GESTATIONAL DIABETES (GDM)… A Challenge?
Do you know that modern sedentary lifestyle, refined diet, lack of exercise, stress, obesity and genetics play a major role in making Diabetes Mellitus; a very common medical problem which can go unchecked or unnoticed as its symptoms can easily be ignored?
It is a condition in which blood sugar levels are abnormally high due to lack or impaired action of insulin hormone. There are three types:
- Type I diabetes is due to complete absence of insulin.
- Type II diabetes is due to impaired action of insulin.
- Type III gestational diabetes occurs during pregnancy.
What is gestational diabetes?
It is a temporary condition of high blood sugar levels during second half of pregnancy, which in most of cases reverts back to normal after delivery.
How many women are affected?
It affects about one in eight to ten pregnant women.
Who are at high risk of developing this problem?
More than half of women who develop this problem do not have any risk factor, therefore all pregnant women should have screening blood tests. The following risk factors are associated with high blood sugar levels which may help to diagnose GDM.
- Age more than 30 years
- Overweight or obese women
- Family history of diabetes
- Diabetes in last pregnancy
- Previous history of abortions, still birth, delivery of large babies >3.5 kg,
- Asian or women of ethnic origin
What is the cause of diabetes?
Insulin is a hormone that helps to maintain blood sugar levels, by shifting glucose from blood into the cells of body, where it is broken down to produce energy for cell usage, extra glucose is stored in form of fats. If insulin is not present or is not working properly then glucose cannot enter into cells and remains in blood, it is lost in urine or is converted into fats and ketones.
What causes diabetes during pregnancy?
The placenta secretes human placental lactogen (HPL) which opposes the action of insulin, for providing nutrition and energy to the growing baby. Some women with risk factors of diabetes are unable to raise their insulin levels as a result maternal blood sugar start rising.
What are the signs of diabetes?
Some of the commonly known symptoms are:
- Excessive unusual thirst
- Frequent urination
- Chronic fatigue
- Bad smelly breath due to ketones
- Feet and hands numbness and tingling
- Dark spots on skin folds
- Generalized Itching
- Delayed wound healing
- Repeated infections
- Excessive vaginal discharge
- Weight gain or difficulty in losing weight
What is the test for screening for gestational diabetes?
All pregnant women are screened between 24 and 28 week of pregnancy. These tests give information that how well body cells are able to absorb glucose after a certain amount of glucose utilization.
Test 1: Glucose Challenge Test or Glucose Stress Test (GST) in which patient drinks 50 gm glucose solution, after 1 hour blood sugar level should be less than 135 mg/dl, if value is more than Glucose Tolerance Test is performed.
Test 2: Glucose Tolerance Test (GTT) in which patient with overnight fast, drinks 75 gm of glucose solution in 300 ml of water, blood sugar levels are checked just before,1 hour and 2 hour.
If no abnormality found repeat test between 24 and 28 weeks, high risk women should be tested in each trimester.
How can it be prevented?
Women with family history of diabetes, ethnic background risk factors should be identified and addressed before and during pregnancy, lifestyle modification is the answer to all problems.
Weight should be controlled with healthy balanced diet, low in sugars and fats, and rich in fiber.
- Prior to pregnancy, maintain ideal weight
- During pregnancy, avoid excessive weight gain
- Post-delivery, reduce weight
Regular physical exercise, adequate sleep, avoiding smoking and alcohol, changing stressful lifestyle helps to lower the risk of GDM.
What could be a simple diet plan for GDM?
The diet should be balanced and healthy with high fiber content, reduced refined carbohydrates and saturated fats. Small five to six small meals should be taken, instead of three large meals. Vitamin D and Vitamin B12 supplementation may be required.
This simple diet chart could be helpful for most of GDM patients:
Breakfast 9:00 am
2 to 3 egg whites/sausages
Oats cereal/ 2 whole grain toasts
A cup of milk
Tea
Snack time 11:00 am
A cup of Tea
Nuggets
Lunch 1:30 pm
1 small bowl green salad
1 small bowl yogurt or lentil, clear soup
250 gm of meat, poultry or fish
1 whole grain bread piece/ roti
Snack time 5:00 pm
A cup of Tea/ Milk
Chicken sandwich (whole grain bread)
Dinner time 8:00 pm
1 small bowl salad
1 small bowl yogurt, soup
250 gm meat, fish or poultry
1 whole grain roti/ bread
Snack time 10:00 pm
1 cup milk /whole grain cereal
Things to Avoid
- All types of root (underground) vegetables
- Bakery items of refined flour, sweets and chocolates
- Canned fruits, juices and fizzy drinks
- Dates, banana, mango
What is the treatment for GDM?
Most women with GDM can be managed with diet modification and physical activity, however in some cases medication is needed to control blood sugar levels and prevent problems for both mother and baby. There are options of oral medicines and various types of Insulin, which are selected according to patient’s requirements, preferences and convenience.
Which exercises are helpful in controlling blood sugars during pregnancy?
GDM mothers without any complication should do only those simple exercises which are recommended during pregnancy. They should undertake physical activity and exercises which they were doing before pregnancy. AVOID STRENUOUS EXERCISES, the safest exercise is 15 to 20 minutes of walk after each major meal.
How is the progress of GDM pregnancy monitored?
The pregnancy outcome depends on strict monitoring of blood sugar levels, which can be done at home by glucometer or through laboratory tests. REMEMBER, 1 hour after meals value should be less than 140 mg /dl, if two values in a week are near or higher than 140 mg/dl, then you should see your doctor for changing dose or type of medicine.
Serial ultrasounds monitor growth, weight, size of baby and amount of fluid around it.
What are the complications of gestational diabetes?
The problems can be minimized by early diagnosis and proper treatment, however uncontrolled high blood sugar levels are dangerous for mother and baby.
- Pregnant women with high blood sugars are prone for high blood pressure and pre-eclampsia.
- There is more fluid around baby (polyhydramnios) which can cause premature rupture of membranes, preterm labor, malpresentations of baby. Uncontrolled blood sugar can cause intra-uterine death of baby.
- The baby size becomes large (macrosomia) which can cause difficult shoulder delivery (shoulder dystocia) leading to damage to arm nerves or paralysis, obstructed labor, birth canal injuries, need for assisted or Caesarean delivery, still birth or intra-uterine death.
- Some women have excessive life threatening bleeding (PPH) after birth of large babies delivery. The risk of infections is also high.
- After delivery, baby has high insulin levels leading to low blood sugars, respiratory distress and jaundice.
Is there risk of developing diabetes in later life?
18 to 20% of women with gestational diabetes have a higher risk of developing diabetes in later life. Blood sugar levels should be checked with (GTT) 6 weeks after delivery to pick potential diabetics. Babies of GDM mothers are increased risk of obesity in later life and are also prone to have diabetes and heart disease.
Can GDM mothers breastfeed?
YES, it helps mother in losing weight, reduces risks of obesity, diabetes and cardiac disease in both mother and baby. It increases baby’s immunity and prevents diarrhea.
REMEMBER!! GDM is treatable and manageable problem, strict blood sugar monitoring can save both the mother and new baby from nearly all the problems
Dr. Ayesha Azam Khan