diabetes and pregnancy

Diabetes and Pregnancy

(Gestational Diabetes)

diabetes and pregnancy

Diabetes in pregnancy is also called gestational diabetes. Gestational diabetes is diabetes that happens for the first time when a woman is pregnant. Most of the time, it gets to normal after you have your baby, but it does increase one’s risk for developing type 2 diabetes later on in life. When you are pregnant, high blood sugars are not good for the baby as well. The child is also at risk for obesity and type 2 diabetes later. Whereas, if you are already diabetic, you should make sure that your blood sugars are well controlled before you plan a pregnancy. High blood sugar levels can be harmful to your baby during the first weeks of pregnancy that is even before you realise you are pregnant. To keep both mother and baby healthy, it is important to keep the mother’s blood sugar as close to normal as possible before and during pregnancy. Some women have more than one pregnancy affected by gestational diabetes. It usually shows up in the middle of pregnancy. Doctors most often test for it between 24 to 28 weeks of pregnancy. It is hence recommended to do blood sugar streaming at a much earlier stage of pregnancy to avoid complications in the mother and in the baby. 

Now before you know more about gestational diabetes, you must understand what normally happens in glucose regulation in a pregnant mother during a healthy pregnancy. During a healthy pregnancy, the mother’s body undergoes a series of physiological changes in order to support the demands of the growing fetus. These include adaptations to cardiovascular, renal, haematology, respiratory and metabolic systems. One important metabolic adaptation is insulin sensitivity. Over the course of pregnancy, insulin sensitivity shifts depending on the requirements of pregnancy. During early gestation, insulin sensitivity increases promoting the uptake of glucose into adipose stores in preparation for energy demands during later pregnancy. As pregnancy progresses, a surge of local and placental hormones including estrogen, progesterone, cortisone, leptin, placental lactogen, placental growth hormone together promote a state of insulin resistance. As a result, the blood glucose is slightly elevated and this glucose is readily transported across the placenta to fuel the growth of the fetus. This insulin resistance state may also promote endogenous glucose production in the breakdown of fat stores, thereby further increasing blood glucose and free fatty acid concentrations. 

Now we must know what happens in gestational diabetes. Majority of gestational diabetic cases present as beta-cell dysfunction on a background of chronic insulin resistance. The normal insulin resistance that we notice during pregnancy adds to this state. Thus affected women tend to have an even greater degree of insulin resistance than healthy pregnant women and therefore have a further reduction in glucose utilisation and increased glucose production and free fatty acid concentrations. Beta cells undergo exhaustion and thereby deteriorate due to excessive insulin production. This ultimately leads to a persistent hyperglycemic state and thereby gestational diabetes. 

What are the common risk factors for gestational diabetes?

The commonest risk factors include overweight or obesity, excessive gestational weight gain, improper or high caloric diet pattern, ethnicity, genetic factors, advanced maternal age, an intrauterine environment like the low or high birth weight of baby, family and personal history of gestation diabetes, other insulin states such as polycystic ovarian disease etc. 

What are the consequences of gestational diabetes for mothers and fetuses?

Gestational diabetes increases the risk of a number of short and long term maternal health issues which include preterm birth, preeclampsia, antenatal depression and mostly surgical delivery of the baby is required. Approximately 60% of women with past history of gestational diabetes, develop type 2 diabetes mellitus in later life. Gestational diabetes also predisposes to a higher risk of cardiovascular disease later in life. Whereas in the infant, due to an increase in placental transport of glucose, amino acids and fatty acids, and thereby the production of insulin and insulin-like growth factor lead to macrosomia or big size baby at birth. Macrosomia can lead to obstructed labour. Thus most of them require a cesarean section. Stillbirth is also very common in gestational diabetic patients, if not controlled properly. Babies that are born of gestational diabetic pregnancies are at increased risk of obesity, type 2 diabetes mellitus, cardiovascular diseases and associated metabolic diseases later on in life. Severe hyperglycemia in newborns and thereby seizures after birth is a very dangerous and life-threatening complication in the baby. 

What are the precautions that need to be taken to prevent gestational diabetes?

There are no guarantees when it comes to preventing gestational diabetes. But the more healthy habits you can adopt before pregnancy the better. Eat healthy food high in fibre and low in fat and calories, keep yourself active by exercising regularly before and during pregnancy. Try to start pregnancy at a healthy weight by losing extra weight before you plan pregnancy, avoid gaining too much weight during pregnancy. If you are at average risk for gestational diabetes, do a glucose challenge test in the second trimester. Also, periodically monitor your sugars if at risk for GDM. If your glucose challenge test values around the higher side, a glucose tolerance test is to be done to confirm the diagnosis of gestational diabetes.

How do you treat gestational diabetes?

Treatment of gestational diabetes primarily involves lifestyle changes in the mother. How you eat and move is an important part of keeping your blood sugar levels under control. Manage and keep your body weight well under control during the course of pregnancy. A healthy diet comprising of fruits, vegetables, whole grains and lean protein is recommended. Consume more fibrous food and those low in fat and calories. Limit highly refined carbohydrates including sweets and follow a healthy meal pattern planned based on your current weight, pregnancy weight gain goals, blood sugar levels, and exercise pattern. Stay active and healthy, monitor your blood sugars at least 4 times a day, if you are diagnosed with GDM. Despite lifestyle changes, 10-20% of GDM patients will require insulin therapy to keep blood sugars under control. Check blood sugars after delivery and again after 6 – 12 weeks to make sure blood sugars have returned to normal. If these tests continue to show higher values, look for type 2 diabetes mellitus and plan further management. Another important part of your treatment plan is close observation of the baby through the pregnancy period. Repeated ultrasound scans and other tests are required to check the baby’s growth and development in utero.