top of page
Writer's pictureWestminster Medical Jamaica
5 min read

What is Gestational Diabetes?

As noted in our last post, there are different types of diabetes. Type 1 and Type 2 Diabetes can occur at any time. Gestational diabetes, however, is a type of diabetes that only occurs during pregnancy. It is one of the most common medical disorders for pregnant women.


What happens during pregnancy?


During gestation, the expectant mother’s body needs more insulin due to higher blood sugar levels.

A graphic explaining why women need more insulin during pregnancy. The background colour is purple. The Westminster Medical Jamaica logo is in the top left corner. The graphic is entitled “Why do pregnant women need more insulin?” in yellow Signika font. The explanation is below “When the mother eats, enzymes in the stomach break down the food into glucose. This glucose is then absorbed into the bloodstream so it can travel around the body. The pancreas secretes insulin to "unlock" cells so they can absorb glucose. But as babies need glucose to grow, the placenta releases hormones to stop insulin from unlocking cells, then absorbs some of that glucose to pass it to the baby, but not all. As such, the pancreas ups insulin production by up to 250% so cells can quickly absorb the remaining glucose & keep blood sugar levels normal.” Under each sentence is a diagram of visualizing each sentence.

With gestational diabetes, however, the pancreas either does not produce enough insulin to meet these new demands or the placental growth hormones increase insulin resistance in the mother’s cells. As such, they fail to use insulin properly.


Gestational Diabetes vs Other Diabetes


A graphic showing how insulin acts as a key for the body’s cells. The first caption reads “Cells have ‘insulin receptors’ that act as ‘locks’ for the glucose channel, where glucose enters the cell.” To the left of the caption is a picture of a green circle, representing a human cell, with a black keyhole, representing the insulin receptor, and a drawing of a glucose molecule. The second caption reads: Insulin acts like a 'key', allowing glucose to enter the cell and be used.” To the left of the second caption is a drawing of a gold key, representing ‘insulin’, an arrow pointing to a green three-quarter circle, with a gold key inside the black keyhole, representing insulin entering the insulin receptor of cells. A drawing of a glucose molecule is shown behind the three-quarter circle, representing glucose entering the cell through the glucose channel. The Westminster Medical Jamaica logo is in the bottom right corner.

Diabetes is the general term for a disorder where the body lacks the ability to manage glucose levels in the blood. With diabetes, the "keys", that is, insulin, either fail to "unlock" cells or there aren't enough "keys" to unlock all the cells. The end result is high blood sugar levels, and when left untreated, it can lead to a number of problems, including death.



“Gestational diabetes actually has a few similarities with all types of diabetes,” says Dr Leo Walker, Obstetrician Gynaecologist, “type 2 diabetes in particular.” For example, for all types of diabetes, there is too much glucose in the blood. The essential difference with gestational diabetes, Dr Walker says, is that “it resolves following delivery”, while both type 1 and type 2 are considered to be lifelong illnesses.

A table showing the differences between Gestational, Type 1 and Type 2 Diabetes. The Westminster Medical Logo is in the top right corner.

Although gestational diabetes resolves after birth, it increases your risk of developing type 2 diabetes later in life. Also, Dr Robyn Khemlani, obstetrician-gynaecologist, notes, “You're more likely to get it again during a future pregnancy.”


Risk Factors for Gestational Diabetes

A graphic showing a woman’s ankles and feet against a purple background with a wood grain texture. She is standing on a scale, wearing white “no-show” socks and black leggings. The caption reads “In 2022, the World Health Organization reported that 1 in 3 Jamaican women is considered obese.” The Westminster Medical Jamaica logo is in the bottom left corner.

As we said in our last post, a 2015 study showed that over 30% of pregnant Jamaican women developed gestational diabetes. Comparatively, gestational diabetes only impacts 2% to 10% of pregnant women in the States. Advanced maternal age and family history of diabetes are two risk factors for developing this disorder. As Dr Lesley Chin, obstetrician-gynaecologist, explains, “Most Jamaicans have close family members such as their mother and aunt who are diabetic,” and women with a family history of diabetes were nine times more likely to develop gestational diabetes than those without it. However, Dr Chin notes, “The biggest risk factors for diabetes in Jamaica are our diet and our higher rates of obesity.”


Both these factors also increase your risk of developing gestational diabetes. Consultant obstetrician-gynaecologist Professor Horace Fletcher explains, “If you get gestational diabetes, you may already be predisposed to diabetes. Pregnancy just acts as an aggravating factor.”


While you cannot totally eliminate your risk of developing gestational diabetes, you may be able to reduce it. Like type 2 diabetes and other diseases, a healthy diet is positively associated with a lower risk of gestational diabetes.


Testing for Gestational Diabetes


Unlike Type 1 and Type 2 diabetes, gestational diabetes often has no symptoms. While Professor Fletcher notes if you are considered low-risk, you may not be tested, Jamaica has a high-risk population, so testing for gestational diabetes is often a routine part of prenatal care. If you’ve had gestational diabetes before or are otherwise considered high-risk (e.g. because of your family history), your doctor may schedule you for testing in your first trimester and again in your second trimester. However, for most women, testing first occurs in the second trimester, between the 24th and 28th weeks of pregnancy.


There are two tests for gestational diabetes: the Glucose Screening test (also called the O'Sullivan Test) and the Glucose Tolerance test.


The first consists of drinking a glucose solution and then waiting an hour. After the 60-minute mark, blood is drawn, and blood sugar levels are tested. For this test, no fasting is required, and if the test results are normal, no further testing is needed. However, if blood sugar levels exceed 140mg/dL, the woman must do a formal glucose tolerance test. Fasting is required. Professor Fletcher explains, "For this test, the blood glucose is measured at fasting (i.e. when the patient first arrives), then one hour after drinking a glucose solution and again two hours after drinking the solution." If blood sugar levels exceed 200mg/dL, gestational diabetes is diagnosed.


Complications of Untreated Gestational Diabetes


As said before, gestational diabetes will resolve after birth. Further, unlike other types of diabetes, Dr Walker explains, "gestational diabetes is not a notable cause of foetal congenital abnormalities".

However, it’s still very important to treat it. “Diabetes that is not well controlled causes the unborn baby’s blood sugar to be high,” Dr Khemlani explained. “This can lead to macrosomia or a big baby." This is because of when gestational diabetes occurs. As Dr Walker notes, "The onset of gestational diabetes is usually in the late 2nd trimester," when the baby's body has already developed. However, during this time, the baby's body is still growing. With uncontrolled gestational diabetes, the baby's body gets more energy than it needs. This extra energy is stored as fat.

In addition to causing discomfort during the last few months of pregnancy, macrosomia can be dangerous. “Normal delivery can be more difficult for both baby and mother, with increased risk for injury to both,” said Dr Khemlani. “The baby, for example, can be born with nerve damage due to pressure on the shoulder during a vaginal delivery.” For mothers, it increases the risk of damage to the birth canal, including vaginal tearing and tearing of the muscle between the vagina and anus. “Any delivery can cause tearing,” Professor Fletcher notes, “but it’s more likely with macrosomia.”


These factors could mean vaginal delivery is not an option. From Dr Khemlani: “The mother might need a C-Section to deliver the baby because the baby is too big.”


A graphic showing a lighter-skinned black woman holding her pregnant belly. She is wearing a white t-shirt. A ring can be seen on her left ring finger. From the top right corner, a hand with white nitrile exam gloves holds a scalpel. The caption reads “The non-elective caesarean section rate for women with gestational diabetes was 6% higher than for women without..” The Westminster Medical Logo is in the bottom right corner.


Having high glucose levels prior to birth can also cause the baby’s pancreas to produce more insulin, which could also be a problem as “this extra insulin can lead to newborns having very low blood glucose levels at birth,” explains Dr Khemlani. Further, she says, “They are also at higher risk for breathing problems.”


Treatment for Gestational Diabetes

“Treatment for gestational diabetes aims to keep blood glucose levels normal,” says Dr Khemlani. “It always includes special meal plans, called a diabetic diet, which focuses on fruits, vegetables, whole grains, lean protein, fibre, low-fat and low-calorie foods, and limits highly refined carbohydrates, including sweets.”


Patient compliance is key to successfully treating gestational diabetes. From Dr Khemlani, “Treatment will also include daily blood glucose testing at home, so your doctor may get an assessment to determine if the treatment is working.” However, Dr Khemlani also noted that some women with gestational diabetes need insulin to reduce glucose levels. “If diet and exercise aren't enough to manage blood sugar levels, they may need insulin injections to reach their blood sugar goals.”



In all, gestational diabetes is a common but treatable condition. With the right treatment and doctor, mum and baby can have a safe, healthy pregnancy and delivery.





















Comentários

bottom of page