- Understanding gestational diabetes
- Risks associated with gestational diabetes
- Strategies of care before delivery
- Gestational diabetes during delivery
- Strategies of care after delivery and for the long term
Diabetes is a condition when the amount of sugar in the blood exceeds the normal level. It is seen that some women who may not normally have diabetes, may develop this condition during pregnancy. The incidence of gestational diabetes is quite common and the condition is generally diagnosed by a routine sugar test. Women with gestational diabetes may suffer from several conditions. Special care is required before, during and after delivery. However, clinical intervention in proper time and carefully regulated diet can vastly reduce the risks associated with diabetes during pregnancy.
When you eat starchy foods, the complex compounds are broken down by the digestive system into glucose. This glucose circulates in your blood. The pancreas secretes a hormone called insulin. This hormone helps the cells of your body to break down glucose and convert it into fuel for the body. Hence, it helps to regulate the amount of glucose present in your blood. However, if your body produces insufficient insulin, glucose cannot be utilized properly by the cells. This leads to accumulation of sugar in blood. This condition is known as diabetes mellitus.
There are two types of diabetes:
- Type I diabetes is a condition where your body cannot produce any insulin.
- Type II diabetes is a condition when your body cannot produce insulin in sufficient quantities or it cannot work properly.
Apart from these two long term conditions, some women may develop gestational diabetes. This is a condition that develops when you are pregnant and which goes away once the baby is delivered. However, women who have gestational diabetes are at greater risk of developing diabetes later in life.
Understanding gestational diabetes
The demand for insulin increases in the body when you are pregnant because of the hormonal change. In case of most women, the pancreas secretes more insulin to maintain the normal blood sugar. However, in some cases, the body cannot produce sufficient insulin or your body does not respond adequately to the increased production of insulin. This results in increased blood sugar leading to gestational diabetes. There are no symptoms of gestational diabetes. So, doctors routinely order a glucose screening test at 24 to 28 weeks of pregnancy. If blood sugar is found to be high, this has to be followed by tests like oral glucose tolerance test (OGTT) and glucose challenge test (GCT) to confirm the diagnosis. 3 to 5% of pregnant women get this condition every year. In USA, this condition is seen in 1 in 2014 pregnant women.
Risks associated with gestational diabetes
Before enquiring about the type of pre and post natal care required by women with gestational diabetes, it is necessary to understand what are the risks associated with this condition:
- If you develop this condition, your baby may become too large in size. This will create complications during labor. Hence, you may have to have labor induced or get a C-section.
- There is also a higher probability of miscarriage and stillbirth. Fasting hyperglycemia has been related with higher incidence of intrauterine death during 4 to 8 weeks of gestation.
- If you already have preexisting condition of the eye or the kidney, these are likely to get worse with diabetes.
- The baby may be born with birth defects – especially those affecting the heart and the nervous system.
- There is a higher incidence of neonatal jaundice, polycythemia and hypocalcemia in infants born to diabetic mothers.
- The baby may develop problems with the heart or breathing and require hospitalization, sometimes leading to death.
- The baby also has a higher risk of developing obesity or diabetes later in life.
- The mother has a higher risk of developing gestational hypertension. The two factors together make a C-section almost unavoidable.
- The mother too has a risk of developing Type II diabetes later in life.
Thus, it is necessary to take sufficient care both before and after delivery to avoid the complications resulting from gestational diabetes.
Strategies of care before delivery
Early screening is necessary in order to start special care and monitoring as soon as possible. There are certain risk factors which increases the risk of gestational diabetes. These are as follows:
- Obesity with BMI equal to 30 or more.
- A history of gestational diabetes in previous pregnancy
- Strong family history of diabetes
- Age over 35
- A previous baby with birth weight more than 4.5 kgs or birth defects
- Unexplained stillbirth in the past
However, even if none of the above risk factors are applicable in your case, you may still develop gestational diabetes. The condition has no symptoms. So, routine glucose tests are performed to identify the condition.
If you are definitely diagnosed with gestational diabetes, following care is essential:
- Once diagnosis is confirmed, the blood glucose level of the mother has to be monitored carefully. The merits of several approaches have been argued. It seems daily self monitoring of blood glucose (DSMBG) is the safest alternative. However, urine glucose monitoring is not an accurate measure.
- There is a high degree of association between gestational diabetes and hypertension. So, blood pressure and urine protein should be checked regularly.
- If the fasting glucose levels exceed 105 mg/dl or if the term extends beyond delivery, it is necessary to increase surveillance for fetal distress and fetal demise.
- Ultrasonography should be used in the third trimester to asses asymmetrical fetal growth and decide whether maternal insulin therapy can be beneficial for the fetus.
- The best way to control gestational diabetes is proper diet. In fact, if you are planning to conceive and are overweight, consider losing some weight before trying for a baby. Even losing 6 kgs can markedly reduce the risk of diabetes. All mothers with this condition should receive nutritional counseling in order to follow proper diet.
- For obese women, carbohydrates should be restricted to 35 to 40% of total calorific requirement.
- Insulin is effectively used in gestational diabetes. However, oral glucose lowering agents are not recommended during pregnancy.
Gestational diabetes during delivery
Mothers with gestational diabetes generally give birth to large babies. The blood glucose passes directly from you to your baby. The baby then produces more insulin to counter the effect. This means the baby ends up storing more fat and tissue. As a result, they are often big in size.
Because of their size, complications may arise during labor and delivery. It is recommended that mothers with gestational diabetes give birth in hospitals attended by medical team.
Strategies of care after delivery and for the long term
Most women who develop gestational diabetes are free of the condition after delivery. But this does not mean that there is no need for follow up long term care after the delivery. The strategies of care as summarized as follows:
- The glucose level of the mother should be checked six weeks after delivery. In most cases, this is found to be within normal limits. In that case, screening for glucose should be repeated every three years because these women have a higher chance of developing Type II diabetes later in life.
- Heel prick blood test is carried out on the baby within two to four hours of birth to find out if his blood glucose is too low. You should feed your baby as soon as possible (preferably within 30 minutes of birth) to keep the blood glucose within safe parameters. If this is not sufficient, the infant may have to be given a drip to increase sugar.
- Babies should be exclusively breastfed if possible.
- All women who developed this condition should be instructed in lifestyle modification. Healthy diet and weight loss can vastly reduce the risk of diabetes. It should be borne in mind that babies born to diabetic mothers have a higher chance of developing diabetes during adolescence. Proper lifestyle changes can also help to fight this.
- Certain medication worsens insulin resistance. Patients should be educated regarding these medications which should be avoided as much as possible.
- Mothers should be educated on ways of contraception and how to avoid recurrence of the condition in subsequent pregnancies.
With proper medical care and lifestyle regulation, it is possible to give birth to completely normal babies and recover your health after delivery even if you did suffer from gestational diabetes.