What is Gestational Diabetes Mellitus or GDM, Know its Causes, Symptoms, Complications

Gestational Diabetes Mellitus or GDM is a special case of diabetes which is acquired during pregnancy or the gestation period and results in increase of blood sugar levels which can be harmful for the mother as well as baby. However, it can be easily controlled by exercising, good diet and using medicines, if necessary.

Usually, gestational diabetes mellitus or GDM results into a temporary diabetes due to the presence of placental hormones that influence liver cells and muscles to resist insulin. Thus it goes away after pregnancy.

Researchers are still trying to find why gestational diabetes mellitus or GDM affects some women but we at least know what causes gestational diabetes mellitus or GDM. The food that we eat is broken down into sugar particles which move into the blood. From blood some of these sugar particles are absorbed into the cells to release energy and this movement of glucose is controlled by insulin.

Placenta is a tissue that connects baby with the blood supply of mother inside womb. It produces certain hormones which can prevent insulin from acting resulting into rise of blood sugar levels. With the growth of the baby, placenta also gets bigger producing more hormones that can be harmful for the baby. Gestational diabetes mellitus or GDM usually occurs after the women completes 20 weeks of pregnancy or later.

Usually gestational diabetes mellitus or GDM does not result into any symptoms and is diagnosed during routine check-up of mother. In other cases, gestational diabetes mellitus or GDM can result into one of more of the following symptoms:

• Blurry eyesight is a primary symptom of gestational diabetes mellitus or GDM.
• Nausea along with vomiting
• Fatigue
• High frequency of infections in skin, vagina or bladder is also a sign of gestational diabetes mellitus or GDM.
• High thirst.
• Reduction in body weight even after increased appetite.
• Frequent urination can also be a symptom of gestational diabetes mellitus or GDM.

It is wise to go through checkups before planning your pregnancy to know about the risk of developing gestational diabetes mellitus or GDM. This way your doctor can take care of your condition as part of the overall wellness program. Once the doctor diagnoses the presence of gestational diabetes mellitus or GDM, you will be checked more frequently especially during the last three months of your pregnancy. Your doctor might also ask you to see diabetes specialist who would help you control your blood sugar levels from rising during pregnancy.

Your doctor would check get your blood sugar levels checked just after pregnancy to ensure that gestational diabetes mellitus or GDM and its symptoms are gone. Blood sugar level check-up is repeated after 6 months.

Usually the occurrence of gestational diabetes mellitus or GDM is revealed during the routine screening checkups conducted as part of pregnancy care. If your blood sugar counts are found to be exceeding the predefined limits then you will have to immediately required to see your doctor. Also it is likely that you will have to go for prenatal checkups more frequently to check for the status of gestational diabetes mellitus or GDM.

Usually there is a predefined set of questions that your doctor would ask to access your condition probably during the very first visit. It can include one or more of the following questions.

• Have you felt any changes or signs of extreme thirst or urination? If yes, then for how long have been experiencing it? What is the frequency of urination or thirst?
• Are you experiencing any other symptoms that feels unusual?
• Is there anyone in your family or close relatives who have been diagnosed for diabetes?
• Is the first time that you are pregnant? If no, then did you experience any symptoms of gestational diabetes mellitus or GDM during earlier cases of pregnancy?
• Did you face any other unusual problems during earlier cases of pregnancies?
• What was the weight of the baby/babies that were born earlier (if applicable)?
• Did you underwent excessive loss or gain of weight at some point of your life?

In the meantime, it is strongly recommended to take necessary steps for controlling symptoms of gestational diabetes mellitus or GDM as soon as possible as every week is crucial for the health of your baby. Follow your routine checkups and never miss your follow-up appointments with the doctor.

It is important that you follow your doctor’s recommendations and take proper care of your health and diet. Exercise regularly and try to gather information about gestational diabetes mellitus or GDM.

Every woman has a risk of developing gestational diabetes mellitus or GDM during pregnancy but the risk increases in some particular cases such as:

• Age Can be a Risk Factor: The risk of occurrence of gestational diabetes mellitus or GDM is higher in case of Women with age of more than 25 years.
• History of Diabetes in your Family or Close Relatives: There is a higher risk of developing gestational diabetes mellitus or GDM if you are prediabetic i.e. you have been experiencing higher blood sugar levels even before pregnancy or someone in your family or close relatives is diagnosed with type 2 diabetes. Also, if you developed gestational diabetes mellitus or GDM during earlier cases of pregnancy/pregnancies or gave birth to a child with weight 9 pounds (4.1 kilograms) or more, or if your baby died in the womb due to some unknown reasons, then your chances of developing gestational diabetes mellitus or GDM increases.
• Excess Weight is a Factor of Risk: Women who are significantly overweight or have a body mass index (BMI) in excess of 30, then you have increased risk of developing gestational diabetes mellitus or GDM.
• Race is Also a Risk Factor for Gestational Diabetes Mellitus or GDM: For some unknown reasons, there is higher risk of developing gestational diabetes mellitus or GDM in case of non white women or those belonging to Hispanic, black, American Indian or Asian group.
• The weight of earlier born child/children was over 9 pounds or had some abnormality.
• Women with high blood pressure (B.P).
• Women with excessive level of amniotic fluid.
• Any history of miscarriage or stillbirth without any prominent explanation.

Usually there are no complications in delivery or with health of baby as long as you followed all the instructions properly and maintain proper blood sugar level during pregnancy.

Some of the complications that may occur due to gestational diabetes mellitus or GDM are as follows:

1. Occurrence Gestational Diabetes Mellitus or GDM can Cause Following Complications in Your Baby:

   • Excessive birth weight is a complication of gestational diabetes mellitus or GDM in newborn babies. When the baby senses increased blood sugar count, its pancreas starts to generate more insulin leading to larger growth with excessive weight of 9 pounds or higher which makes you baby more prone to birth injuries and increases requirement of surgery for delivery.
   • Another complication of gestational diabetes mellitus or GDM is early (preterm) birth and respiratory problems. There is an increased risk of early or preterm birth because of larger size of baby. Such preterm babies are more prone to difficulty in breathing which is referred as respiratory distress syndrome. In case of such babies, there is often requirement of breathing aids until his/ her lungs become stronger.
   • Low blood sugar (hypoglycemia) is also a possible complication of gestational diabetes mellitus or GDM in babies. There is also a risk of babies developing hypoglycaemia just after the birth which results into low blood sugar count. If the blood sugar counts are extremely low, seizures may be required . However, supplying glucose solution through veins of instant feeding can help in bringing down count to normal.
   • Type 2 diabetes later in life. There is also an increased risk of obesity or developing type 2 diabetes in babies at some point of life.

   However, if the symptoms are left unattended or untreated, it can be life threatening for baby.

2. Complications of Gestational Diabetes Mellitus or GDM that May Affect the Mother:

   Occurrence of gestational diabetes mellitus or GDM can lead to following complications in mother:

   • High B.P or blood pressure and preeclampsia. Occurrence of gestational diabetes mellitus or GDM can cause increased blood pressure or preeclampsia in mother. Preeclampsia is a serious complication related to pregnancy which can lead to several life threatening problems including increased blood pressure.
   • Future diabetes is a complication of gestational diabetes mellitus or GDM. Once you develop gestational diabetes mellitus or GDM during pregnancy, there are increased chances of experiencing gestational diabetes mellitus or GDM in your next pregnancy. Also, you are at much higher risk of developing type 2 diabetes in future. However, you can reduce the risk of developing type 2 diabetes to some extent by following a healthy lifestyle including proper diet and exercising regularly. Moreover, there are lesser chances of developing type 2 diabetes if women regains proper body weight after giving birth to child.

Fortunately in case of gestational diabetes mellitus or GDM, there is single set of guidelines for testing of gestational diabetes mellitus or GDM during pregnancy. While some experts do not believe that it should followed in case of pregnant woman below 25 years of age and no risk factors, other group feels that it is safer and best to ensure that no cases of gestational diabetes mellitus or GDM goes unrecognized.

Time for testing for gestational diabetes mellitus or GDM depends on the risk factors which are evaluated by your doctor. If the risk is higher like in case of women with medical history of diabetes in family or with high body mass index (BMI), screening is conducted as early as during first prenatal visit. If the risk is moderate then screening is scheduled somewhere in between 24th and 28th week of pregnancy which is applicable for most cases.

• Initial Glucose Challenge Test for Gestational Diabetes Mellitus or GDM: In this test to diagnose gestational diabetes mellitus or GDM, a women is first made to drink a syrupy solution of glucose and then after an hour, her blood is tested for blood sugar level. Usually, blood sugar level not exceeding the reading of 7.2 to 7.8 millimoles per liter (mmol/L) or 130 to 140 milligrams per deciliter (mg/dL) is regarded as a safe value and no more testing is required. However, if the blood sugar count is higher, the women has to undergo glucose tolerance test as there is higher risk of diabetes.
• Follow-up Glucose Tolerance Testing: For this test to diagnose gestational diabetes mellitus or GDM, a women has the fast overnight. In the morning you are given a concentrated solution of glucose which is followed by blood sugar level test thrice with an interval of one hour each. If at least two results out of three indicates blood sugar readings higher than the normal levels, it is confirmed that you have a case of gestational diabetes mellitus or GDM.

If you are diagnosed with gestational diabetes mellitus or GDM, you will have to visit doctor for frequent checkups, especially in the third and the last trimester of your pregnancy. During every visit, doctor will monitor your blood sugar level and many even ask you to check your blood sugar level daily at home yourself to keep a check on increasing blood sugar count.

If you cannot control blood sugar level, then doctor would prescribe insulin as the last measure. In case of any other complications related to pregnancy, doctor may recommend additional tests to ensure that your baby in the womb is receiving necessary nutrients and oxygen through placenta as gestational diabetes mellitus or GDM can affect functioning of placenta leading to complications. The tests also includes monitoring the overall growth of the baby in the womb.

Once you give birth to the baby, doctor would check your blood sugar level and then follow it up with another check up in following six to twelve months to ensure that your blood sugar levels have dropped to normal readings and there are no signs of gestational diabetes mellitus or GDM. Also, your doctor would check for diabetes after every three years.

If any of your tests in future indicates the presence of prediabetes or diabetes, you must consult your doctor to work out proper preventive measures to manage your diabetes.

Also Read:

• Treatment of Gastroparesis in Diabetics & Non-Diabetics
• Pancreas and Diabetes: Why does Pancreas Stop Producing Insulin?
• What Happens if a Non-Diabetic Takes Insulin?
• What Happens if Type 2 Diabetes is Untreated?