ne of the most common medical problems that is encountered in pregnancy is elevated blood sugar levels. This is called diabetes in pregnancy, or gestational diabetes mellitus
Gestational diabetes mellitus (GDM) is an important condition that has an effect not only on just the health of the mother but also on the health of the baby.
By definition, gestational diabetes is diagnosed if a pregnant woman has never had diabetes before but developed it after getting pregnant.
In the medical world however, gestational diabetes mellitus is defined as ‘any degree of glucose intolerance with onset or first recognition during pregnancy’. From clinical studies, it has been found that 7 out of 10 pregnancies are complicated by this condition.
Gestational diabetes commonly affects mothers later in pregnancy.
How Does It Develop?
In simple terms, diabetes during pregnancy occurs because there is insufficient quantity of insulin in the body. Due to this, the levels of glucose rise in the blood stream leading to diabetes and hyperglycemia (high blood glucose).
The placenta provides the growing fetus with nourishing blood and oxygen. In addition, it also secretes a number of hormones that help growth of the fetus into a baby.
Unfortunately these hormones can block the action of insulin in the mother leading to a condition called ‘insulin resistance’.
Gestational diabetes mellitus develops when the insulin response to glucose intake is inadequate. In other words, when you eat and digest your food, insulin either is insufficient or just does not work.
How Can It Affect Your Baby?
The excess glucose that is present in your blood can pass through the placenta to the growing fetus.
Glucose stimulates the release of excessive insulin from the pancreas in the fetus. This phenomenon is called ‘fetal hyperinsulinemia’. This high insulin levels stimulates the growth of the fetus.
Babies that are born of excess insulin levels often exceed 4 kg in weight at birth.
Am I At Risk?
A number of risk factors have been established.
The presence of a high body mass index (BMI) prior to pregnancy and an elevated BMI at 28 weeks are linked to the development of insulin resistance.
A high BMI indicates a larger quantity of fat tissue in the body. This fat tissue can produce certain harmful compounds called adipokines that may lead to the development of insulin resistance.
Ethnicity also plays an important role. In particular, individuals from Asia have a higher risk of developing diabetes in pregnancy as compared to other races. Those who have a prior history of developing high blood sugars during pregnancy are at an increased risk.
Clinical studies have shown that having children after the age of 25 years may increase the risk of GDM.
How Can Diabetes Mellitus Be Detected In Pregnant Women?
A simple way of detecting this condition is by performing a fasting blood glucose test very early in pregnancy.
A screening test may be performed to determine the family history of diabetes mellitus, any past medical history of diabetes and whether babies born to other family members have been abnormally large.
When diagnosing gestational diabetes mellitus, glycated hemoglobin i.e. HbA1c levels may be inadequate. This is because the red blood cells that carry this type of hemoglobin have a variable lifespan. Any attempt to measure the mean glucose level through an HbA1c will result in an underestimated value.
In other words, a HbA1c test is not a good test to diagnose diabetes in pregnant women.
The oral glucose tolerance test is a useful way of detecting diabetes in pregnancy. The table below gives you a clear idea on the World Health Organisation recommendations for diagnosis of gestational diabetes.
What Are The Complications During Pregnancy And At Birth?
If you suffer from gestational diabetes mellitus, then you have a higher risk of development of hypertension, pre-eclampsia and eclampsia.
High blood glucose levels in pregnancy appear to be linked with an increased chance of undergoing a Caesarean section.
Babies born to women with diabetes may have a large head (‘macrosomia’) and increased body fat. The greater the blood sugar level in the mother, the higher the amount of fat tissue in the baby.
The larger size of the baby makes it difficult for it to pass through the birth canal during delivery. Any attempt to manage this may result in a condition called ‘shoulder dystocia’. This risk is a lot higher if the weight of the baby exceeds 4 kg.
Finally, there is always a risk of stillbirth with diabetes in pregnancy.
Risks For The Mother
Women who have diabetes in pregnancy have a higher risk of developing type 2 diabetes mellitus after delivered.
Some studies have gone to the extent of stating that 40% of women with gestational diabetes go on to develop full-blown diabetes.
Metabolic syndrome is a combination of several risk factors that include obesity, high blood pressure, abnormal cholesterol levels and insulin resistance. It is a well-recognised cause of heart disease and stroke.
In gestational diabetes, the expectant mother has a significantly increased risk of developing metabolic syndrome.
It is therefore important that the blood glucose levels be closely monitored during pregnancy and any action be taken sooner rather than later.
That’s not all.
Diabetes in pregnancy has been linked to an increase the risk of cardiovascular disease in women. Treatment options that are currently available may reduce this risk as long as any other risk factors for heart disease are treated simultaneously.
Risks For The Baby
Babies born to mothers with gestational diabetes mellitus have an increased risk of developing type 2 diabetes, obesity and metabolic syndrome. There are a number of different genetic factors and environmental factors that play a role as well.
As previously mentioned, the high levels of blood glucose in the mother can increase the levels of insulin in the fetus. Fetal hyperinsulinemia can modify growth of the fetus and alter birth weight.
In fact, from clinical research, it is now understood that children of mothers with diabetes are 6 times more likely to develop type 2 diabetes in the future as compared to children of mothers without diabetes.
Diabetes in the mother during pregnancy can also lead to obesity in the baby. In fact, the risk of becoming overweight is two times more in children of mothers diabetes compared to those who do not have diabetes.
How is Gestational Diabetes Mellitus Treated?
It is important to recognise that treating diabetes in pregnancy can avoid a number of different complications on the growing fetus. In addition, it can prevent health problems in the baby in the future.
Managing at home
The first step in managing this condition is to follow a healthy diet with guided physical activity. It is important to monitor the sugars at home using the glucose monitoring device on a regular basis.
Your aim is to make sure your glucose levels are equal to those of pregnant women who do not suffer from diabetes.
Don’t panic. This is easily achievable through your own willpower and with the help of your obstetrician, physician and dietician.
If diet and exercise do not work, insulin therapy may be required. Insulin can be injected under the skin of the leg or the abdomen. It bears a significant advantage as it does not cross the placenta and therefore does not have any effect on the fetus.
However, if insulin is being used, it is important to recognise certain side-effects of the medication such as weight gain and hypoglycemia.
Oral medical therapy is still controversial and only certain medications may be prescribed. For example, metformin appears to be a relatively safe and effective.
Compliance is an issue and patients often prefer to take tablets than inject themselves with insulin regularly.
Make sure you speak to your doctor with regards to what the best treatment is for you to manage your sugars when you are pregnant.
Preventing Future Diabetes
As previously mentioned, gestational diabetes can increase your risk of developing diabetes in the future. So how can you prevent diabetes in pregnancy?
Well, it simple.
Make sure you eat healthy foods including fresh fruits and vegetables and limit your intake of fried, fatty foods. Keep your meal portion size moderate.
Exercise regularly. This can not only help utilize the glucose that is floating in the blood stream, it can also help combat insulin resistance. Make sure you speak to your doctor before you commence any exercise program.
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