Lara was pregnant. Routine blood tests revealed that she had gestational diabetes mellitus [GDM]. Totally clueless about this condition, her major concerns were whether she will have a normal delivery, and how it will impact her child during and after delivery.
These are not just Lara’s concerns, but of all the women who are diagnosed with gestational diabetes. There is nothing alarming about GDM.
It can be managed by taking good care of yourself, eating healthy food, exercising regularly and if necessary, taking medication [insulin].
What is gestational diabetes?
When a pregnant woman is diagnosed with diabetes, it is termed as gestational diabetes. She may be diabetic even before she is pregnant or develop it during pregnancy. About 3–6 per cent of pregnant women have GDM.
What causes gestational diabetes?
During pregnancy, the body needs more insulin to meet the growing energy needs of the child. But the hormones produced inside the placenta during pregnancy [progesterone, oestrogen, cortisol, prolactin and human placental lactogen], block the effect of insulin, causing GDM.
GDM usually affects women who:
- Are overweight
- Are over 35 years of age
- Have family history with a first degree [nearest] relative with Type-2 diabetes
- Have been diagnosed with gestational diabetes earlier
- Have previously given birth to a large baby
- Have gained excessive weight during pregnancy
- Have had recurrent abortions
- Have had a bad obstetric history.
Women at risk must get themselves tested for diabetes every trimester. Those who are at a higher risk may also have to undergo an oral glucose tolerance test.
What are the symptoms of gestational diabetes?
Unfortunately, often, women do not show any symptoms. And their diabetes gets detected on routine screening around the 24 – 28 week of pregnancy. Usually, such diabetes disappears after delivery.
How does GDM affect the mother?
GDM could lead to excessive weight gain, oedema [swelling of feet], hypertension, pre-eclampsia [high blood pressure], eclampsia, premature labour, intrauterine foetal death, urinary tract infections, and ketoacidosis [high concentrations of ketone bodies].
Moreover, women with GDM are prone to developing type-2 diabetes mellitus, post delivery. In fact, more than 40 – 50 per cent women with GDM go on to develop type-2 diabetes later, if they do not modify their lifestyle.
In what way does GDM affect the child?
The uncontrolled sugar levels could lead to congenital anomalies and neural birth defects.
Further, high blood sugar can also cause macrosomia [babies to become large], increasing the chances of a difficult delivery, caesarean [C-section] or birth trauma.
Complications that could arise in the baby after birth include: breathing difficulties due to non-expansion of the lungs at birth, abnormally low levels of glucose, calcium and magnesium in the blood, increased bilirubin levels and infections.
How to manage gestational diabetes
Women who manage to control their diabetes well often carry their baby to term without any problems. If you develop diabetes during pregnancy, you may be able to control your blood sugar level with—diet, exercise, insulin and monitoring.
The meal plan should provide enough calories to meet the nutritional needs and maintain optimal body weight. Instead of three large meals a day, split your daily food intake into six smaller ones—regularly spaced and carefully planned. Snacks are important, and should include a complex carbohydrate [such as whole-grain bread], protein [such as sprouts and paneer], fruits, and raw vegetables. It is best to restrict fat intake [oil/ghee/butter] and prefer roasted/grilled and baked foods in place of fried food. Eat at regular intervals; skipping meals can lower blood glucose to dangerous levels.
Exercise benefits both the mother and the baby. If you aren’t exercising regularly, now is a good time to start. Check with your doctor about your planned activity and start slowly. You’ll need to plan your periods of activity along with your food intake and insulin injections. Exercise improves the efficiency of your own insulin to manage both, weight and blood sugar. Exercise 4 – 5 days a week, as it keeps your blood sugar in control. Do not exercise if your doctor does not approve of it or has asked you take complete rest.
Walking after meals improves post-meal blood sugar. Other exercises you may perform during pregnancy are low-impact aerobics and swimming. Exercise reduces your sugar levels. Hence, check your blood sugar for hypoglycaemia [abnormally low sugar].
If diet and exercise fail to control your blood sugar or when your blood sugar is abnormally high, you may need to take insulin, since tablets that control sugar levels may affect the unborn foetus. You will require 2 – 4 doses of insulin every day; your dose could increase as your pregnancy progresses to keep things in check. If you are on insulin, you may have to undergo additional ultrasound scans and electronic foetal monitoring to check the health of the baby.
Pregnant women are advised to monitor blood sugar levels at least four times a day [Fasting Blood Sugar <90 mg%, Post Lunch BS< 120mg %]. If you are on a low-cal diet, you may have to also monitor urine ketones to maintain your caloric or carbohydrate levels. You may also have to measure your blood pressure and urine protein to detect hypertensive disorders.