Combating diabetes during pregnancy

In 2011, India had 62.4 million people with type 2 diabetes, compared with 50.8 million the previous year, according to the International Diabetes Federation (IDF) and the Madras Diabetes Research Foundation.

The nationwide prevalence of diabetes in India now tops 9 per cent, and is as high as 20 per cent in the relatively prosperous southern cities. By 2030, the IDF predicts, India will have 100 million people with diabetes. Thus there is a’ Diabetes Boom’ in India making it   a huge public health issue that needs to be dealt with urgently, says, Dr Devika Gunasheela, MRCOG (London) Fellow in Reproductive Medicine (RGUHS), Director – Gunasheela Surgical and Maternity Hospital and Gunasheela Assisted Reproduction Centre Pvt Ltd.

The doctor outlines the ways in which a diabetic women can improve their chances of having a healthy baby by normalizing their blood sugars before their next pregnancy.

1. What is gestational diabetes?

Gestational diabetes is the condition where a woman develops diabetes during her pregnancy. This occurs in 7% of all pregnancies, usually in the second half. There is no diabetes in the non pregnant state. It almost always disappears after the baby is born. However sometimes it persists after delivery. Screening for this condition normally is done between 24-28 weeks of pregnancy.

2.  What is the problem here?

Gestational diabetes means that the blood sugar level is high. There are several reasons for this:

Glucose is used by the body for energy and for all functions. It is also very important for the developing embryo in the mother’s womb. Insulin is the hormone produced by the pancreas and is responsible for glucose utilization by the cells. Hormones like oestrogen and progesterone may cause the body to become resistant to the action of insulin during pregnancy. In gestational diabetes insulin produced by the body fails to effectively move glucose into the cells. Thus glucose levels in the blood rise producing high blood sugars viz. diabetes.

3.  What are the symptoms to look out for?

Sometimes there may be no symptoms at all and it may be detected by routine tests. However   symptoms of excess thirst, frequent urination, and fatigue may also indicate the condition.

4.  How is it diagnosed?

Blood glucose levels are checked after a sweet beverage. If the levels are high it is diagnostic.

5.  What are the risk factors for gestational diabetes?

Being overweight, diabetic parents or siblings, gestational diabetes in a prior pregnancy, giving birth to a baby weighing more than 9 lbs in the past are few of the risk factors.

6.  Is there a genetic predisposition for this condition?

African Americans, Native Americans, Latinos, are few of the races genetically predisposed.

7.  How does gestational diabetes affect the developing baby?

High birth weight - Exposure to high sugar levels in the mother’s blood   can result in a larger baby with a higher than normal birth weight.

Low blood sugar – If the blood sugar is elevated in the mother during pregnancy the baby also has a high sugar level. Thus it produces extra insulin to metabolize it. However after birth, the continuous supply of sugar from the mother’s blood stops but the extra insulin that the baby produces continues. This insulin brings down the baby’s blood sugar for a short time after birth. This has to be watched for.

8.   How are complications avoided?

Stringent blood sugar control is essential through out pregnancy.

9.  What are the treatments available?

Following a proper diet given by a dietician is most essential.

The main principles of the diet are:

a. Avoidance of high –sugar foods like sweets, soft drinks, cookies and chocolates. Fruit can be eaten , one small serving at a time as it contains a high level of fruit sugar called fructose. Packaged fruit juices should be avoided.

b. Carbohydrates are found in bread, pasta, rice, potatoes, beans and fruits etc. Carbohydrates get broken down into glucose in the body. They are essential nutrients for the body and growing baby. They need to be eaten at every meal, but in measured amounts.

c. Eating smaller meals frequently keeps the blood sugar normal. Three small meals with three or four healthy snacks interspersed every 2-3 hours a day meets the nutritional needs of pregnancy without elevating the blood sugar.

d. For those who cannot control their sugars with diet alone, insulin therapy is started.  
e. Daily walks are recommended.

10. How often should the blood sugar be monitored?

Home blood sugar monitoring needs to be done with a glucometer.

Checking a level in the fasting state before breakfast and one hour after breakfast, lunch and dinner are essential. Target blood sugar levels should be maintained.

11. What are the other problems anticipated?

Women with gestational diabetes are at a risk of developing Type 2 Diabetes later on in life.

Women with gestational diabetes in one pregnancy must check their sugars before becoming pregnant again. Women, diabetic before pregnancy are a risk for several complications during pregnancy.

Elevated sugar levels in the mother during the first 12 weeks of pregnancy when the major organ systems are developing, is a risk to the fetus.