Gestational Diabetes Mellitus (GDM) is defined as any degree of glucose intolerance that develops with the onset of or during the pregnancy. GDM poses health risks to the fetus and to the mother. GDM also leads to complications during the pregnancy and at the end of the term.

If gestational diabetes is timely identified and managed during the full course of pregnancy, a lot of the complications can be avoided and a healthy baby is delivered post full term.

In the past few years, the incidence of GDM has increased multi-folds, especially for Asian origin women! Once GDM is diagnosed, one needs to be highly vigilant of their diet and physical activity to manage the blood sugar level within a safe range. GDM may subside or may continue post full term.

Symptoms of Gestational Diabetes

There are usually no symptoms of GDM. It is detected by the routine glucose tolerance test as described below. But when it is out of control, one may experience the following symptoms:

• Excessive hunger or thirst
• Excessive tiredness
• Frequent Urination
• Episodes of black-out or low blood sugar

Since these symptoms are very commonly associated even with healthy pregnancy during the last trimesters, it is quite hard to confirm GDM without actual tests.

Development of Gestational Diabetes

1. Glucose tolerance decreases with the progress of pregnancy due to various additional hormones secreted via placenta in the body. Placental Hormones such as human placental lactogen, progesterone, prolactin, and cortisol lead to increased insulin resistance.
2. As the level of the above hormones increases during the last phase of pregnancy, it may subsequently lead to GDM in some cases. Hence, it is detected during the later stages of the 24-28th week in pregnancy.
3. Gestational Diabetes usually develops due to pre-existing hyperglycemia and insulin resistance, which gets aggravated during pregnancy.

Who is susceptible to gestational diabetes?

Every year, around 2% and 10% of women are diagnosed with gestational diabetes, with 4 million women in India alone. Over the past decades, both the incidence and ratio of pregnancy diabetes has increased.

Here are some of the factors that can increase your susceptibility to develop gestational diabetes:

• Your age is more than 25
• Have a family history of diabetes
• You are overweight before your pregnancy
• Have high blood pressure
• Are having multiple babies
• During pregnancy, the weight becomes more than normal
• In the past, suffered from gestational diabetes
• Must have given birth to a baby weighing more than 9 pounds
• Have had a mysterious miscarriage or stillbirth
• Taking glucocorticoids
• Have conditions like polycystic ovary syndrome (PCOS), acanthosis nigricans, or shows insulin resistance
• Have undergone treatment of infertility
• Have suffered from recurrent Urinary Tract Infections (UTI)

Complications associated with Gestational Diabetes

If gestational diabetes is not properly managed, the blood sugar levels will stay in the elevated state throughout the pregnancy. This can cause many complications and possibly harm both the mother and fetus.

With GDM, a mother has higher chances to face pregnancy-induced hypertension, preeclampsia, antepartum hemorrhage, preterm labor, and cesarean delivery. Some of them can be avoided by managing gestational diabetes well.

However, others such as higher susceptibility of the baby and the mother towards Diabetes at a later stage needs to be tightly controlled post delivery. GDM also poses following health risks and complications to the fetus/baby:

• high birth weight of the baby and hence higher possibility of cesarean section birth
• post birth unit care requirement
• high-intensity jaundice after delivery
• baby will have much higher chances of developing metabolic disorders, Diabetes, cardiovascular disorders
• congenital malformation
• difficulties during labor
• higher risk of diabetes in future
• a risk to the life of fetus and mother such as stillbirth, neonatal deaths, or perinatal mortality

Types of Gestational Diabetes

GDM is of two classified into 2 levels based on the required level of intervention for the management of the condition:

• Class A1 – It can be controlled by diet and physical activity
• Class A2 – It needs to be managed by insulin and/or oral medications.

How would GDM affect the delivery?

As stated earlier, GDM poses multiple health risks to the fetus and to the mother. Should one be diagnosed with GDM, it is necessary to make the required changes to diet and lifestyle and or take medications along with. While management is necessary, GDM could still affect baby delivery via:

• Making cesarean section necessary: One should be mentally prepared for the requirement of C-section in case of emergency due to sudden changes in blood pressure, blood sugar, heartbeat, or planned due to the size of the baby.
• A requirement of insulin during delivery: Blood sugar levels must be maintained during labor and delivery as hyperglycemia (high blood sugar) in the mother leads to hypoglycemia (low blood sugar) in the newborn. When a mother has GDM, she may require insulin support either via a shot or via a plastic tube.
• Pre-term delivery: This may be required if pre-eclampsia (sudden high blood pressure) develops during the third trimester. Should this happen, then the only solution to save the life of mother and baby is via early delivery. Apart from this, early delivery may need to be planned for various other reasons including the size of the baby.
• The risk to the life of Mother and baby due to the possibility of Still Birth, Perinatal Mortality, or Neonatal Death

How is GDM diagnosed?

Placental hormones progressively increase Insulin Resistance with pregnancy. It often triggers GDM in the third trimester.

For women with no past history of diabetes or blood sugar at a normal level at the beginning of pregnancy, the gestational diabetes test is done around 24-28 weeks.

For women who are prone to GDM due to past history, high BMI, or existing Diabetics; pre-screening for GDM is done at the first prenatal visit.

Glucose challenge test

GDM is confirmed in 2 ways depending on the national norms and the Doctor. These are called as one-step testing and two-step testing as explained below.

One-step test

1. First, you undergo the test of fasting (overnight fasting for at least 8 hours) blood sugar
2. You are given 75 grams (g) of glucose solution to drink.
3. Blood sugar levels are checked repeatedly after one hour and two hours.

GDM is confirmed by the Doctor if your blood sugar level is higher than any of the following values.

Time of Test	The blood Sugar level is higher than or equal to (mg/dL) milligrams per deciliter
Fasting	92
1 Hour	180
2 Hours	153

Two-step test

For the two-step test, fasting isn’t required. The patient is provided with a 50g glucose solution to be consumed orally. After one hour, blood sugar is tested. If the blood sugar level is greater than or equal to 130 mg/dL or 140 mg/dL, a second step test is done for GDM confirmation.

The threshold for the first test is decided by the Doctor according to the patient’s profile and history. The second test is conducted on another visit.

1. In the second test, the fasting blood sugar level is also checked.
2. A 100 g glucose solution is consumed orally after fasting for a minimum of 8 hours.
3. After the consumption of glucose, blood sugar is tested at one, two, and three hours.

GDM confirmation is done if any of the 2 or more values are higher than the stated range. These values are based on Carpenter guidelines.

Time of Test	The blood Sugar level is higher than or equal to (mg/dL) milligrams per deciliter
Fasting	95
1 Hour	180
2 Hours	155
3 Hours	140

What should you eat if you have GDM?

Dietary intervention is absolutely essential to managing the blood sugar levels with or without additional treatment. One should be watchful of the quantity and quality of foods consumed to avoid large fluctuation in glucose levels in the blood.

In a majority of the cases, complications of GDM can be avoided and GDM managed well by switching one’s diet. Here are some of the points to consider:

• Stop the consumption of simple carbohydrates such as processed and packaged foods, white carbohydrates such as white flour, white sugar, and white rice.
• Consume foods rich in complex carbohydrates such as brown, red, or black rice, millets, whole wheat flour, and tubers.
• Reduce the number of carbohydrates and replace them with proteins and healthy fats.
• Go for plant-based proteins such as peas, lentils, and beans whenever possible. Proteins will keep you full for long, hence help avoid low blood sugar episodes.
• Include probiotics rich foods such as fermented foods in your diet. This supports gut flora and helps to mitigate the effect of placental hormones in the body.
• Avoid big meals that are far apart. Instead, consume multiple small to moderate sized meals with healthy snacks such as sprouts, salads, nuts, and fruits in between.

After the birth of the baby!

Women with GDM have a 40% higher chance of developing Diabetes Mellitus later in life. Once the baby is delivered, your doctor would recommend monitoring your blood sugar levels on a regular basis. After 6 weeks of delivery, the blood test is conducted to check whether the glucose level has turned to normal! Based on this, one would fall into 3 possible categories:

• Normal: Blood glucose level has returned to normal after all the hormonal changes have balanced out.
• Impaired Glucose/Insulin Tolerance: This would require tight monitoring of blood glucose and also permanent changes to diet and lifestyle.
• Diabetic: May or may not require medication. Dietary and lifestyle changes are mandatory.

Management of Gestational Diabetes with Ayurveda and Yoga

Management of GDM with Ayurveda involves intervention with Aahara (diet), Vihaara (lifestyle), and Ayurvedic herbs.

A mother’s body undergoes various hormonal and physical changes that affect the mental state and put additional stress on the functions and organs. Maternal stress can affect the intrauterine environment through placenta’s stress system and eventually result in poor development of the baby.

Breathing, relaxation, and meditation have proven to be highly effective to reduce the complications that arise with DM and with hypertension during pregnancy. These are essential components of yogic asanas, which help to support both body and mind.

• Mind and body practices help to relieve the physiological and mental stress that a mother undergoes during pregnancy.
• Additionally, yoga increases blood and hence oxygen circulation through the uterus, placenta, and through to the fetus.

Pranayama and Deep Breathing to Manage Vata Dosha

• Breathing exercises such Pranayam involve controlled deep breathing to stretch the lung tissues and vagal nerve. 
• It has been proven to be effective in the management of stress and increase the flow of oxygen to the body’s tissues.
• It also helps to reduce blood pressure, heart rate, metabolic rate, and hence the requirement of oxygen.
• Pranayama also positively affects the brain by increasing the neuroplasticity – the capability of our neural networks to reorganize and regenerate – which in turn directly affects your memory, cognition, and response to any situation – and indirectly reduces stress.

Two types of Pranayama are recommended for GDM:

• Anulom-Vilom Pranayama
• Bhramari Pranayama

Ayurvedic Herbs

Gurmaar: Gurmaar (Gymnema Sylvestre) is known as “The Sugar Killer”. It contains the gymnemic acid molecules which are anti-diabetic in nature. These prevent the glucose molecules from entering the bloodstream.

Karela: Karela (Bitter gourd) is also anti-diabetic. The micronutrients present in it reduces the complications arise due to gestational diabetes.

Tulsi: Tulsi is one of the holy plants in Hindu mythology which has excellent medicinal properties. It is widely used to treat cough, cold, sore throat and also used to reduce blood glucose levels during pregnancy.

Turmeric powder: It can be taken with aloe vera juice to control the initial stage of diabetes.

Curry leaves: It is quite common in Indian kitchens. You can take 5-7 leaves regularly in empty stomach. It works well in reducing blood glucose levels.