This form of diabetes is caused by a hormone produced by the placenta called placental lactogen that interferes with the action of insulin.


The gestational form can be defined as “physiological”, since such action of placental lactogen hormones is counteracted by the pancreas which, in order to bypass the problem, produces a greater amount of insulin. 
Often this increase in insulin of the pancreas is not sufficient to neutralize the action of the placental lactogen, the consequence is a reduced tolerance to glucose with consequent increase in blood glucose. The onset of gestational diabetes occurs around the second trimester and usually ends at delivery, when the concentration of placental lactogen decreases rapidly and blood glucose returns to normal.

Metabolism of sugar, hyperglycemia and hypoglycemia

Sugar is the fuel of the cell. 
Once in the intestine, it is absorbed by the mucosa and passes into the blood which should classify it into the cells of all organs and tissues for food.

The transfer of sugar to different cells is regulated by a hormone produced by the pancreas: insulin. 
If the blood insulin level is right, the cells absorb the right amount of sugar and the right glucose  concentration  (blood glucose) is in the blood. 
A greater amount of insulin produces an increase in sugar transfer to the cells and a decrease in blood glucose (hypoglycemia). 
Conversely, a decrease in insulin causes an increase in the concentration of sugars in the blood (hyperglycemia), resulting in a decrease in the nutrition of the cell. 
Diabetes is a disease that undermines this mechanism.

There are 2 types of diabetes 
Type I diabetes is characterized by a total lack of insulin. 
It is an autoimmune disease, in which the immune system recognizes the cells of the pancreas as enemies and destroys them completely. 
The Type II diabetes is characterized by low levels of insulin and unable to perform its natural function. 
Gestational diabetes is type II. 
This disorder occurs in pregnancy and regresses with the child’s birth. 
In some cases, however, it returns and stabilizes over time.


Spread of disease

Gestational diabetes is a very common disease, statistics estimate that one in seven women is at risk of developing the disease and that gestational diabetes has a frequency ranging from 2 to 4%.

The disease is also uncommon in pregnant women under the age of 25, while it is very common over 35 years.


What are the risk factors that increase the chance of developing gestational diabetes?

There are several risk factors, including:

  • Mother’s age: Gestational diabetes usually develops in women over 35 years of age.
  • Mother’s weight: an overweight or obese woman have a higher risk of developing gestational diabetes.
  • Diet and diet:  A diet rich in fat causes an increase in cholesterol and triglycerides in the blood that hinders insulin activity.
  • Familiarity : A woman who has a reduced glucose tolerance, a fasting hyperglycemia, first-degree relatives with diabetes, previous pregnancies where she developed gestational diabetes, has a greater risk.
  • Fetal macrosomia: A woman in her second pregnancy, who gave birth to a first child weighing more than 4 kg, has a higher risk of developing gestational diabetes during the second pregnancy.
  • Other risk factors include smoking , twin pregnancies due to increased production of placental lactogen and polycystic ovary syndrome that causes insulin resistance even before pregnancy.


Risks for the child: from malformation to obesity

Gestational diabetes can cause miscarriage or fetal death in the last trimester of pregnancy (late death of the fetus) and cause problems in the child that can be fatal:

  • Fetal malformations are linked to increased ketones (a characteristic of diabetic disease) and hyperglycemia that causes delayed growth of various organs, such as delayed development of the nervous system, the result is mental retardation.
  • Fetal development: The main consequence of gestational diabetes is excessive fetal growth due to the presence of high blood glucose concentrations, so the child will have a waist circumference greater than the norm. 
    Excessive development of the fetus may cause a risk of fracture and dislocation of the shoulder at delivery. In these cases, it is advisable to have a cesarean section . 
    Sometimes to avoid macrosomia is made induction of labor, but does not decrease the risk of other complications.
  • Hypoglycemia: Gestational diabetes can cause a hypoglycemic problem in the newborn. When the child is born after having lived in conditions of hyperglycemia, it reduces the concentration of sugar in the blood and in 48 hours after childbirth can develop a severe hypoglycemia. The situation may normalize during breastfeeding, but it is often necessary to use blood and glucose transfusions to normalize the glucose in the newborn’s blood.
  • Hyperbilirubinemia that causes neonatal jaundice , characterized by yellowish skin, respiratory distress of the newborn and lack of minerals such as calcium.
  • Premature labor , mainly due to the increase in amniotic fluid caused by hyperglycemia. In a pregnancy with diabetes, the risk of preterm birth increases by about 30%, and the newborn may be weaker.
  • Predisposition to obesity: According to recent studies, children born to mothers with gestational diabetes have a greater risk of developing obesity. Although this is not yet clear, the mechanism seems to be that the mother’s higher blood sugar level greatly affects the future of children and increases the risk of being overweight or obese in the age range ranging from 5 to 7 years .

Complications for the mother

Gestational diabetes can have very serious complications for the mother. Although the prognosis is favorable after delivery and the total disappearance of diabetes occurs, in some cases it reappears after a few years as type II diabetes. In addition, there are other complications in the short term:

Gynecological complications: a cesarean section may be necessary to prevent the passage of the   macrosomic fetus through the birth canal from causing vaginal cuts.

Endocrinological complications: women with gestational diabetes have a risk of developing subclinical hypothyroidism (ie, they do not develop specific symptoms) and the development of direct autoantibodies against the thyroid.


Diagnosis of gestational diabetes and exams

To make the diagnosis of gestational diabetes, it is necessary to rely mainly on the laboratory tests normally performed during the second trimester of pregnancy, around the 24th week. The diagnosis should be made by specific tests:

  • Basic screening: it is the first examination and is called the glycemic curve. It is a test that is performed on pregnant women at week 26 – 28 (and about 16 to 18 weeks for women at risk). The woman should drink the glucose-rich solution (50gr) and take 2 exams after 1 hour, before taking the solution and after taking the solution. Before taking the solution, the blood sugar values ​​should not exceed 110 mg / dl, while after taking the solution, the blood glucose values ​​are normal up to a maximum of 140 mg / dl. 
    If the test shows values ​​greater than 140 mg / dl it is positive and it is passed to the next examination. If the value found is more than 198 mg / dl she has gestational diabetes.
  • Oral glucose load curve: This test is similar to the previous one, except that the drink contains a double amount of glucose, about 100 g, and the blood glucose tests are now four, one before taking solution and the other 3 at a distance of one hour, two hours and three hours after taking the solution. The diagnosis of diabetes in this case occurs when glycemia values ​​are greater than 95 mg / dl before taking the solution, greater than 180 mg / dl after one hour, more than 155 mg / dl after 2 hours and more than 140 mg / dl after three hours of taking the solution.
  • Two blood values ​​are controlled: glycated hemoglobin and fructosamine to understand when diabetes began.
  • The urine test may show the glycosuria, ie the presence of sugar in the urine (must be absent).

After the diagnosis of gestational diabetes is made, it is prudent to perform tests to control the growth and health of the fetus, such as:

Monitoring fetal well-being: used to determine if the fetus is affected by macrosomia, ie if it is larger than the norm.

Screening of congenital anomalies: it allows to verify if there were fetal malformations during the development of the organs. It is a simple ultrasound that is performed on the 16th week.

Ultrasonography  test is a test to measure fetal heart rate and fetal movements to see if they are within the norms. 
It is also planned to evaluate the amount of amniotic fluid. It is an examination done through an instrument that, through ultrasound , determines the fetal heart rate . It is usually done at the end of pregnancy, at a time close to delivery, but under risky pregnancy conditions it is also performed in the months prior to birth.


The symptoms

Gestational diabetes is a disease that in most cases is asymptomatic and is discovered during routine exams during pregnancy. Unspecific symptoms such as nausea , headache and vomiting (typical of pregnancy) or typical symptoms of diabetes, such as polyuria ( frequent urination ),  glicosuria (presence of glucose in the urine), an excessive increase of amniotic fluid that occurs during an ultrasound, polydipsia (feeling thirsty), fatigue  and rapid weight gain.


Prevention and treatment: how to prevent gestational diabetes with a healthy diet and adequate nutrition.

The prevention of gestational diabetes provides a healthy diet rich in fiber and vegetables, it is necessary to eliminate sugary foods, it is also important a lifestyle with a regular physical activity.

A gymnastics course for pregnancy is useful. The diet for gestational diabetes should be prescribed by a specialist and should not be too calorie to not affect the growth of the baby, but should reduce the amount of sugars. 
The tendency  of glucose in the blood should be constantly monitored to control the effectiveness of the treatment.


Food for gestational diabetes

Very important in prevention and even more in the treatment of gestational diabetes is the feeding of women. It is the first therapy prescribed by the doctor when he discovers this form of diabetes. Let’s see what foods should be avoided and how to create a balanced diet for this type of disease, considering that such a diet should never be less than 1800-2000 kcal to encourage the adequate supply of nutrients to the mother and child. It is not recommended for all forms of fasting, such as therapeutic fasting that may be helpful in case of type II diabetes.


Foods to be avoided and foods allowed

To maintain control of glucose through eating it is necessary to limit the consumption of carbohydrates and sugars contained in food. We can structure the food intake as follows:

Avoid processed foods and dairy products, such as sweets and ice creams. It is necessary to limit the intake of foods rich in animal protein and fat: cheese, meat, seafood, eggs, etc. 
Carbohydrates should be limited, but not excluded, it has to be 45% of the daily calories. 
Among the foods allowed are bread, pasta, vegetables and rice.

It is permitted and recommended to increase fruit, vegetables and fiber-rich foods. 
It is better to eat the raw vegetables .

For protein intake, fish and vegetables are recommended in comparison to red meat, to prevent the rise in cholesterol. 
This is essential to reduce fat in the diet because obesity promotes the onset of diabetes. 
You should also limit your intake of fats avoiding eating too much cheese. 
For the seasoning the olive oil is better.

Example of a diet

The diet recommended during pregnancy, including gestational diabetes, should be approximately 1800-2000 kcal and can be structured into five meals, three main and two snacks.

Breakfast – choose:

  • A coffee sweetened with aspartame, a slice of 50g whole wheat bread and an apple
  • A coffee sweetened with aspartame, 2-3 wafers and a peach
  • A coffee or tea sweetened with aspartame, 2-3 wholemeal biscuits and 3 slices of melon.

Morning and afternoon snacks, the following proposals:

  • A fruit (for example, orange or apple).

Lunch – Choose from the following options:

  • A serving of pasta or rice (50 g) with vegetables, a fruit or a vegetable.
  • A 200 g serving of legumes (chickpeas, beans or peas), 50 g whole wheat bread and a fruit or a greens.
  • A serving of 250 g of fish (worth all kinds of fish), 50 g of whole wheat bread and a fruit or a vegetable.

Dinner – one of the alternatives to be chosen:

  • A soup of vegetable or broth with 20 g of pasta or rice, two fruits and a portion of greenery.
  • One 250 g fish or one 80 g tuna can, 50 g whole wheat bread, one fruit.
  • A serving of nuts and pistachios (50 g), 50 g whole wheat bread, a fruit or vegetable.


Pharmacological therapy

The doctor may prescribe an oral hypoglycaemic medication that is usually given for type II diabetes and is not recommended for gestational diabetes because it may harm the unborn child. 
There are three types of insulin that can be used to cure diabetes:

  • Insulin zinc should be administered three times a day with average daily action
  • Normal insulin given three times a day, half an hour or one hour before meals
  • Insulin isophane, a type of insulin where activity is average and dosage depends on severity.


Natural Remedies and Alternative Medicine

There are some homeopathic remedies that can be taken after changing the diet. 
The herbal remedies to take into consideration are for example herbal teas containing walnut leaves with slightly hypoglycemic substances and fiber supplements, such as psyllium seeds to reduce sugar intake. 
It seems that other plants have a hypoglycemic action such as eucalyptus and myrtle.

Eucalyptus contains substances that reduce the absorption of sugars, while the myrtle inhibits the enzymes that serve to absorb sugars and the rue-capry reinforces the action of insulin.


Frequently Asked Questions:

Can gestational diabetes be prevented by early diagnosis? 
People at risk should be routinely screened for diabetes prevention.

Can gestational diabetes be controlled with food? 
Yes, gestational diabetes can be cured with food. If feeding alone is not enough you should consult your gynecologist or endocrinologist to determine the most appropriate insulin therapy.

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