Gestational pregnancy and how to navigate it through pregnancy

Finding out you have gestational diabetes can cloud your pregnancy – but when you’re armed with knowledge and have the right care, you can navigate a healthy journey until the moment you get to hold the little bundle of new life you’ve created.

Understanding the condition and identifying whether you’re at risk is vital for the health of both mother and child, says Dr Martin de Villiers, a physician at Mediclinic Cape Town.

“You might have gestational diabetes without even realising it,” he says. “And as it can come with risks and consequences, it’s essential to know as much as possible about it.”

What is gestational diabetes and who’s at risk?

Gestational diabetes is diabetes diagnosed for the first time during pregnancy and like other forms of the condition, it affects how your cells use glucose.

Gestational diabetes causes high blood sugar that can affect your pregnancy and your baby’s health.

“If you are overweight or have a family history of Type 2 diabetes or gestational diabetes, you could be at risk,” Dr de Villiers says.

Another warning sign is if you’ve had a baby before with a birth weight of 4kg or heavier, he adds. “You could have had undiagnosed gestational diabetes in your previous pregnancy.”

A mom’s excess amounts of blood glucose are transferred to the baby during pregnancy, Dr de Villiers explains. The baby’s body secretes increased amounts of insulin which results in increased tissue and fat deposits, making the baby heavier.

Women with polycystic ovary syndrome are also at risk of gestational diabetes. “Polycystic ovary syndrome is associated with high blood sugar and insulin resistance,” Dr de Villiers says. “Women over 35 are also at increased risk of gestational diabetes.”

Knowledge is vital

Undiagnosed gestational diabetes has serious implications. Women with the condition are at higher risk of developing high blood pressure and are 50% more likely to develop Type 2 diabetes in the future.

The risk of having a heavy baby can lead to complications at birth, Dr de Villiers says. The baby could get stuck in the birth canal and babies of moms with gestational diabetes are also more likely to have stillbirths. Gestational diabetes can cause changes in the placenta and affect nutrients and oxygen supply to the foetus.

Women diagnosed with the condition are more likely to have a Caesarean delivery, Dr de Villiers says, and often the C-section is done a week or so before term as a safety precaution.

Get tested

If you have known risks – or even if you just want to set your mind at rest – you should be screened, he adds. Your gynaecologist will do a HBA1c blood test to measure the glucose in your blood.

“It tests the glucose in your blood over the past three months. If the test shows elevated levels of glucose, your gynaecologist will set up a strategy plan to keep your glucose under control.”

Taking action

The first step is lifestyle intervention, Dr de Villiers explains. A healthy eating regime based on the Mediterranean diet – plenty of vegetables, some fruits, herbs, olive oil, whole grains and lean white meat – is often recommended.

“It’s also important to exercise and elevate your heart rate to between 60 and 70% of your resting heart rate. Walking, cycling in the gym and even a chilled run are all good, safe ways to exercise during pregnancy.”

Women with gestational diabetes are categorised according to two “types” – A1 and A2, Dr de Villiers says. “A1 is managed with lifestyle intervention. But if you’re A2, you might need medication to get your glucose under control.

“An insulin therapy such as Metformin is quite safe to use in pregnancy but generally doctors try to see if lifestyle intervention works before prescribing medication.

“It’s often recommended that patients see a dietician to get the right diet for glucose control.”