Gestational Diabetes : Diabetes in Pregnancy

Seema could not believe her report was the right one .It showed a blood glucose level of 200 plus and her gynec told her she had diabetes. That happened to her mother when she was 50 . Seema wanted her blood test to be repeated fought with the lab personnel about the error and repeated her test at another reputed lab. But to her surprise the blood glucose values were higher nearing 300 . She met her gynecologist immediately and was told not to worry . She was started on a diabetic diet ,asked to start exercise, meet a specialist called an endocrinologist and learn to monitor her sugars herself.

What is gestational diabetes?

Diabetes that develops during pregnancy is known as gestational diabetes. It occurs because the body cannot produce enough insulin (a hormone important in controlling blood glucose) to meet its extra needs in pregnancy. This results in high blood glucose levels. Gestational diabetes usually starts in the middle or towards the end of pregnancy.

Who has the risk of developing diabetes in pregnancy ?

All pregnant women are offered blood test to screen for diabetes in pregnancy.

The risk is higher when any of the following factors are present

• body mass index (BMI) is 30 or higher

• previous birth of a large baby> 4kg

• previous history of gestational diabetes

• parent, brother or sister with diabetes

Why is the test done ?

Doctors test for gestational diabetes during early or mid pregnancy because the placenta is producing large amounts of hormones that may cause insulin resistance. If the results indicate elevated levels, further testing is done to confirm the diagnosis. The test indicates whether enough insulin is produced or not.

How is the test done in pregnancy ?

A glucose tolerance(GTT) is done during pregnancy during 24 weeks of pregnancy. A GTT involves fasting overnight (not eating or drinking anything apart from water):

• In the morning, before breakfast, a blood test is done . Then a glucose drink is given .

• The blood test is repeated 1–2 hours later to see how the body reacts to the glucose drink.

What does gestational diabetes mean ?

Most women who develop diabetes in pregnancy have healthy pregnancies and healthy babies. Some times gestational diabetes can cause serious problems. If the blood glucose is too high, baby will produce more insulin, which can make the baby grow bigger and increases the likelihood of having caesarean section, serious birth problems and stillbirth. A baby that is making extra insulin may have low blood glucose levels after birth and is more likely to need additional care in a neonatal unit. There may also be a greater risk of developing obesity and/or diabetes in later life.

Controlling levels of blood glucose during pregnancy and labour reduces the risks of all these

complications . These risks are higher if gestational diabetes is not detected and controlled.

If the test is positive how is the treatment done?

The most important treatment for gestational diabetes is a healthy eating plan and exercise. If it does not reach a satisfactory level after 1–2 weeks, or if an ultrasound scan shows that the baby is

larger than expected, tablets or insulin injections are given for treatment . If insulin is needed , expecting mothers are taught how to inject themselves, how often to do it and when to check blood sugars. Extra ultrasound scans are done to monitor baby’s growth more closely.

What else should be advised?

During the pregnancy, doctors and midwives will give information and advice about:

• planning the birth, including timing and types of birth, pain relief and changes to medications

• during labour and after baby is born

• looking after baby following birth

• care for mother and baby including contraception.

When is the best time for the baby to be born?

Ideally baby should be delivered at 38 weeks due to GDM and its risks .

How is baby delivered ?

If the ultrasound scans show that the baby is very large or macrosomia healthcare team discusses the risks and benefits of vaginal birth, induced labour and caesarean section.

What happens in labour?

Blood glucose level is controlled during labour and birth and it should be monitored every hour during labour to ensure it stays at an acceptable level. An insulin drip may help control blood glucose level. During labour, baby’s heart rate is continuously monitored.

What happens after delivery ?

• Baby may stay with mother or need extra care in Newborn unit to monitor sugar levels of the baby .

• Breastfeeding is best for babies, and should be started as soon as possible . Feeding him or her as soon as possible after birth, and then every 2–3 hours helps baby’s blood glucose stay at a safe level.

• Baby should have his or her blood glucose level tested a few hours after birth to make sure that it is not too low. Sometimes baby may need to be looked after in a neonatal unit if he or she is unwell, needs close monitoring or treatment, needs help with feeding or was born prematurely.

What post natal follow up is done ?

If the blood glucose levels are high then it is better to consult an endocrinologist for annual check ups. Fasting blood glucose test is done once a year .

Future pregnancies

Being the right weight for height (having a normal BMI), eating a healthy diet and taking regular physical exercise before pregnancy reduces risk of developing gestational diabetes again. Before planning the next pregnancy a blood sugar level should be checked and a high dose (5mg) of folic acid daily should be taken.