One of the many things that can happen to a woman when she’s pregnant is diabetes. Such diabetes is called gestational diabetes mellitus [GDM]. It usually develops in the second trimester, around the 20th week of pregnancy, and in most cases, resolves after childbirth.
What causes gestational diabetes?
During pregnancy, there is increased insulin resistance due to hormonal changes. Normally, this is offset by an increased secretion of insulin. However, in some women, this mechanism fails and their blood glucose levels start to rise, leading to diabetes.
Who is at risk of gestational diabetes?
You are at a risk of developing diabetes during pregnancy if you:
- Are overweight, physically inactive, over 25 years of age, consume a diet rich in saturated fats and smoke.
- Have had diabetes during previous pregnancies.
- Have a first degree relative with a history of gestational diabetes or who has delivered a large baby.
- Have been diagnosed with polycystic ovarian syndrome.
Gestational diabetes, if not taken care of, can harm both the baby and mother.
How does it affect the baby?
When the mother’s blood sugar is high, the baby too develops high blood glucose. As the baby is getting more glucose than required, the excess glucose is stored as fat. This causes the baby to become exceptionally large for age, making delivery difficult. It may also induce early labour, which has its own complications such as difficulty in breathing, birth injuries and may also require a caesarean section.
High blood sugar also causes the baby’s pancreas to overwork to produce extra insulin. As an after-effect of this, the baby may have low blood sugar after birth in the first few days of life.
How does it affect the mother?
Gestational diabetes may bring with it all the complications of type-2 diabetes. It may also increase the risk of high blood pressure, urinary infections and need a caesarean section during delivery. In most cases, gestational diabetes normalises completely after delivery. However, having it during pregnancy, puts you at a risk for the same in all future pregnancies. Some women with gestational diabetes continue being glucose intolerant and develop type-2 diabetes in their later years.
How is gestational diabetes detected?
All pregnant women should be screened for gestational diabetes between the 24th and 28th weeks. Women at risk must undergo complete check-ups for diabetes every trimester. A woman has gestational diabetes when her fasting plasma glucose levels are more than 92mg/dL; 1hr plasma glucose levels are more than 180 mg/dL; and 2hr plasma glucose levels are more than 153mg/dL.
In high risk cases, an oral glucose tolerance test is recommended. In this procedure, the blood sugar is tested thrice, once after 12 hours of fasting, and then at one- and two-hour intervals after consuming 75g glucose.
How is gestational diabetes managed?
The key in treating gestational diabetes, just as in any other form of diabetes, is to keep the glucose level in the normal range. Well-planned healthy meals, moderate physical activity and regular blood sugar testing can help to have a normal pregnancy and carry the baby till the full term of the pregnancy. In addition, regular follow-ups with your obstetrician are essential for monitoring foetal growth and wellbeing.
Meal plan: It’s important to eat well-balanced meals at a regular time. The food you eat helps your baby grow and develop inside you. Take the help of your doctor and dietician to create a diet personalised for your needs and lifestyle. Avoid eating foods that contain extra simple sugars such as juices, cake, cookies, candy or ice cream. Do not skip meals or snacks, since that can lower your blood glucose to dangerous levels.
Physical activity: Exercise benefits both the mother and the baby. If you are overweight and are planning to have a baby, start an exercise routine before you conceive. During pregnancy, discuss with your doctor about what kind of exercise is safe for you and how much you should do. Generally, it is best to stick to the forms of exercise that you have been doing before you got pregnant. Walking is the best. If you are on insulin or oral medications for diabetes, inform your doctor about your exercise schedule. This will help her determine the time and dosage and avoid periods of low blood sugar.
A word about insulin: In cases where oral medications are insufficient to regulate blood sugar, insulin injections are prescribed. They are discontinued after delivery, once the sugar levels are in control. Insulin is a natural hormone that every one needs and is not harmful for the baby.
Many women with gestational diabetes feel stressed and tend to blame themselves for their condition and also the health of their baby. It’s essential to understand that high stress levels can only worsen blood sugar levels. While gestational diabetes is a cause for concern, the good news is that women with it, most often deliver healthy babies if their diabetes is controlled and treated. But you can only seek treatment if you know there’s something wrong.
Hence, do regular antenatal check-ups during pregnancy. Though more than 15 per cent of pregnant women in India are overweight or obese, lack of awareness about gestational diabetes is what causes the disease to go unnoticed. So, insist on getting the blood sugars checked during pregnancy. Early diagnosis and proper management of gestational diabetes is crucial for the health of the mother and baby.
Questions to ask your doctor?
- What are the things that I should do to help control my condition?
- How bad is my condition? Do you foresee complications either during pregnancy or after delivery?
- What kind of symptoms should I watch out for to seek immediate medical attention?
- Is my baby at any kind of risk?
- Will it help if I learn more about my condition through the internet?
- Do you recommend any websites I should check out?