sugar in their blood and pass it on to the fetus as well. This causes the fetus to grow larger.
What Are the Reasons for Preterm Delivery Among Those With Gestational Diabetes?
Most women with GD generally complete full-term pregnancies. Those who undergo certain complications may have undergone preterm delivery.
The reasons include,
Macrosomia: When the fetus is larger than a normal fetus, it is called macrosomia. When a fetus weighs more than 9 pounds, it can create more strain on the birthing parent’s body. It may cause some complications.
These include,
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Issues related to delivery.
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Experience heavy bleeding after delivery.
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Severe tears may occur during delivery.
Healthcare professionals may advise preterm cesarian delivery if the fetus is large. They may advise completing the full pregnancy term if there are no associated complications.
Preeclampsia: Women with GD may have high blood pressure. This condition is called preeclampsia. This condition is more common among women with GD. High blood pressure may create strain on the birthing parent. This may sometimes result in heart problems for the birthing parent and may be life-threatening. Early delivery may be recommended for such individuals if this condition reaches a certain point.
Signs of preeclampsia:
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Experience headaches.
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Abdominal pain may be seen.
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Feel nausea and vomiting.
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Experience shortness of breath.
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Hands and feet may be swollen.
If these symptoms appear, immediate medical help is needed.
Is It Safe to Have Pre-term Delivery?
Most of the women with GD who undergo pre-term delivery are found to be safe. Generally, if these women are not associated with complications, they tend to complete full-term pregnancy. Experts consider 37 weeks to be full-term. Delivering before 40 weeks is considered safe.
According to studies, it was observed that infants born before 37 weeks are considered to be healthy and thriving. A Canadian study has found that 87 % of infants born at 26 weeks survived.
Early delivery is considered based on the risks to both the parent and the fetus. The recommendations for early delivery may vary depending on individual situations, complications of pregnancy, and access to healthcare. The American College of Obstetricians and Gynecologists (ACOG) advises that women with poorly controlled GD and other complications must deliver before 39 weeks of pregnancy.
What Are the Risks Linked to Pre-term Delivery Due to Gestational Diabetes?
Pre-term delivery may increase the risks due to some of the complications.
Risks associated with motherhood include,
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Increased rates of cesarian delivery.
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Increased blood pressure.
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Problems related to the placenta.
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Experience emotional distress or anxiety.
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Difficulties faced in bonding.
Risks related to infants of women with GD due to pre-term delivery include,
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Face breathing problems.
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Problems related to feeding.
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Delay in growth and development.
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May experience cerebral palsy.
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Vision problems occur.
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Hearing problems may be noted.
These babies may exhibit additional risks, such as problems in controlling blood glucose levels and a higher risk of developing diabetes in the future.
Other Risks Due to GD:
According to a study done in 2020, the incidence of adverse maternal outcomes was found to be 52.9 % among women with GD. It was also found that 8.1 % of adverse maternal outcomes were observed among those without GD.
These women tend to exhibit
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Cesarean delivery.
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It may have induced labor.
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High blood pressure may be seen.
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Premature rupture of the amniotic sac may be observed.
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Pre or postpartum bleeding may be seen.
The study outcomes were influenced by some of the drawbacks of the study.
How to Prevent Gestational Diabetes?
Gestational diabetes must be managed well by controlling and monitoring blood glucose levels. Along with this, adopting a healthy lifestyle and following proper dietary patterns may help prevent GD.
Conclusion:
Gestational diabetes occurs during pregnancy. GD may cause complications, which may require early delivery. Most of the women with GD may need to undergo cesarean delivery. If the blood glucose levels are well controlled, the risk of complications and pre-term delivery may be low. Hence, it becomes important to know about GD, its complications, risks, and how it affects delivery. Knowing helps identify the condition early and get it treated well. This, in turn, improves the quality of life.
