Gestational diabetes (also known as gestational diabetes) is one of the most common complications of pregnancy. The women affected do not already have diabetes, but only develop it during pregnancy. While this was still the case in 1.5 % of expectant mothers in 2002, 4.4 % of pregnant women in Germany developed the condition in 2014. In 2020, 9.3 % of pregnant women were already affected by gestational diabetes - and the trend is still rising. And we must not forget: This figure does not yet include those women who already have before had diabetes mellitus during their pregnancy.
The reasons for the increasing number of cases of gestational diabetes are the generally higher age of pregnant women and a large proportion (47 %) of overweight women. Both risk factors favour the development of this disease. In addition, it has also been diagnosed more frequently since 2012 because health insurance companies have been covering the costs of the glucose tolerance test during pregnancy since then. Pregnant women who are carrying a baby boy have a higher risk of developing gestational diabetes than women who are expecting a girl.
However, if diagnosed in good time, gestational diabetes is easily treatable. If this is done, most pregnancies are largely unproblematic. And most babies born to mothers with gestational diabetes are also born healthy.
But there is also something insidious about this disease: it is often not easy to recognise. However, unrecognised gestational diabetes can be dangerous for mother and child.
Development of gestational diabetes
A pregnant woman goes through many hormonal changes. In the beginning, for example, they are necessary so that the fertilised egg can implant and develop properly. From the 20th week onwards, there is also an increased release of hormones. It controls, for example, that the mother's body now provides more energy for the development and growth of the unborn child.
In this case, more energy means more sugar (glucose) in the mother's blood. This is the case with all pregnant women. Thanks to the messenger substance insulin, which is produced in the pancreas, the glucose can then be absorbed by the mother's body cells as a source of energy. This lowers the blood sugar and the blood sugar level is regulated.
On the other hand, hormonal changes during pregnancy are also responsible for the fact that all The effect of insulin is weakened in pregnant women. No problem, the mother's body normally says to itself - then I'll just produce more insulin and compensate for it. This reaction also occurs in just under 91 % pregnant women - but in a good 9 % this process is disrupted. The result: as the mother's body lacks insulin, too little glucose is channelled into the body's cells. The blood glucose level rises accordingly. If it then permanently exceeds certain levels, gestational diabetes develops. Too much sugar in the pregnant woman's blood then ultimately leads to excessive sugar in the blood of her unborn child.
The effects
In most cases, there are no symptoms that are typical of diabetes; or it is only noticeable in a milder form. Without the so-called "sugar test" between the 24th and 28th week of pregnancy, many of the women affected would probably not have noticed their condition at all. More on this later.
In the case of diabetes, excessive thirst, increased urination or strong urge to urinate usually indicate that you have diabetes. Tiredness Indications of a possible disease. If pregnant women notice that they are tired very often or have to go to the toilet "again", many do not think this is gestational diabetes, but rather a normal side effect of their pregnancy. This may well be the case, as so much changes in the female body when a child is on the way. Above all, the hormonal balance is turned upside down and the metabolism also changes.
However, it is also possible that the pregnant woman's blood sugar metabolism is disturbed as just described.
If left untreated, gestational diabetes harbours considerable risks for both the pregnant woman and her baby. For the mother, these include vaginal and urinary tract infections and high blood pressure, Pre-eclampsia and complications during labour. After the birth, the mother's blood sugar level usually quickly returns to normal. The blood glucose levels are then checked once again. However, the mother now has an increased risk of developing type 2 diabetes mellitus in the coming years. This risk is reduced by a long breastfeeding period.
Children of untreated mothers with gestational diabetes are often born with a conspicuously high birth weight of more than 4,000 grams. There may also be respiratory problems in the newborn and there is a risk that the baby's blood sugar level will be too low after birth. This is because the foetus has a high insulin production to compensate for the increased maternal blood sugar level. After birth, this increased activity is not regulated quickly enough. Without treatment of the sick mother, the risk of premature birth or even stillbirth increases if the foetus's organs do not mature in time. And the child also has an increased risk of developing type 2 diabetes mellitus later on.
The "sugar test" during pregnancy
Gestational diabetes usually occurs from the 20th week in the second half of pregnancy. Therefore, according to the maternity guidelines, every pregnant woman is entitled to gestational diabetes screening between the 25th and 28th week of pregnancy as part of the regular check-ups.
This oral glucose tolerance test is carried out in two stages and is completely risk-free for your baby. Firstly, you will be given Pre-test drink water with 50 grams of glucose dissolved in it at your gynaecologist's surgery or with your midwife. After an hour, your blood sugar will be measured. If the value is abnormal (135 mg/dl or 7.5 mmol/l or higher), the Diagnostic test. To do this, you must not have eaten anything eight hours beforehand, so you have to turn up for the test on an empty stomach. Firstly, your blood sugar level will be determined. You must then drink a sugar solution containing 75 grams of glucose. Your blood glucose level will then be measured again at intervals of one and then two hours. Based on these three values, your doctor or midwife can determine whether you have gestational diabetes. This is the case if one of the following values is reached or exceeded during the diagnostic test:
- 92mg/dl or 5.1 mmol/l when fasting,
- after one hour 180mg/dl or 10.0 mmol/l
- and after two hours 153mg/dl or 8.5 mmol/l.
Should I be worried?
Diabetes that develops during pregnancy is, as described above, a temporary metabolic disorder. As a rule, it does not need to be treated with medication. For around 80 % of diagnosed pregnant women, it is sufficient if they adjust their diet accordingly and also get enough exercise.
The type of Change of diet can be carried out by you as an affected pregnant woman following medical advice. However, you may also be referred to a diabetological consultation. This applies in particular to overweight expectant mothers. Under no circumstances should they go on a strict diet on their own during pregnancy, as this can harm the child.
In general, pregnant women with gestational diabetes are advised to eat three main meals that are not too rich and a few small snacks in between. They should also reduce their intake of carbohydrates. This means, for example, eating less bread, pasta, rice and potatoes and avoiding "treats" such as sweets, honey, jam and fruit juices as much as possible. These carbohydrate bombs increase blood sugar levels. Fruit in excess can also have the same effect.
To further reduce the blood sugar level Regular exercise important. This should be at least 30 minutes three times a week. Why not talk to your midwife or doctor about what kind of exercise makes sense for you - e.g. gymnastics, walking or swimming? You can also run small errands on foot. Every bit of extra exercise helps you to improve your health.
With an adapted diet and intensive exercise, in many cases the blood sugar level does not remain so high that medication is necessary. This would mean that an affected pregnant woman would have to inject herself with insulin. In some cases, this is necessary because diabetes medication in tablet form is not authorised for pregnant women.
By the way: Pregnant women can also find out for themselves whether the change in diet and exercise is helping. To do this, they measure their blood sugar level several times a day for a few weeks, note the values and bring them with them to their next visit to the doctor's surgery. They will then discuss how to proceed.
The risk factors
As a preventive measure, a healthy Nutrition with plenty of vitamins, especially from vegetables and fibre, and in combination with sufficient exercise, is the best thing you can do for yourself and your baby.
However, there are some risk factors that favour the development of gestational diabetes. As already mentioned, these include (severe) obesity of the woman and a Age from 35+ to this. However, gestational diabetes during a previous pregnancy and cases of type 2 diabetes mellitus in parents or siblings also increase the risk of developing the disease. The same applies to certain pre-existing conditions in the woman, such as high blood pressure, repeated miscarriages and tobacco addiction. But even "just" a long-term unhealthy diet with lots of carbohydrates (consisting of sugar and many white flour products) poses a health risk.
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