Starting a family is perhaps the most exciting moment for a married couple. In the event of bringing a whole new life into the world, most women progress smoothly in their pregnancies, giving birth to healthy babies. In a few cases, however, some women may develop certain risk factors that can cause problems. One such medical condition that poses a risk to both mothers and babies is gestational diabetes mellitus (GDM).
What is GDM?
Diabetes is actually a condition in which the levels of blood sugar, better known as glucose are not properly regulated. This is related to a hormone, known as insulin, which controls glucose levels. During pregnancy, additional hormones particularly pregnancy hormones (such as estrogen, progesterone or human placental lactogen) create an anti-insulin effect. Under normal circumstances the insulin produced by the mother’s pancreas is sufficient to counter this effect but in some cases the production may not be sufficient. This results in high levels of glucose in the blood known as gestational diabetes. Thus, a higher amount of glucose passes through the placenta to fetus.
Gestational diabetes is the type of diabetes that is specific to pregnancy. It refers to when women develop diabetes when pregnant or when women with diabetes become pregnant. In an established diabetic who gets pregnant, it is very important that the blood glucose levels are well controlled before pregnancy. Any complication of established diabetes also needs to be corrected before pregnancy to decrease the risk to the mother, such as kidney, nerve or eye complications.
In general, gestational diabetes does not usually pose much threat to the mother. Those who have a risk of developing it must be tested because undetected gestational diabetes poses some risks to the baby. If gestational diabetes goes undetected, the baby has an increased risk of stillbirth, structural anomalies (including of the spine and heart). The baby is also prone to be overweight in utero and can have episodes of low blood sugar, increased incidence of jaundice and poor temperature control at birth.
How does GDM affect the mother and baby?
The major risk for babies born to women with gestational diabetes is macrosomia or excessive weight at birth. Many doctors define macrosomia as birth weight of 4.0 kg or more that causes difficulty in passing through the mother’s pelvis. These babies are therefore prone to injuries at birth as they are delivered with more difficulty.
Another problem that may develop as a result of GDM is hypoglycemia (low blood sugar level) shortly after birth. This occurs because the baby has been so accustomed to receiving high levels of blood sugar across the placenta and the supply is abruptly stopped when the umbilical cord is cut at birth.
Other complications of GDM include jaundice, hypocalcemia (low calcium level) and polycythemia. Newborn polycythemia occurs when a baby’s red blood cell count reaches a level so high that the blood is too thick to flow effectively through the body. As a result, this exacerbates jaundice when the cells break down. For the expectant mother, GDM is associated with an increased frequency of maternal hypertensive disorders and the need for caesarean delivery. Although GDM is not itself an indication for caesarean delivery or delivery before 38 weeks of gestation, prolongation of gestation past 38 weeks actually increases the risk of macrosomia. Thus, elective delivery at 38 weeks is normally recommended and if the diabetes has affected the pregnancy (eg baby has become too big or mother develops raised blood pressure) then a caesarean delivery is indicated. In most cases, gestational diabetes disappears after the birth of baby.
However, in some cases women who have had gestational diabetes face a higher risk of developing type 2 diabetes mellitus later in life. Babies born to mothers with GDM may face higher risk of impaired glucose tolerance or developing diabetes in late adolescence or young adulthood, and becoming obese.
Are YOU at risk?
Q: “I want to conceive but am I at risk of developing gestational diabetes?”
Women with clinical characteristics consistent with a high risk of GDM, namely over the age of 30, obesity, previous history of GDM, recurrent glycosuria (repeated presence of glucose in the urine) and a strong family history of diabetes (first degree relatives ie mother, father or siblings) should undergo a risk assessment for GDM. They will be given blood glucose testing in the early second trimester. At the initial testing, if there are no signs of GDM, they should be retested between 24 to 28 weeks of gestation.
What to do?
Q: “If I am already pregnant and discover that I have GDM, what should I do?”
A balanced diet is important during pregnancy. Ensure that you do not gain excessive weight during pregnancy. Do not consume too much sugar. In most cases, the key to managing gestational diabetes is to control your blood sugar level through a carefully planned diet, lots of exercise and regular testing of your blood glucose level.
Because of all the problems that might occur, you must get advice from your doctor on how you can keep your diabetes well controlled, in order to deliver a healthy baby.Your doctor will refer you to consult a dietitian for a diet plan that helps keep your blood glucose levels normal and achieve healthy weight gain during pregnancy.You must also test your blood glucose level several times a day (before eating in the morning and two hours after meals) at home to ensure that your levels are within normal limits.
As long as your blood glucose level is under control and baby is carefully monitored, baby will be able to grow normally. In most cases, gestational diabetes can be controlled through diet, regular physical activity and regular monitoring of glucose levels. If there is still difficulty in controlling your blood glucose levels in spite of the above measures, you will be prescribed insulin injections.
Q: “Does that mean that women who are at risk of developing gestational diabetes due to their age and family history of diabetes should not get pregnant for fear of giving birth to stillborn babies or bigger than usual babies?”
It is possible for women with the above risk factors eventually give birth to healthy babies. But, remember, you are personally responsible for not only your life, but also your baby’s! So, you just have to practise a healthy pre-pregnancy lifestyle. Also be completely motivated to maintain normal blood glucose levels so as to decrease the risk to you and your baby.
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