Gestational diabetes (also called glucose intolerance of pregnancy) is a temporary condition that occurs during pregnancy. It affects two to four per cent of all pregnancies and involves an increased risk of developing diabetes for both mother and child.

Gestational diabetes means diabetes mellitus (high blood sugar) first found during pregnancy. In most cases, gestational diabetes is managed by diet and exercise and goes away after the baby is born.

Any woman can develop gestational diabetes, but certain factors, including a family history of diabetes and being overweight or older than age 30, can increase your risk. Still, the majority of women who develop gestational diabetes have no known risk factors.

The goal in treating gestational diabetes is to keep your blood sugar levels within a normal range. Most women can control their blood sugar with diet and exercise alone, but some may also need medication. The good news is that controlling your blood sugar can help ensure a healthy pregnancy for you and a healthy start for your baby.

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Signs and symptoms

It's unusual for women to experience any signs or symptoms with gestational diabetes. When they do occur, symptoms may include:

• More fatigue than would be expected during pregnancy

• Excessive thirst

• Increased urination

• fatigue

Causes

During digestion, your body breaks down carbohydrates from food you eat into various sugar molecules. One of these sugar molecules is glucose, the main energy source for your body. Glucose is absorbed directly into your bloodstream after you eat, but it can't enter your cells without the help of insulin.

Your pancreas — a gland located just behind your stomach — produces insulin continuously. But when the amount of blood sugar increases after eating, insulin production also increases. The extra insulin "escorts" more sugar into your cells, providing your body with energy and maintaining a normal level of sugar in your blood.

Your liver also plays a key role in maintaining a normal blood sugar level. If you have more glucose than your cells need for energy, your body can remove that excess from your bloodstream and store it in your liver as glycogen. Then, when you run low on glucose — if you haven't eaten for a while, say — your body can tap into that stored glucose and release it into your bloodstream.

The amount of glucose in your blood fluctuates in response to a number of factors, including food you eat, exercise, stress and infections. Yet the complex relationship among insulin, glucose and your liver ensures that your blood sugar stays within set limits.

But during pregnancy, your placenta — the organ that supplies your baby with nutrients through the umbilical cord — produces hormones that make it harder for glucose to enter your cells. These hormones, which include estrogen, cortisol and human placental lactogen, are vital to preserving your pregnancy. Yet they also make your cells more resistant to insulin.

As your placenta grows larger in the second and third trimesters, it secretes even more of these hormones, further increasing insulin resistance. Normally, your pancreas responds by producing enough extra insulin to overcome this resistance. But sometimes your pancreas simply can't make enough insulin, which means too little glucose gets into your cells. The result is an increase in the level of sugar in your blood. When that happens, you're said to have gestational diabetes. After your baby is born and placental hormones disappear from your bloodstream, your blood sugar levels should quickly return to normal.

During digestion, the sugar (glucose) in the food you eat is absorbed into your bloodstream. Insulin from your pancreas escorts glucose into your cells, where it provides energy for your body.

Risk factors

Some women are at greater risk of gestational diabetes than others. Factors that make it more likely you'll develop the disorder include:

• Family history. Your chance of developing gestational diabetes increases if a close family member, such as a parent or sibling, has type 2 diabetes (formerly called adult-onset diabetes or noninsulin dependent diabetes).

• Weight. Being overweight before pregnancy makes it more likely you'll develop gestational diabetes, but gaining a lot of weight during your pregnancy doesn't cause gestational diabetes. Your obstetrician will recommend a good target for weight gain.

• Complicated pregnancy. If you've had a stillbirth, a large baby or gestational diabetes in a previous pregnancy, you'll be screened more closely for gestational diabetes the next time you become pregnant.

When to seek medical advice

If you're pregnant or planning to become pregnant and are at risk of gestational diabetes, be sure to tell your doctor.

If you develop gestational diabetes, see your obstetrician for regular checkups. How often you see your doctor likely depends on how well your blood sugar levels are controlled. Office visits are especially important during the final three months of your pregnancy, when your doctor will carefully monitor your blood sugar levels. He or she will also watch for complications that can occur during the late stage of any pregnancy, such as high blood pressure, kidney problems or excessive amniotic fluid.

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In addition, your obstetrician may refer you to other health professionals who specialize in the management of diabetes, such as an endocrinologist, a registered dietitian or a diabetes educator. They can help you learn to manage your blood sugar during your pregnancy.

To make sure that your glucose level has returned to normal after your baby is born, your doctor may check your blood sugar once or twice the day after delivery and again in six weeks. Once you've had gestational diabetes, continue to have your blood sugar tested at least once a year.

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