Pregnancy and Gestational Diabetes

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 Did you know there is a particular type of diabetes which develops in women pregnancy called gestational diabetes?

Diabetes can develop during pregnancy in women who have not previously had the condition. This is called gestational diabetes, and it affects around 2 to 7 out of 100 pregnant women. It can lead to problems for the mother and baby if it is not controlled properly.

About diabetes in pregnancy

Diabetes is a condition in which your blood sugar level is high because there isn't enough insulin in your blood, or your body is not responding to insulin properly. Insulin is a hormone that allows your body to break down sugar in your blood to be used as energy. During pregnancy, various hormones block the usual action of insulin. This helps to make sure your growing baby gets enough sugar. Your body needs to produce more insulin to cope with these changes. Gestational diabetes develops when your body can't meet the extra insulin demands of the pregnancy. This type of diabetes usually begins in the second half of pregnancy, and goes away after the baby is born. If it does not go away after the baby is born, there could be a possibility that there is a slowly developing form of what is known as type 1 diabetes, and that it was picked up by chance during pregnancy. The other form of diabetes is called type 2 diabetes and both type 1 and 2 are lifelong conditions.

Symptoms of diabetes in pregnancy

This form of diabetes does not usually cause any symptoms. Sometimes the main symptom is high blood sugar, including:

• increased thirst
• frequent urination
• feeling tired

Sometimes these symptoms are also common in a normal pregnancy.

Complications of diabetes in pregnancy

Gestational diabetes is not an immediate threat to the health of the pregnant woman. However, poorly controlled diabetes in pregnancy exposes you to a higher risk of various problems. These include:

• a condition called pre-eclampsia, which causes high blood pressure
• premature labor
• too much amniotic fluid (the fluid around your unborn baby)

Women, who suffer from gestational diabetes, are more likely to need a caesarean delivery than those who don't have diabetes. They are also more likely to develop gestational diabetes in future pregnancies, and are at a higher risk of developing type 2 diabetes later in life.

For your baby

The baby may grow larger than usual in women who experience cases of high blood sugar levels.  This is because he or she has to make extra insulin to control the increased blood sugar, which causes more fat and tissue to be stored. This can make delivery difficult. For example, there is an increased risk of shoulder dystocia (difficult childbirth). This can occur when the baby's head has been born but one of his or her shoulders is stuck behind the pelvic bone, preventing his or her body being delivered. This in turn can damage nerves in the baby's neck or result in a fracture of one of his or her arms or shoulders. Very rarely, it can cause brain damage if the blood supply to the baby’s brain is blocked off for too long.

The baby may have low blood sugar (hypoglycaemia) after birth. This is because he or she makes extra insulin to respond to the mother’s high blood sugar levels. Shortly after birth, the baby may continue to make extra insulin causing his or her blood sugar level to be too low.

In order to avoid such instances, It is recommended that the baby be breastfeed within 30 minutes of delivery to keep his or her blood sugar levels at a safe level. Otherwise, he or she may be given a sugar solution through a drip (directly into a vein). Midwives or doctors should check the baby's blood sugar level regularly.

The newborn baby is at risk of jaundice (yellowing of the skin and whites of the eyes). This usually fades without the need for medical treatment. In some cases however, the baby may need treatment with a special ultraviolet light after being born. There is a likelihood that the baby will be born with a birth defect. At times, babies born by a mother who had gestational diabetes could present with respiratory distress syndrome, in which the baby has problems breathing because his or her lungs have not developed as they should. This usually clears up with time, although it may mean that the baby needs to be ventilated with a machine.

Sometimes there is a higher chance of stillbirth or death as a newborn, but this is rare as long as blood sugar levels in both the mother and the baby are well controlled. There is also an increased risk of the baby becoming obese as a child and an increased risk of him or her developing diabetes during childhood.

Causes of diabetes in pregnancy

No empirical research has been done to establish why some women develop gestational diabetes and others don't, but the following category of are more at risk:

• have a family history of gestational diabetes (ie mother, grandmother or sister had it)
• have previously given birth to a large baby, weighing over 4.5kg (9lb)
• are overweight or obese
• have polycystic ovary syndrome (PCOS)

There are also incidences of gestational diabetes in Women whose families originate from certain area. These include women from South Asia (specifically India, Pakistan or Bangladesh), the Middle East (specifically Saudi Arabia, United Arab Emirates, Iraq, Jordan, Syria, Oman, Qatar, Kuwait, Lebanon or Egypt) and black Caribbean women.

Diagnosis of diabetes in pregnancy

Diagnosis can be done using a glucose tolerance test, which is carried out in the morning, normally before taking breakfast. The doctor gives the patient a solution of glucose to drink and then takes blood samples at different intervals to see how the body deals with the glucose over time.

If a Woman is at risk of developing diabetes in pregnancy, she will be offered a glucose tolerance test by her doctor or midwife between 24 and 28 weeks. If she has had gestational diabetes before, she will be offered a test at 18 weeks, and another one at between 24 and 28 weeks if the first is normal.

Treatment of diabetes in pregnancy

This is done by doctors and nurses who are experienced in looking after pregnant women with diabetes

1.      Self management

 Most women can control their blood sugar level through a carefully planned diet and regular exercise. The doctor or a dietitian should be able to give advice on what to eat. An important part of the diet will be to eat plenty of slowly absorbed carbohydrates such as wholemeal bread and pasta, oats, brown rice, potatoes, lentils and beans. These types of food have a low glycaemic index (GI) and can help even out blood sugar levels in diabetic mothers. The meal plan will probably consist of such slow absorbing carbohydrates and a variety of lean proteins, as well as at least five portions of fruit and vegetables each day.  Exercises, such as walking or cycling, helps to reduce blood sugar levels and promote a sense of wellbeing. At least 30 minutes of activity that gets the patient slightly breathless each day will be good.  Regular testing of blood sugar levels will be paramount. The family doctor should will give you advice on how to test for blood sugar level, how often to do it, and the levels that are healthy; this should be every day.

 

2.      Medicines

Some cases of gestational diabetes cannot be controlled with diet and exercise and will need insulin injections or tablets. The doctor will teach the pregnant mother how to use injections, or when to take tablets if necessary. It is possible to have too much insulin; this can cause low blood sugar (hypoglycaemia - sometimes called a 'hypo'). Common symptoms of this are paleness, shaking, hunger and sweating. The doctor will explain how to recognise the symptoms of hypoglycaemia, and what to do if it happens. Keeping a sugary soft drink handy will be a good idea in dealing with low blood sugar. Sometimes, low blood sugar can cause lose of consciousness, in such incidences, an injection is necessary.

Finally, it is advisable that the family and friends know what to do if the blood sugar gets very low and you pass out.

After your baby is born

The mother and the baby should have your blood sugar levels monitored after birth to make sure they are back to normal. Doctors recommend that the baby be breastfeed within 30 minutes of delivery to keep his or her blood sugar levels at a safe level and then every two to three hours.

Any medication for diabetes which was being taken can be stopped after the baby has been born.    

Prevention of type 2 diabetes

If you have had gestational diabetes chances are that you can get type 2 diabetes, however, healthy lifestyle choices can reduce this risk. Aim to eat a balanced diet, take regular exercise and maintain the correct weight for your height.Everyone needs this  

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