Polycystic Ovarian Syndrome & Gestational Diabetes

Diagnosis of Gestational Diabetes in PCOS

Women with PCOS are predisposed to developing gestational diabetes mellitus (diabetes that develops in pregnancy), irrespective of whether they are over-weight or not. Insulin levels significantly increase in the second and third trimesters of pregnancy as a normal part of pregnancy; the majority of women with PCOS already present high insulin levels in the blood. If not well managed, gestational Diabetes Mellitus can be troublesome, placing the health of both the mother and child at stake. However, diet and exercise prove to be effective measures in controlling gestational diabetes mellitus.

Screening for Gestational Diabetes in PCOS

All women are monitored for gestational diabetes through a regular blood test at 24 to 28 weeks to check for sugar levels. Since PCOS can result in higher blood sugar due to insulin resistance, women with PCOS are screened for gestational diabetes beforehand, at earlier stages in pregnancy.

There are two different ways to screen for gestational diabetes – the glucose challenge test and glucose tolerance testing. Both methods require that you drink a sugary solution, though the amount differs depending on which test the doctor is using.

The glucose challenge test requires a single blood withdrawal at one hour after you drink the solution. You do not need to fast before this test. However, this test alone is not sufficient to diagnose gestational diabetes. If the test is abnormal, you’ll need to have the glucose tolerance testing.

During the glucose tolerance test, you’ll again drink the sugary solution (though you’ll need to drink more of it), with four blood draws: one before drinking the solution, and at one, two and three hours after finishing it. You will need to fast before taking this test.

If any of these tests show an abnormally high blood glucose level, it indicates gestational diabetes mellitus.

Does PCOS Increase My Risk of Gestational Diabetes?

While it is a fact that women with Polycystic Ovarian Syndrome have a higher risk of developing gestational diabetes during pregnancy, is your PCOS the only cause of this condition? PCOS and pregnancy create the perfect storm for gestational diabetes because many women with PCOS are insulin resistant and being pregnant increases glucose intolerance in the body.

However, it’s illogical to assume that only women with PCOS develop gestational diabetes; many women without underlying PCOS also develop gestational diabetes mellitus. The series of biological processes that happen during a normal pregnancy can also lead to increase in blood sugar levels, irrespective of PCOS. During pregnancy, your baby is connected to your blood supply through the placenta, which produces hormones that can severely alter the way your insulin interacts with the cells in performing the function of controlling blood glucose levels, ultimately resulting into increased blood sugar levels. As your pregnancy progresses the placenta puts out an increasing volume of insulin-blocking hormones, which can in the later trimesters develop into gestational diabetes. A few extra risks and factors can tip the blood sugar see-saw of pregnancy onto the gestational diabetes side even without considering PCOS.

Other factors and conditions that can increase the risk of gestational diabetes beyond Polycystic Ovarian Syndrome or rising blood sugar are

  • Age: Above 25 years
  • Personal history: your risk of gestational diabetes is higher if you had gestational diabetes in a previous pregnancy or had a baby over nine pounds.
  • A prediabetic condition before pregnancy
  • Obesity: women with a body mass index of 30 or higher
  • Ethnicity: Asian, black, American Indian or Hispanic women have a greater risk of gestational diabetes
  • Family history: Your risk of gestational diabetes increases if a close family member has Type 2 diabetes
  • If you do develop gestational diabetes during pregnancy due to PCOS or other risk factors, you can experience other complications beyond those stemming from Insulin Resistance and a rise in blood sugar.

Other complications from Gestational Diabetes

High blood pressure: This condition can develop during pregnancy especially if you have PCOS. Women with PCOS have a higher risk for pregnancy-induced hypertension.

Preeclampsia and Eclampsia: These are very serious conditions that can threaten the lives of both the mother and baby. They are characterized by high blood pressure, swelling in the extremities, and in severe cases seizures.

Gestational diabetes: Gestational diabetes resolves itself when the baby is born but once you have had this condition you are at higher risk of having it again in future pregnancies.

Type 2 diabetes: If you experience gestational diabetes your risk for developing Type 2 diabetes later in life is higher. PCOS can also increase this risk because Insulin Resistance plays a role in both PCOS and diabetes. A proactive approach involving healthy life choices such as following a balanced diet and exercising daily following the birth can be instrumental to prevent the development of diabetes.

What effect does gestational diabetes have on the baby?

Most women with gestational diabetes and PCOS give birth to perfectly healthy babies. But, if the condition is not managed, the health of the baby may get adversely affected. Hence, appropriate medical surveillance at the time of pregnancy is highly important.

Issues that can affect your baby are:

Excessive birth weight (macrosomia) if your baby gets too much glucose while in the foetus, which can lead to an overweight or rather over-sized baby. This is an alarming situation for both the mother and child as it can prevent normal delivery. Thus, the doctors might have to do a C-section in order to prevent the baby from getting trapped in the birth canal

Hypoglycemia: Initially, high blood glucose levels can pass from mother to child through the placenta, and the baby’s body can start producing excess insulin, which may cause the baby to present excessively lowered sugar levels by the time it is born. Babies born to women with gestational diabetes can develop low blood sugar. Hence, as a preventive measure, babies are infused with IV glucose solution to prevent any further complications.

Preterm birth: Because premature labor is a risk when a mother has gestational diabetes, sometimes an early delivery is induced when the baby is growing too large.

Respiratory distress syndrome: Babies with this condition may have immaturely developed lungs, to handle the respiratory system effectively. Often, it’s an outcome of premature delivery, but has strong associations with PCOS.

Type 2 diabetes: This complication can occur later in life. When gestational diabetes is left ineffectively managed, the body can develop a resistance to insulin leading to causing type 2 diabetes mellitus.

Gestational Diabetes Management in PCOS

Gestational diabetes can be managed using a collaborative approach with various strategies such as lifestyle changes (in mild blood sugar abnormalities) and medications. Your doctor will recommend you measuring your blood sugar levels periodically, and based on the quantum of sugar and it’s degree of deviation from the normal values, you will be suggested various strategies to be followed. Lifestyle modification include having balanced and healthy diet, avoiding refined sugars and fried or fatty foods. Healthy diet includes diet rich in fruits, vegetables, lean proteins and whole grains.

If lifestyle changes aren’t fall short to control your blood sugar, you maybe suggested by your doctor to take medications to control your diabetes.

Other complications from Gestational Diabetes

High blood pressure: This condition can develop during pregnancy especially if you have PCOS. Women with PCOS have a higher risk for pregnancy-induced hypertension.

Preeclampsia and eclampsia: These are very serious conditions that can threaten the lives of both the mother and baby. They are characterized by high blood pressure, swelling in the extremities, and in severe cases seizures.

Gestational diabetes: Gestational diabetes resolves itself when the baby is born but once you have had this condition you are at higher risk of having it again in future pregnancies.

Type 2 diabetes: If you experience gestational diabetes your risk for developing Type 2 diabetes later in life is higher. PCOS can also increase this risk because Insulin Resistance plays a role in both PCOS and diabetes. A proactive approach involving healthy life choices such as following a balanced diet and exercising daily following the birth can be instrumental to prevent the development of diabetes.

Management:

Gestational diabetes can be managed using a collaborative approach with various strategies such as lifestyle changes (in mild blood sugar abnormalities) and medications. Your doctor will recommend you measuring your blood sugar levels periodically, and based on the quantum of sugar and it’s degree of deviation from the normal values, you will be suggested various strategies to be followed. Lifestyle modification include having balanced and healthy diet, avoiding refined sugars and fried or fatty foods. Healthy diet includes diet rich in fruits, vegetables, lean proteins and whole grains.

If lifestyle changes aren’t fall short to control your blood sugar, you maybe suggested by your doctor to take medications to control your diabetes.

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