Gestational diabetes occurs in 5-10% of pregnancies during the second half and is related to hormonal changes. Early diagnosis and appropriate management of gestational diabetes in Warsaw are crucial to prevent serious health risks for both mother and baby, as well as to reduce the likelihood of developing type 2 diabetes in the future.
If you are in Poland and looking for a Russian-speaking gynecologist who can help you, consider Dr. Anastasiia Sergienko. She will support you with care and professionalism at every stage of your treatment and answer all your questions in your native language.
Our body produces a hormone called insulin, which keeps blood glucose levels within a normal range. Pregnancy itself can be a cause of insulin resistance (i.e., a reduced sensitivity of the body's tissues to the action of insulin) due to the effect of placental hormones with an anti-insulin effect.
What is Gestational Diabetes Mellitus (GDM)?
Gestational diabetes mellitus (GDM) is a metabolic disorder that develops in women during pregnancy. It occurs due to hormonal changes when the pancreas cannot cope with the increased demand, causing the pregnant woman's blood sugar level to rise. GDM can lead to complications for the health of both the mother and the future baby, so it is important to diagnose and treat this condition in a timely manner. Regular blood glucose checks and adherence to your doctor's recommendations will help control the condition and minimize risks.
Risk Factors for Gestational Diabetes
- Overweight/obesity;
- Diabetes in close relatives;
- GDM during previous pregnancies;
- Previous baby weighing over 4 kg;
- History of stillbirth;
- Arterial hypertension and other cardiovascular diseases;
- PCOS (Polycystic Ovary Syndrome).
Gestational diabetes in pregnancy develops due to hormonal changes that can lead to an increase in blood sugar levels. This condition is associated with impaired insulin production and action, which can have serious consequences for both the mother and the fetus.
In some cases, GDM can develop in the absence of all these factors. Therefore, screening should be conducted for ABSOLUTELY ALL WOMEN, regardless of whether they are in a risk group. Because, once again — pregnancy itself is ALREADY a risk factor for developing GDM.
Potential (Not Inevitable!) Risks of GDM for the Mother
- Development of severe gestosis (toxemia);
- Polyhydramnios (excess amniotic fluid);
- Development of pre-eclampsia;
- Preterm labor;
- Stillbirth;
- Ketoacidosis;
- Other pregnancy complications.
Potential (Not Inevitable!) Risks of GDM for the Fetus
- Macrosomia (large fetus);
- Hypoglycemia in the newborn (low blood glucose);
- Developmental defects.
Symptoms of Gestational Diabetes
In the vast majority of cases, GDM shows NO symptoms. Sometimes, a woman may experience:
- Intense thirst;
- Frequent urination;
- Persistent fatigue. In other words, complaints that are extremely non-specific for a pregnant woman.
Screening and Diagnosis of GDM in Poland
✅ ALL pregnant women are subject to GDM screening.
✅ At the first pregnancy visit, all women undergo a biochemical blood test, which must include a fasting glucose level measurement. Early diagnosis, including tests like glucose level measurement and the glucose tolerance test, is vital for preventing potential complications for the mother and child.
✅ If you have no risk factors (see above), a 2-hour oral glucose tolerance test (OGTT) is performed at 24-28 weeks of pregnancy (sometimes up to 32 weeks).
✅ If you have at least one risk factor, the OGTT is performed on the day of your first pregnancy visit (usually before 12 weeks, when you register for prenatal care). If the results are normal, the OGTT is repeated at 24-28 weeks.
How is the Oral Glucose Tolerance Test (OGTT) Performed?
The OGTT is performed in the morning on an empty stomach after an 8-hour fast, provided there are no contraindications.
The sugar level is determined in VENOUS BLOOD PLASMA (and NOT with a rapid test meter). This means blood should be drawn from your vein, not your finger.
After the fasting blood draw, the pregnant woman is asked to drink 75g of glucose dissolved in 300ml of water (fresh lemon juice can be added). Some women find the taste of glucose very unpleasant, but here you can (and should!) endure it, as the test is VERY important (and safe — IT CANNOT CAUSE DIABETES OR ADVERSELY AFFECT YOUR PANCREAS), and there are no alternatives available anywhere in the world today.
Two hours after drinking the 75g of glucose, a second blood sample is taken.
IMPORTANT❗️Throughout these 2 hours, the pregnant woman must remain in a state of complete calm — no running, rushing, stressing, eating, or smoking. Get comfortable on a couch, turn on your favorite series, and be patient!)
Glycated Hemoglobin (HbA1c) in Pregnancy
Glycated hemoglobin (HbA1c) is an indicator that reflects the average blood sugar level over the past 2-3 months. In pregnant women with gestational diabetes, the HbA1c level may be elevated, indicating the need for treatment adjustment. However, it is important to note that HbA1c is not the primary indicator for diagnosing GDM, and its use should be limited. The main focus should be on regular blood glucose measurements and the oral glucose tolerance test.
Diagnosing Gestational Diabetes Mellitus
We can speak of gestational diabetes if at least one of the following criteria is met:
✔️Fasting plasma glucose: 5.1–6.9 mmol/L (92–125 mg/dL);
✔️Plasma glucose 1 hour after ingesting 75g of glucose: ≥ 10.0 mmol/L (180 mg/dL);
✔️Plasma glucose 2 hours after ingesting 75g of glucose: 8.5–11.0 mmol/L (153–199 mg/dL).
A diagnosis of 'manifest diabetes during pregnancy' is made if one or more of the following criteria are present:
✔️Fasting plasma glucose: ≥ 7.0 mmol/L (126 mg/dL);
✔️Plasma glucose 1 hour after ingesting 75g of glucose: ≥ 11.1 mmol/L (200 mg/dL);
✔️Plasma glucose ≥ 11.1 mmol/L (200 mg/dL) at any time, in the presence of diabetes symptoms.
And here, I urge you not to panic.
Medicine is not an exact science and never has been. The normal blood sugar values for a pregnant woman can vary between different countries and medical societies. The figures I have provided are consistent with WHO recommendations.
But there is no need to create a tragedy if your fasting glucose is not 5.0, but 5.2 or 5.3. Yes, formally this is enough to diagnose you with GDM, and most importantly! — to draw your and your doctor's attention to a trend towards higher sugar, which is a reason NOT for panic, but for careful monitoring of your condition.
If GDM is diagnosed, the pregnant woman will be co-managed by a gynecologist and an endocrinologist.
Preventing Gestational Diabetes
Preventing gestational diabetes involves several measures that can help reduce the risk of developing this condition. These include:
- Healthy eating: Avoid foods high in sugar and fat, as well as those with a high glycemic index.
- Regular physical activity: Exercise can help improve insulin sensitivity and reduce the risk of GDM.
- Maintaining a healthy weight: Excess weight can increase the risk of GDM, so it is important to maintain a healthy weight during pregnancy.
- Avoiding harmful habits: Smoking and alcohol consumption can increase the risk of GDM.
Following these recommendations will help you reduce your chances of developing gestational diabetes and maintain your health throughout your pregnancy.
Which Doctor Treats Gestational Diabetes?
Gestational diabetes is treated by an endocrinologist — a doctor specializing in diseases of the endocrine system, including diabetes. The endocrinologist can prescribe treatment that includes dietary adjustments, physical activity, and, if necessary, medication. In some cases, consultation with other specialists, such as a dietitian or an obstetrician-gynecologist, may be necessary. The collaborative work of these specialists will help ensure an optimal pregnancy outcome and the health of both mother and child.
If I Had GDM, Will I Definitely Develop Type 2 Diabetes?
No, not necessarily. In most cases, after childbirth, blood glucose levels return to normal, and you become a completely healthy woman again. However, gestational diabetes is indeed a risk factor for developing type 2 diabetes in the future.
About the Author
Anastasiia Sergienko — Ukrainian Gynecologist, practicing in Warsaw. She adheres to the principles of evidence-based medicine and focuses on patient comfort and care. Anastasiia has international experience and has trained at Harvard Medical School. She also runs a women's health blog for over 34,000 followers (Instagram & Facebook) and provides consultations in Ukrainian, English, Polish, and Russian.
If you have concerns about gestational diabetes or require expert prenatal care in Warsaw, our team at Aurora Medical is ready to assist you. To schedule a visit, please use our online booking system: Umów wizytę.