Gestational Diabetes And Preeclampsia: A Complicated Relationship

In the United States, gestational diabetes affects over 2% to 10% of pregnancies¹ every year. Pregnant women can develop this condition regardless of their previous medical history. In most cases, gestational diabetes can be treated with a healthy diet and exercise.

Women who develop gestational diabetes are at a higher risk of facing preeclampsia, a blood pressure disorder. Preeclampsia which affects 5%-8% of pregnancies² can result in premature birth and possible related complications, such as epilepsy, cerebral palsy, and learning disability.

Let's take a look at how gestational diabetes and preeclampsia are related.

What is gestational diabetes?

Gestational diabetes (also known as gestational diabetes mellitus or GDM) is a condition that affects your body's ability to turn glucose into energy. To produce energy, your pancreas creates a hormone called insulin. Insulin helps glucose enter cells and turn into energy.

When you are pregnant, your body's hormonal balance changes. Due to this, your cells may not use insulin as effectively as they should. This is called insulin resistance.

Insulin resistance calls for your body to produce more insulin. Some women manage to make enough insulin to handle the resistance. Others develop gestational diabetes.

Risk factors for this type of diabetes are:

• Excess weight or obesity

• Lack of activity

• History of GDM and prediabetes

• PCOS (Polycystic Ovary Syndrome)

• Inheritance (if parents or siblings have any type of diabetes)

• Race

Since gestational diabetes rarely has any symptoms, doctors routinely test for it between 24 and 28 weeks of pregnancy. Women with a history of diabetes or certain risk factors get tested earlier.

Gestational diabetes usually goes away once a woman gives birth and hormone production returns to normal. However, the risk of developing type 2 diabetes later in life remains.

What is preeclampsia?

Preeclampsia is hypertension (high blood pressure) combined with either  proteinuria ( protein in urine) or one or more of the following complications:

• Decreased blood platelet count

• Problems with kidneys or liver

• Fluid in the lungs

• Cerebral symptoms (e.g., seizures)

• Vision problems (e.g., blurred vision)

This condition develops after the 20th week of pregnancy and typically goes away after a woman gives birth.

If not treated, preeclampsia puts serious strain on your heart and other organs. It can affect the blood supply to the placenta and may lead to pre-term birth.

In the United States, preeclampsia causes around 15% of pre-term deliveries³ (births before the 37th week of pregnancy). In the world, it's the leading cause of maternal and perinatal mortality.

Symptoms of preeclampsia

Sometimes, preeclampsia develops without any visible symptoms. The first warning sign is elevated blood pressure (BP). Since women may not always feel their blood pressure rising, measuring it is an integral part of prenatal care.

If your blood pressure is 140/90 mm Hg or higher during pregnancy, it's a reason to contact your doctor, who will run further tests to diagnose or rule out preeclampsia.

Other symptoms of this condition include:

• High levels of protein in the urine

• Swelling in face, hands, and feet

• Continuous headaches

• Blurred vision

• Pain in the upper right abdomen (right below the ribs)

• Breathing problems

• Nausea and vomiting

• Fast weight gain (due to fluid retention)

If you notice any of these symptoms, you need to call your ob-gyn immediately. The doctor will measure your blood pressure and check for protein in your urine. They may also run tests to check if your organs are working properly.

Left uncontrolled, preeclampsia could cause severe consequences for both the mother and the baby.

Causes of preeclampsia

Currently, the cause of preeclampsia is unknown. One of the theories has to do with the blood supply to the placenta. When the placenta starts changing to provide enough nourishment to the growing fetus, it develops new blood vessels.

When these vessels don't develop or function properly, you may develop preeclampsia. Blood vessels in the placenta are narrower than other blood vessels. They also have a different reaction to hormone production. This limits the amount of blood they process.

The causes of abnormal blood vessel development can include genetics, insufficient blood flow to the uterus, immune system problems, and blood vessel damage.

Other theoretical causes include systemic inflammatory response, changes in the placenta, hormonal imbalance, and more.

Risk factors for preeclampsia

Some women are more likely to develop preeclampsia than others. Common risk factors include:

• Age – Older age is related to higher preeclampsia risks. Studies show⁴ that women over 35 are 4.5 times more likely to suffer from preeclampsia than women between 25 and 29.

• Race – African American women are 60% more likely⁵ to develop preeclampsia than white women are.

• Obesity – Studies show that⁶ excessive weight gain both before and during pregnancy can increase the risk of pre-eclampsia.

• In-vitro fertilization (IVF) – Studies show⁷ that women who have had IVF are six times more likely to develop preeclampsia than other pregnant women.

• Multifetal pregnancy – If you are carrying more than one baby, your chances of developing preeclampsia increase. One study⁸ showed that women with multifetal pregnancies develop preeclampsia more than five times as often as women with singleton pregnancies.

Other risk factors include a history of high blood pressure, preeclampsia, kidney disease, lupus, and rheumatoid arthritis.

Preeclampsia usually goes away after a woman gives birth. However, those women who suffer from this condition during pregnancy are at a higher risk of developing kidney disease, heart problems, and high blood pressure issues later in life.

Treatment for preeclampsia

The treatment for preeclampsia depends on the severity of your condition.

Mild preeclampsia

You have mild preeclampsia⁹ if you don't have a history of high blood pressure problems and:

• Your blood pressure is 140/90 mm Hg and proteinuria or;

• Your blood pressure is 140/90 mm Hg and there are signs of kidney, liver, or hematological (blood) dysfunction.

The treatment for mild preeclampsia involves:

• Monitoring your condition by visiting the ob-gyn once or twice a week

• Measuring blood pressure at home regularly

• Taking medication to manage blood pressure

• Taking medication to help the baby’s lungs develop quicker

• Monitoring the baby's condition by keeping track of its movements

• Bed rest

After the 37th week of pregnancy, your doctor may suggest inducing delivery. This may be necessary to prevent complications. At 37 weeks, the pregnancy isn't considered full term yet. However, early delivery could be less dangerous than carrying to term.

Severe preeclampsia

You have severe preeclampsia¹⁰ if you have:

• Systolic (the first number) BP of 160 mm Hg or higher

• Diastolic (the second number) BP of 110 mm Hg or higher

• Severe proteinuria

• Infrequent urination

• Low platelet count

• Pain in the stomach

• Poor liver function

• Respiratory problems

• Vision problems

• Low baby weight

The treatment for severe preeclampsia includes:

• In-patient monitoring

• Blood pressure medication

• Corticosteroids improve liver function and help your baby's lungs mature faster

• Anticonvulsant medication to prevent seizures

If a woman has signs of severe preeclampsia and is at least 34 weeks pregnant, the doctor may recommend early delivery. If the woman is less than 34 weeks pregnant, doctors will do everything possible to delay delivery. In such a situation, even a few days can make a huge difference in the baby's development.

Complications of preeclampsia

If not controlled, preeclampsia can lead to serious complications. The most severe complications are:

HELLP syndrome

HELLP stands for:

• Hemolysis (blood cells that carry oxygen are damaged)

• Elevated Liver enzymes

• Low Platelet count (blood clotting problem)

HELLP is a medical emergency that requires immediate attention. Its symptoms include chest pain, blurred vision, severe headache, swelling, and bleeding from the nose or gums.

Placental abruption

Placental abruption occurs when the placenta suddenly separates from the uterus. This can lead to heavy bleeding and stillbirth.

Placental abruption¹¹ also increases your chances of developing preeclampsia during the next pregnancy.

Other complications of preeclampsia include:

• Eclampsia (preeclampsia + seizures)

• Cardiovascular problems

• Organ damage

• Preterm birth

• Fetal growth restriction¹²

Regular ob-gyn appointments can help you identify the onset of preeclampsia and prevent complications.

Preventive measures

The key to preventing preeclampsia is identifying risk factors and addressing them before and during the pregnancy. Other preventive measures include:

• Taking low-dose aspirin in early pregnancy (only if your ob-gyn recommends it)

• Losing weight (for overweight and obese women)

• Keeping blood pressure and blood sugar under control

• Staying active

• Getting enough rest

• Maintaining a healthy diet

If you have a history of high blood pressure, preeclampsia, and diabetes, make sure to let your doctor know at the pregnancy planning stage. Proper prenatal care can help you prevent complications.

Preeclampsia and gestational diabetes

Gestational diabetes and preeclampsia have numerous similarities. Both of them:

• Are dangerous health conditions that develop in the second half of the pregnancy

• Require close monitoring and treatment

• Usually, go away after a woman gives birth

• Carry risks of developing related conditions in the future (diabetes and hypertension accordingly)

• Have similar risk factors

• Have many similar symptoms

• May result in premature birth or stillbirth

These two conditions are closely related to each other. Gestational diabetes increases the risk of preeclampsia since high glucose levels can cause high blood pressure.

Gestational diabetes may cause preeclampsia

When blood with high glucose content makes its way through your body, it can cause serious damage to the blood vessels and kidneys.

Both of these organs play a significant role in regulating your blood pressure. When damage occurs, the BP rises, and you can develop hypertension.

Preeclampsia may cause diabetes

A meta-analysis¹³ of 4.1 million people published in the Journal of the American College of Cardiology (JACC) showed that people with hypertension have a higher risk of developing type 2 diabetes.

Other studies¹⁴ show that women who have had preeclampsia during pregnancy are at a higher risk of developing type 2 diabetes later in life.

One more study¹⁵ showed that preeclampsia increases the risk of developing gestational diabetes in subsequent pregnancies.

More studies need to be done to determine whether preeclampsia may cause gestational diabetes during a current pregnancy.

When to call a doctor

Pregnancies are often accompanied by numerous health problems, including preeclampsia and gestational diabetes. That's why regular monitoring is imperative for carrying a pregnancy to term and keeping the mother's health in top shape.

If you are at a high risk of developing gestational diabetes and preeclampsia, you may need to see your ob-gyn more often than women without risk factors do.

During pregnancy, it's important to pay close attention to your body. If something seems even a little off, it's a valid reason to call your doctor.

The lowdown

Gestational diabetes and pre-eclampsia are closely related conditions that can complicate pregnancy.  Gestational diabetes is a risk factor for preeclampsia during pregnancy, while preeclampsia may cause diabetes later in life.

While preventive measures exist, they aren't 100% effective. That's why regular ob-gyn appointments remain the key to discovering both problems on time and preventing complications during pregnancy and in the future.