Gestational Diabetes

Gestational Diabetes overview and Definition

During pregnancy, some women develop high blood sugar levels. This condition is known as gestational diabetes mellitus (GDM) or gestational diabetes. Gestational diabetes typically develops between the 24th and 28th weeks of pregnancy.


Advanced maternal age , overweight / obesity and ethnicity ,hypertension, type 2 diabetes mellitus, polycystic ovarian syndrome, polymorphisms of susceptible genes, increase low grade inflammation, increase insulin receptor phosphorylation defects, decrease adiponectin, Increase in adipocyte fatty acid binding protein results  in beta cell dysfunction   insufficient insulin production and insulin resistance. There is increase in glucose and increase free fatty acids resulting in gestational diabetes .

During pregnancy oestrogen, progesterone, cortisol and prolactin, increase in human placental lactogen


 Defective insulin receptor phosphorylation IRS 1 expression p58 subunit of P13K expression


Decrease in pancreatic beta cell and increase in insulin secreation


It leads to hyperinsulemia and causes INSULIN RESISTANCE


Increase in glucose and increase and increase free fatty acids leads to Insulin resistance

Clinical signs & symptoms


Excessive thrist

Frequent urination


Blurred vision


Differential Diagnosis

The American diabetes association also advises that you to be tested for type 2 diabetes if you have the risk factors forthis condition. This testing should be done at your first prenatal visit.

Screening is done by these tests:

One hour glucose tolerance test:

The person is aske to drink a special beverages which is high in sugar. One hour later the healthcare provider measures your blood sugar (glucose) levels. If the levels are hogher than a certain level, this is considered an abnormal result.


Three-hour glucose tolerance test:

If the 1-hour test is abnormal, you will have a second glucose tolerance test done to confirm the diagnosis. You will drink another special beverage, but with more sugar. Your healthcare provider will measure your blood sugar levels 1 hour, 2 hours, and 3 hours later. You have gestational diabetes if at least two of the glucose measurements are higher than normal.

If you are diagnosed with gestational diabetes, you should get tested for diabetes 4 to 12 weeks after your baby is born. You should also get this screening at least every 3 years for the rest of your life.

First-trimester laboratory studies

  • HbA1C :  4-5.6 % is the normal range of HbA1C
  • Blood urea nitrogen (BUN): 5-20mg/dl is the normal range.
  • Serum creatinine: Adult men, 0.74 to 1.35 mg/dL (65.4 to 119.3 micromoles/L) For Adult women, 0.59 to 1.04 mg/dL (52.2 to 91.9 micromoles/L)
  • Thyroid-stimulating hormone: 0.9 – 2.3 nanograms per deciliter
  • Free thyroxine levels
  • Spot urine protein-to-creatinine ratio: less than 3.5(mg/mg)
  • Capillary blood sugar levels

Second-trimester laboratory studies

  • Spot urine protein-to-creatinine study in women with elevated value in first trimester
  • Repeat HbA1C
  • Capillary blood sugar levels


  • First trimester - Ultrasonographic assessment for pregnancy dating and viability
  • Second trimester - Detailed anatomic ultrasonogram at 18-20 weeks and a faetal echocardiogram if the maternal glycohemoglobin value was elevated in the first trimester
  • Third trimester - Growth ultrasonogram to assess fetal size every 4-6 weeks from 26-36 weeks in women with overt preexisting diabetes; perform a growth ultrasonogram for fetal size at least once at 36-37 weeks for women with gestational diabetes mellitus


If maternal diabetes is longstanding or associated with known microvascular disease, obtain a baseline maternal electrocardiogram (ECG) and echocardiogram.


Normal range:

  • Before a meal (preprandial): 95 mg/dl or less
  • One hour after a meal (postprandial): 140 mg/dl or less
  • Two hours after a meal (postprandial): 120 mg/dl or less



The gestational diabetes can lead to diabetes in later stages of life and and also it predicts whether the diabetes is present before the pregnancy. The appropriate treatment at the time might leads to the deterioration in the diabetes of the pregnant women.


Spend atleast 150 minutes per week of anaerobic exercises such as walking or cycling .

Avoid saturated and trans fats along with refined carbohydrates out of your diet.

Take large amounts of fruits, vegetables and grains.

Eat smaller portions and don’t take large amount of food at a time.