Gestational Diabetes

What is Gestational Diabetes?

Gestational diabetes is high blood sugar that is first detected during pregnancy, at levels below those that define overt diabetes.^{[1, 2]} About 14% of pregnancies worldwide are affected.^[1] It needs medical care during pregnancy, and complementary care cannot control blood sugar.

Common symptoms

Gestational diabetes often causes no noticeable symptoms, which is why screening matters. When symptoms occur, they can include increased thirst, frequent urination and tiredness, but these are also common in pregnancy, so they are not a reliable guide.^[2]

Causes and risk factors

During pregnancy the body becomes more resistant to insulin, and gestational diabetes develops when insulin production cannot keep up.^[3] Being overweight or obese, older age at pregnancy, a previous episode of gestational diabetes, a family history of type 2 diabetes and ethnicity are major risk factors.^[3]

How it is diagnosed and treated conventionally

Diagnosis is usually made with an oral glucose tolerance test, often at 24 to 28 weeks of pregnancy. In some places a glucose challenge test is used first to select women for the full test.^{[1, 3]} Some women, especially those with risk factors, are diagnosed earlier in pregnancy.^[1]

Dietary changes and more physical activity are the first treatments. Insulin is used when blood sugar targets are not met, and some countries also use metformin or glibenclamide.^[3] Treatment lowers the chances of excess fetal growth and high blood pressure in pregnancy.^[3]

After birth, blood sugar usually returns to normal, but women who have had gestational diabetes remain at higher risk of type 2 diabetes and need follow-up testing.^{[2, 4]}

Why Gestational Diabetes calls for a whole-person approach

Gestational diabetes is driven by hormones, weight, diet, activity and family history together, and its effects reach beyond blood sugar. It increases the risk of hypertensive disorders, preterm delivery and newborn metabolic and breathing problems, and later of obesity and impaired glucose metabolism in both mother and child.^{[1, 3]}

Supportive care can address parts of the experience around the diagnosis, such as worry, but it sits alongside, not in place of, glucose targets set by your obstetric team.

Diet and physical activity

Lifestyle change is essential in managing the condition. Nutrition advice focuses on the type, amount and distribution of carbohydrates while still supporting the baby's growth.^[5] Physical activity improves glucose and insulin levels, although a review of 14 studies found mixed effects of exercise on blood sugar and no clear effect on pregnancy outcomes.^{[5, 6]}

Stress and anxiety

Women with diabetes often have more anxiety than others, and a new diagnosis in pregnancy can add to it.^[7] Relaxation methods during pregnancy, including yoga, breathing and mindfulness, lowered stress, anxiety and depressive symptoms in a meta-analysis of 32 studies of pregnant women in general, not only those with gestational diabetes.^[8]

Life after the pregnancy

Higher body weight after delivery, a repeat episode of gestational diabetes and raised blood sugar markers were among the factors linked with later type 2 diabetes in a meta-analysis of 46 studies.^[4] This is why postpartum testing and healthy routines matter after birth.

Acupuncture as supportive care in Gestational Diabetes

What the research shows

No trials of needle acupuncture for gestational diabetes were found in PubMed. A 2019 review of traditional Chinese medicine for gestational diabetes noted that treatment of the condition by alternative interventions is grossly understudied.^[9]

Two small randomized trials tested acupressure, which is pressure on acupuncture points without needles, and they are not the same as acupuncture. In one trial of 60 women with gestational diabetes, acupressure at true points reduced anxiety compared with pressure at sham points over two days.^[7] In another trial of 30 women, blood sugar measures did not differ between the acupressure and usual-care groups at 24 and 36 weeks.^[10] These are small studies and cannot show that acupuncture helps.

How acupuncture may work

No mechanism has been studied for acupuncture in gestational diabetes. Any effect on anxiety is not explained by the trials above, and we do not make claims about blood sugar.

What treatment involves

Treatment uses fine, sterile, single-use needles at points chosen for the symptoms being addressed, usually left in place for about 20 to 40 minutes. Points and techniques are adapted to pregnancy, and a short course is followed by reassessment.

In prospective studies of acupuncture in general, about 9 in 100 patients had a minor reaction such as bleeding, pain or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[11] This review was not specific to pregnancy. Tell the practitioner how far along you are, whether you are taking insulin or other medicines, and about any bleeding disorder or blood thinner.

Ayurvedic medicine as supportive care in Gestational Diabetes

The Ayurvedic view

Ayurveda describes diabetes in general as Madhumeha, a disorder involving imbalance of Kapha and other doshas, and it advises on diet and daily routine. This is a traditional framework and not a medical diagnosis, and it has no classical description of diabetes first found in pregnancy.

Therapies that may be used

Supportive care in pregnancy is gentle and individualized, and may include:

• Advice on regular meals and sleep, fitted around the dietary plan from your obstetric team or dietitian
• Relaxation, breathing practices and gentle movement approved by your physician
• Herbs only after your obstetric team has been told, because many are not studied in pregnancy

Panchakarma procedures are not appropriate during pregnancy and we do not use them for pregnant patients.

What the research shows

There are no clinical trials of Ayurvedic medicine for gestational diabetes in people. The only study found tested preparations of Tinospora cordifolia (guduchi) in pregnant mice with chemically induced diabetes and reported better insulin measures. Its authors called for clinical trials, and it does not show benefit in women.^[12]

A single randomized trial in Thailand of mindfulness eating plus yoga exercise in women with gestational diabetes reported lower fasting, after-meal and HbA1c blood sugar results in the intervention group.^[13] This was not an Ayurvedic treatment study and was not testing the clinic's services.

Herbal medicine as supportive care in Gestational Diabetes

Herbs and formulas that have been studied

The 2019 review identified three herbal products associated with blood sugar control in gestational diabetes: Zuo Gui Wan, red raspberry leaves and Orthosiphon stamineus. Most of the further evidence it discussed was in type 2 diabetes.^[9] A 2021 review of herbalism in obstetrics also covers herbs used in pregnancy, including for gestational diabetes.^[14]

What the research shows

The evidence for herbs in gestational diabetes is very limited. The 2019 review says the field is understudied and calls for standardized protocols to judge whether herbal products work.^[9] We did not find randomized trials showing that any herb improves blood sugar or outcomes in gestational diabetes.

Safety and herb-drug interactions

Pregnancy calls for particular caution. A meta-analysis of 111 studies found that 34.4% of pregnant women used herbal medicine, often because they thought it safer, and only 27.9% told their providers. Disclosure was linked with better maternal and child outcomes.^[15] Please tell your obstetric team about any herb you consider.

Herbs can also interact with medicines. A literature review reported hypoglycemia when garlic was taken with a diabetes drug, and bleeding when several herbs were combined with warfarin.^{[16, 17]} Because insulin and other diabetes medicines also lower blood sugar, any herb that affects glucose needs review by your prescriber.

About one fifth of Ayurvedic medicines bought online contained detectable lead, mercury or arsenic, which is of particular concern in pregnancy.^[18] We do not prescribe herbs without knowing your full medicine list and your stage of pregnancy.

Translating traditional medicine into modern biological language

This is interpretation, not equivalence. Traditional Chinese medicine descriptions such as kidney yin deficiency with dryness are sometimes applied to diabetes, and Zuo Gui Wan is a formula traditionally used to nourish kidney yin. Researchers instead study glucose, insulin resistance and insulin secretion.

In Ayurveda, Kapha imbalance and impaired digestion (agni) are described in relation to diabetes. No study has shown that these ideas match measurable changes in the insulin resistance or placental hormones that drive gestational diabetes.^[3]

How this care fits with your medical care

Supportive care is complementary. For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care.

Keep every prenatal visit, blood sugar check and scan. Do not stop or change insulin, metformin or any other prescribed medicine, or the diet plan from your team. We do not diagnose gestational diabetes or manage blood sugar.

Please bring your diagnosis, your due date, recent glucose readings, a list of all medicines and supplements, and the name of your obstetric provider.

When to seek urgent medical care

Contact your obstetric provider promptly, or seek emergency care, for any of these.

• Decreased or absent baby movements
• Vaginal bleeding, leaking fluid, or regular contractions before 37 weeks
• Severe headache, vision changes, sudden swelling or upper abdominal pain, which can signal pregnancy high blood pressure
• Blood sugar readings far above or below your target, or symptoms of low blood sugar such as shakiness, sweating or confusion
• Persistent vomiting, extreme thirst or drowsiness

For emergencies, call 911 or go to the nearest emergency department.