Diabetes is one of the most common lifestyle diseases of the world and about 1 in 11 people suffer from it. Consequently we all know at least a little bit about it, the foods to abstain from and the possible side effects. One of my close friends delivered a baby girl after being diagnosed with gestational diabetes during her second trimester. I remember how she asked me about it as she assumed I had medical background and a family full of diabetics, so I would have knowledge about gestational diabetes as well. However, there were only a limited number of questions I could answer, which made me realize how little we know about a condition which affects about 12% of all pregnancies.
My friend is a little paranoid by nature and had asked me to accompany her for her appointments with the gynecologist and endocrinologist. The doctors were kind enough to explain to us in great detail, however, there were still a lot of queries that either we forgot to ask or remained unanswered. I watched her struggle with lack of information, stress and myths surrounding gestational diabetes till the time of her very uneventful delivery. Not wanting other women to suffer from the same dilemma, I did some further research and suggested my friend to keep a close and regular check on her blood sugar levels. She often checked her sugar at home by using One Touch, and then started maintaining a strict diet chart to keep everything under control. I even decided to jot down information for quick reference to Gestational Diabetes, to make sure I am fully aware and could even assist other women in my life when the need be.
While the world wide incidence of Gestational Diabetes Mellitus [GDM] is 3-4%, Indian women are 4 times more likely to suffer from it, all the more a reason for everyone to know about it.
Basis my research, here are the top 6 things everyone must know about gestational diabetes.
1. What is gestational diabetes and why does it occur?
Gestational diabetes is diabetes that occurs in pregnant women and usually goes away 4-6 weeks postpartum. It means a woman has high glucose levels during pregnancy.
Gestational diabetes is thought to arise because of the hormonal and other changes that occur in the body during pregnancy. The placenta makes hormones that can lead to a buildup of glucose in blood. Usually, pancreas can make enough insulin to handle that. If not, blood sugar levels rise and can cause gestational diabetes.
2. Risk factors for developing GDM
Certain risk factors that increase the chances of a woman getting this condition are
- Age greater than 25 which is very common these days due to late marriages and career aspirations.
- Obesity or being overweight before getting pregnant
- A history of gestational diabetes in a previous pregnancy
- Previous delivery of an infant with a high birth weight (over 9 pounds/4kgs)
- A parent or sibling with type 2 diabetes
- A personal history of polycystic ovary syndrome (PCOS)
- Having pre-diabetes i.e. high blood sugar levels, but not high enough to be diabetic
3. How to diagnose Gestational diabetes
Gestational diabetes usually happens in the second half of pregnancy and is diagnosed with blood tests. Most pregnant women are tested between the 24th and 28th weeks of pregnancy, but in presence of risk factors, doctor may decide to test earlier. These tests include Glucose challenge test, glucose tolerance test and HBA1c levels. However, it is important to look out for symptoms such as excessive hunger, thirst and urination and report it to doctor.
4. Risk to the baby
Women with gestational diabetes who receive proper care and monitoring typically deliver healthy babies. However timely diagnosis and management is necessary as there may be harmful effect on fetus every month GD goes unnoticed. Persistently elevated blood glucose levels throughout pregnancy can lead to -Elevated blood glucose levels in fetus which can cause fetal overgrowth, possibly making delivery more complicated.
- Low blood glucose immediately after birth.
- Greater risk of jaundice
- Pre-term birth and increased risk for respiratory distress
- A higher chance of still birth
- Greater risk of baby becoming overweight and developing type 2 diabetes later in life.
If diabetes is present in an early pregnancy, there is an increased risk of birth defects and miscarriage compared to that of mothers without diabetes.
5. Effects of GDM on mother
Improper care, irregular monitoring and poor control can lead to –
- Greater chance of needing a Cesarean birth (C-section), in part due to large infant size.
- Increased risk of preeclampsia, a maternal condition characterized by high blood pressure and protein in the urine.
- Increased risk of having type 2 diabetes after the pregnancy.
Most women with gestational diabetes who maintain normal blood sugar levels go on to deliver healthy babies. After baby is born, gestational diabetes usually goes away. Risk of developing Type 2 Diabetes can be reduced by following a good nutritional plan, exercising, and maintaining a healthy weight.
6. Prevention and management
There are no guarantees that gestational diabetes can be prevented but the more healthy habits before pregnancy, the better. Eating healthy food which is rich in fiber and vitamins and low in fats and calories along with regular exercise to lose excess weight reduce the risk of developing GDM as well as risk of developing Type 2 Diabetes post pregnancy.
What happens if gestational diabetes is diagnosed?
Doctor will likely recommend frequent checkups, especially during last three months of pregnancy. Close monitoring of baby’s growth and development with repeated ultrasounds or other tests is an important part of treatment plan.
Treatment strategies include:
- Monitoring blood sugar: Constant monitoring to know if glucose is within normal test range is of paramount importance and first step towards effective management. Patient may need to check blood sugar four to five times a day –
- Fasting blood glucose – right after waking up in the morning,
- After breakfast
- After lunch
- After dinner
These testing periods are important because it allows knowing how efficiently body’s hormones are regulating the metabolism and uptake of glucose. As a side benefit, knowing that you have to test makes you accountable for making healthier choices at each meal.
It is important to maintain a Gestational Diabetes sugar level chart to make sure glucose levels stay within a healthy prescribed range. This may sound inconvenient and difficult, but gets easier with practice. Glucometers available now to give blood glucose readings are painless, nice and compact, and super easy to use.
- Diet regulation and portion control: Based on personal information (weight and height) Body Mass Index (BMI) is calculated which is important to determine what would be a healthy weight gain for each pregnancy. Eating the right kinds of food in healthy portions is one of the best ways to control blood sugar and prevent too much weight gain for both mum and baby. A healthy diet focuses on foods that are high in nutrition and fiber and low in fat and calories and limit highly refined carbohydrates, including sweets.
- Exercise: Regular physical activity plays a significant role in every woman’s wellness plan before, during and after pregnancy. Exercise lowers blood sugar by stimulating glucose to move inside cells, where it can be used for energy. Exercise also increases sensitivity to insulin, which means body will need to produce less insulin to utilize same amount of sugar.
As an added bonus, regular exercise such as walking can help relieve stress as well as some common discomforts of pregnancy, including back pain, muscle cramps, swelling, constipation and trouble sleeping. However all exercise during pregnancy should be done only with permission of concerned doctor.
- Medication: If diet and exercise aren’t enough and the sugar levels exceed GD test range, a woman may need insulin injections to lower blood sugar. However, only 10-20 percent of women with gestational diabetes need insulin to reach their blood sugar goals. Doctors may prescribe an oral blood sugar control medication, but some doctors feel oral drugs may not be as safe and as effective as insulin injections to control gestational diabetes.
Even though my friend was worried about her baby during pregnancy, there is a silver lining to every dark cloud. Due to regular monitoring and strict diet control, she did not gain excessive weight and even managed to come back to her pre-pregnancy weight quite easily. Not being judgmental and even though it’s just a superficial comfort; when rest of life turns topsy-turvy with a little baby, it feels good to be back to your normal appearance. Also she swears that for an anxious person like her it may have been hard to go week after week, trusting God without knowing what the baby was doing in there. The additional monitoring at home and hospital reassured her that the baby was doing fine, and helped her relax during those final weeks of pregnancy.
Of course, gestational diabetes is a serious condition that needs to be carefully managed; it doesn’t mean one can’t enjoy pregnancy. It’s stressful to have a condition that can affect unborn baby’s health but women need to be kind to themselves. Family and friends need to support and reassure the affected women that it’s not their fault and can be managed with proper monitoring and care. Despite the myths, a diagnosis of Gestational Diabetes does NOT mean a big baby or a cesarean. A gentle, calm and intervention-free vaginal birth with gestational diabetes is possible for most women.
In fact right attitude, healthy changes to eating habits and exercise can help form habits that not just lead to a smooth sailing pregnancy but last a lifetime.
Disclaimer: The opinions expressed in this post are the personal views of the author. They do not necessarily reflect the views of Portea. Any omissions or errors are the author’s and does not assume any liability or responsibility for them.