PREGNANCY AND DIABETES

PREGNANCY AND DIABETES

You might have never ever before experienced a high glucose episode in your life until you got pregnant. If you have high sugar during pregnancy you are suffering from gestational diabetes.

Around 50% of Asian women suffer from diabetes during pregnancy which is constantly raising its bar because of multiple lifestyle changes and other factors.

WHY GESTATIONAL DIABETES?

During pregnancy, maternal tissues automatically become resistant to insulin sensitivity. This may be due to raging hormones such as estrogen, cortisol, and human placental lactogen (hCG), produced by the placenta that blocks insulin. Hence the sugar cannot enter the cells and remains in the blood. This is what we call hyperglycemia, the primary condition of diabetes.  It can even be lethal for you as well as for your baby. If it arrives in the early pregnancy it may even lead to birth defects.

HOW GESTATIONAL DIABETES CAN AFFECT YOUR BABY?

Many women usually do not discover their pregnancy until 2-4 weeks of conception. During the first trimester, the baby’s heart, brain, spinal cord, digestive system, urinary tract, etc. start developing. If blood glucose remains high during this time this leads to severe birth defects. So, it’s important to always keep your sugar in check if you are anyway near planning to be a mother.

Excess sugar in blood supplies more than required sugar (glucose) to the baby. This results in high insulin response by your baby which leads to excess fat deposition and makes the baby large in size. This is called macrosomia, where a child is born with more than 4000g of weight. Macrosomia can cause injuries to your baby during birth due to a large size. Some babies are too big to be delivered vaginally, and you’ll need a cesarean delivery or C-section. Your doctor will keep an eye on your baby’s size so you can plan for the safest way to give birth. Stillbirth (fetal deaths) is more likely in pregnant women with diabetes. The baby may grow slowly in the uterus due to poor circulation or other conditions, such as high blood pressure or damaged small blood vessels. The exact reason stillbirths happen with diabetes is not known. The risk of stillbirth goes up in women with poor blood glucose control and blood vessel changes.

The baby may have low levels of blood glucose right after delivery. This problem occurs if the mother’s blood glucose levels have been high for a long time. This leads to a lot of insulin in the baby’s blood. After delivery, the baby continues to have a high insulin level, but no longer has the glucose from the mother. This causes the newborn’s blood glucose level to get very low. The baby’s blood glucose level is checked after birth. If the level is too low, the baby may need glucose in an IV.

Too much insulin or too much glucose in a baby’s system may keep the lungs from growing fully. This can cause breathing problems in babies. This is more likely in babies born before 37 weeks of pregnancy.

HOW DIABETES CAN AFFECT YOU DURING PREGNANCY?

Pregnancy can worsen certain long-term diabetes problems, such as eye problems and kidney disease, especially if your blood glucose levels are too high.

You also have a greater chance of developing preeclampsia, sometimes called toxemia, which is when you develop high blood pressure and too much protein in your urine during the second half of pregnancy. Preeclampsia can cause serious or life-threatening problems for you and your baby. The only cure for preeclampsia is to give birth. If you have preeclampsia and have reached 37 weeks of pregnancy, your doctor may want to deliver your baby early. Before 37 weeks, you and your doctor may consider other options to help your baby develop as much as possible before he or she is born.

Also, women with gestational diabetes have greater chances of developing diabetes later in life and also cardiovascular diseases (CVD).

ARE YOU AT A GREATER RISK OF DEVELOPING GESTATIONAL DIABETES MELLITUS (GDM)?

Risk factors are categorized as low, average, and high:

You are at low risk if:

  1. You are less than 25 years of age
  2. You have a normal BMI
  3. No family history of diabetes
  4. No history of poor perinatal outcome
  5. You are not a member of a group with a high prevalence of diabetes, which includes African, Hispanic, Asian,
  6. Pacific Islander, or Decent Native American.

You are at high risk if:

  1. Obese
  2. Previous history of GDM
  3. Glycosuria (Presence of glucose in the urine)
  4. Strong family history of diabetes
  5. Member of an ethnic group with a high prevalence of diabetes.

High-risk women are screened during their first prenatal visit. The test is repeated between 24-28 weeks of gestation if the initial screen was normal.

WHAT TO DO IF YOU DEVELOP GDM?

According to the American Diabetes Association, Nutrition Therapy from a registered dietitian who will provide you with customized diet plans is a must to keep your blood glucose in check. It has the following benefits:

  • Keeping your blood glucose in check won’t let you compromise with increased caloric needs
  • Keeping sufficient supplies of nutrients to you and the growing fetus.

Although nutrition therapy is a must to control GDM, there are still quite a few self -management tools that you can abide by:

  1. Glucose Monitoring: You can use a glucose meter to monitor blood sugar levels daily and lab testing is done weekly. Researches have shown reduced chances of macrosomia and the development of ketosis.
  2. Physical Activity: Getting yourself involved in moderate physical activities are helpful in GDM. It helps in increasing insulin sensitivity and may even help in obviating insulin therapy. This is also a great stress buster and gives you a fruitful ‘me-time’ for you and your baby. It is usually recommended after meals and supervision of an expert is recommended before starting.
  3. Medication: Insulin therapy is used concurrently along with nutrition therapy if normal blood glucose levels are not achieved through diet only. Human-based insulin is preferred over animal-based insulin as they are found to be less allergic. Oral medications are started only under the supervision of medical practitioners. Medical drugs should not cross the placenta and reach the fetus.

Divya

M. Sc. Gold Medalist

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