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Pathophysiology of Gestational Diabetes

Carrie Mccorkindale, MPH, RD, CDE
December 21, 2020

Most likely, if you are reading this, you probably had or are suffering from diabetes during pregnancy. You might be worried about your baby, but that means you are going to be a great, loving mother. It is important to know what you do during pregnancy and afterwards, so that you may set you and your child up for a healthy and fulfilling life. But as you’ll soon discover, much of it is hormone related. Read on to understand the body before, during, and after Gestational Diabetes to understand how the body works and what you can do about it.

How the Fetus Gets Energy

Typically, when a pregnant mother eats a meal, her body digests and absorbs the food. The body organs will be able to maintain stable levels of sugar (glucose) in the blood for the fetus to develop. This way, the fetus’ developing organs will not be taxed with sugar over-absorption. Instead, the fetus can obtain just enough sugar for its energy and proper growth. 

Controlling Sugar the Fetus Receives with Diabetes

The pathophysiology of all types of diabetes is related to the hormone insulin, which is secreted by the beta cells of the pancreas. In a healthy person, insulin is produced in response to the increased level of glucose in the bloodstream, and its major role is to control glucose concentration in the blood. Insulin allows the body cells and tissues to use glucose as the primary energy source. Also, this hormone is responsible for the conversion of glucose to glycogen for storage in the muscles and liver cells. This way, sugar level is maintained at a near stable amount.

In a person with diabetes, there is an abnormal metabolism of the insulin hormone. The body cells and tissues do not make use of glucose from the blood, resulting in elevated blood glucose or hyperglycemia. This condition also causes the conversion of stored glycogen to glucose, causing the liver to make too much sugar.

For women with Gestational Diabetes, the body has trouble regulating the sugar levels in the blood, meaning that the fetus must filter all that excess sugar even when its organs are still immature and developing. When glucose in the mother’s blood is too high, and if gestational diabetes is left untreated, the fetus is exposed to an excess of glucose, which leads to an increase in the amount of insulin produced by the fetus. This can significantly affect the baby’s organs during the pregnancy and after. 

If glucose is not well controlled during the pregnancy, some of the complications can have effects that reach into the next 50 years of your child’s life. See this link for how Gestational Diabetes can impact the baby.

  • Damage to the baby’s shoulders during childbirth, or shoulder dystocia 
  • The extra insulin made by the baby's pancreas can cause newborns to have very low blood glucose levels at birth, causing a higher risk for breathing problems
  • This little one has a higher risk for childhood obesity
  • The risk for type 2 diabetes as an adult is also significantly higher than the general population

Since insulin stimulates growth, the baby develops a larger than normal body at their gestational age. Once the baby is born, the excess glucose is removed; however, the newborn still has increased insulin production, putting them at risk for low blood glucose levels. 

How Do I Manage My Gestational Diabetes?

Once you are diagnosed with gestational diabetes through appropriate tests, gestational diabetes requires specialized treatment for the rest of the pregnancy. After the pregnancy is over, most women will have normal blood sugars again; however, up to 20-50 % (Gestational Diabetes | CDC) will develop type 2 diabetes within ten years. Regular screening is recommended. The best prevention strategy is to eat healthy, control weight, and stay active.