Getting pregnant can be the happiest time of a woman’s life. However, gestational diabetes can create complications in getting pregnant. In this article, Dr. Renuka has tried to explain what is gestational diabetes or diabetes during pregnancy and what we can do to minimise the complications associated with it.

Diabetes in pregnancy - An introduction

Dr. Renuka Dangare is an experienced resident doctor. Renuka has been Chief Medical Officer (CMO) at Shlok Multispeciality Hospital, Pune and has completed rotations in Cleveland Clinic, Allegheny General Hospital, University of Texas Houston, Larkin Hospital Miami and Brooklyn Methodist New York. When she isn’t working, she loves to bake to unwind.

What is Diabetes?

Diabetes is a medical condition when the levels of glucose in the blood are higher than normal. The values for blood glucose are usually defined in a range..

What is Diabetes in Pregnancy?

Gestational diabetes is a temporary state of diabetes in a pregnant mother that starts during her pregnancy and in most cases, resolves after childbirth. Almost 1 in 10 pregnant mothers develop increased blood sugar levels during their pregnancies.

The hormones secreted by the placenta and the mother’s body during pregnancy, such as Human Placental Lactogen (HPL), Growth Hormone (GH), Corticotropin Releasing Hormone, Prolactin and Progesterone ensure that the growing baby continues to get its supply of vital nutrients. These same hormones throw the blood sugar metabolism in the body awry and are what we call “diabetogenic”.The secretion of these hormones normalizes as soon as the baby is born and metabolism returns to normal.

Gestational diabetes occurs in those women who cannot make enough insulin to control these rising levels of blood sugar in pregnancy.

Screening and diagnosing for gestational diabetes

Therefore, it’s very important to be screened. Screening for gestational diabetes requires an Oral Glucose Tolerance Test. Most women are screened around the 28th week of Pregnancy as at this stage the hormone levels are higher than earlier. 

You are at a higher risk of gestational diabetes if you’re over 30 years of age, have a family history of Type-2 Diabetes are above your healthy weight range, have Gestational Diabetes with a previous Pregnancy. Women with more risk factors can be screened earlier around the 20th week and screening is repeated at the 28 week mark as well.

Glucose Challenge Test: A Glucose Challenge Test typically entails one to drink a syrupy glucose solution. An hour later, a blood test is conducted to measure blood glucose levels. If your blood sugar level is higher than normal, you’ll need another glucose tolerance test or a 7 sugar profile to determine if you have the condition.

Follow-up glucose tolerance testing: This test is similar to the initial test — except the sweet solution will have even more sugar and your blood sugar will be checked prior to taking the solution and afterwards, every hour for three hours. If at least two of the blood sugar readings are higher than expected, you’ll be diagnosed with gestational diabetes.

7 sugar profile : 

The 7 point blood sugar test involves an overnight stay at the hospital where your blood sugar is assessed 7 times in the day, before and after your meals. 

Why is gestational diabetes bad for the mother and the baby:

Gestational diabetes that’s not carefully managed can lead to multiple complications in pregnancy both for the mother and the baby.

For the mother it means an increased risk of raised blood pressure during pregnancy, an increased likelihood of needing a C-section to deliver the baby and a high risk for developing diabetes in the future.

 Babies of mothers with diabetes may be exposed to high blood sugar levels in the womb, and are generally larger or heavier babies. They are born sooner (preterm births) and in very rare cases are stillborn if the mother’s diabetes is poorly controlled. Infants of diabetic mothers can also develop breathing difficulties and dangerously low blood sugar levels before birth.

What are some factors that may increase your risk of developing gestational diabetes?

Some women are at a greater risk of Gestational Diabetes. Some conditions that make you prone to gestational diabetes include obesity or a BMI over 25 at the time of conception, a lack of physical activity prior to and during pregnancy,  previous gestational diabetes or prediabetes and a history of  polycystic ovary syndrome in yourself or diabetes in your family. 

How can one minimize complications related to Gestational Diabetes?

The first step towards managing gestational diabetes is to know what gestational diabetes is. When detected with gestational diabetes it’s important to follow an ideal diet and lifestyle plan.

Diet – It is recommended that you develop a sustainable nutrition plan with consultations from your doctor and nutritionist.Most healthcare providers recommend a diet high in protein and lower in saturated fats, sugar and processed foods. It likely will comprise high fibre foods, vegetables, whole grains, and legumes. The goal of the diet is to maintain a normal blood sugar level without compromising on adequate nutrition for mother and child.

Physical Activity- Pregnancy is not an ideal time to start an intense workout. Any physical activity you have to start has to be approved by your doctor prior to starting. Brisk walking for around 30 minutes a day for a minimum of 5 days a week is the most easiest recommended exercise. Swimming is also a great alternative but fall prevention needs to be kept in mind. 

Maintaining ideal weight gain during pregnancy – Women with higher than normal BMI are advised to keep weight gain under 10kgs for the entire pregnancy. 

In women already detected with diabetes, treatments include a stepwise escalation. Most women are able to keep blood sugars in check by diet and lifestyle alone. Unfortunately some do have to use insulin during pregnancy. It is important to know that most anti diabetic drugs are unsafe to be taken during pregnancy so patients should always consult a provider.

 

Conclusion

Most women with gestational diabetes can have an uneventful pregnancy if blood glucose levels are kept within a safe range. It’s important to recognize that implementing healthy lifestyle modifications on time will ensure a healthy mother and child.

Disclaimer: This article is for informational purposes only and is not a substitute for medical advice or treatment.

Links :

https://www.uptodate.com/contents/gestational-diabetes-beyond-the-basics

https://www.mayoclinic.org/diseases-conditions/gestational-diabetes/symptoms-causes/syc-20355339

https://www.nice.org.uk/guidance/ng3/chapter/1-Recommendations#preconception-planning-and-care-2

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