A not-so-sweet side

Hyperglycemia can increase the risk of miscarriage or birth defects in the baby, warns Dr Srinivasa P Munigoti

Pregnancy is a very special time in any woman’s life. It is a not only a time of great joy but also one that gives anxious moments for mothers as they worry about labour and delivery, apart from nurturing fears of whether the baby is okay? These questions get even more worrisome for women with diabetes.

Until recently, pregnancy was risky for women with diabetes. Fortunately, today, with good medical care and rigorous self-management, most women with diabetes have a successful pregnancy and a healthy baby, provided they pay close attention to glucose levels and work hard to keep them as close to normal as possible.

Pregnant women who have never had diabetes before, but who have high blood glucose (sugar) levels during pregnancy are said to have gestational diabetes. According to a 2014 analysis by the Centre for Disease Control and Prevention, the prevalence of gestational diabetes across the globe is as high as 9.2%. Prevalence in Indians is quoted to be even higher up to 20%. High maternal age, high Body Mass Index (high maternal obesity or being overweight) and a family history of parents having diabetes increase the risk of developing gestational diabetes.

Given that pregnancy-related diabetes is primarily aimed at minimising risks to the baby, expectant mothers do not tend to have any signs or symptoms on their own. This is the reason why their routine pregnancy care may include a blood test (screening glucose tolerance test) to check if they are at risk of developing gestational diabetes.

Preconception planning

Women who are considering pregnancy and have been diagnosed with diabetes must achieve excellent blood glucose control before conception. That’s because hyperglycemia can increase the risk of miscarriage or birth defects in the baby. When women have maintained strict blood glucose control prior to conceiving and during their first trimester, the incidence of malformations is much lower than in women with diabetes who did not.

The following steps can help you achieve a healthy pregnancy and a healthy baby:

• An appropriate meal plan: Your eating patterns are especially important now since you want to control blood glucose levels and also ensure that both you and your baby are getting adequate nutrition during your pregnancy.

• Your calorie requirement will increase by about 300 calories a day over what you needed earlier.

• You will need about 30 grams more of protein a day that’s about the equivalent of one serving of meat or fish.

• To maintain normal blood glucose levels, you’ll have to be sure to get enough carbohydrates in the morning.

• Snacks will be important, and should probably include a complex carbohydrate (such as whole grain bread) and a protein (such as meat or cheese).

• Frequent monitoring of blood glucose (SMBG): The only way to tell if you are succeeding in controlling your blood glucose is to monitor your levels and to do it frequently. Pregnant women may be advised to monitor up to four times a day, and sometimes as often as seven times a day

Adding physical activity: If you aren’t exercising regularly, now is a good time to start, but check with your doctor about your planned activity and start slowly. Brisk walking is an excellent way to start. You’ll need to plan your activity along with your food intake and insulin injections.

Along with following a low carbohydrate diet and increased exercise appropriate to their pregnant status, pregnant women with diabetes must also closely monitor their sugar levels at home to ensure a safe pregnancy.

(The author is diabetologist & endocrinologist, Fortis Hospital)