Gestational diabetes mellitus (GDM) develops during pregnancy (gestation). However, in Malaysia, most women neglect to have a medical examination before embarking in their pregnancy. Therefore, overt diabetes mellitus is usually only picked up when pregnant women go for their routine checkups.
It is the national policy to screen women based on risk factors but more and more evidence is suggesting that all pregnancies should be screened for diabetes. The earlier the disease is identified and managed, the better the chance of reducing the complications. Like all other types of diabetes, it causes high blood sugar (blood sugar level ≥ 7.8 mmol/L). This can affect your pregnancy and your baby’s health.
GDM complications:
- over-nutrition and excess growth of the baby. Weighing more than 4kg or termed macrosomia
- unusually large size of the baby increases the need for induced labour or a caesarean birth, and may lead to birth problems or injuries to both mother and baby
- birth defects (affect major organs such as the brain and heart)
- increased rate of miscarriage
- increased risk of stillbirth
- premature birth – birth before 37th week of pregnancy
- increased risk of having gestational diabetes in future pregnancies
- baby may be at greater risk of developing diabetes, heart disease or obesity later in life
Almost all women have some degree of impaired glucose intolerance as a result of hormonal changes that occur during pregnancy. However, blood sugar usually returns to normal soon after delivery.
Are you at Risk?
Any woman can develop gestational diabetes, and the risk factors are quite similar to any form of type 2 diabetes. These include:
- Women older than age 25
- Family or personal history of diabetes mellitus
- Excessive weight or obese (BMI score of ≥30)
- Previously gave birth to a baby over 4kg or gave birth to a stillborn baby.
Still, many women who develop gestational diabetes have no known risk factor – which is why you should go for your scheduled health screening. You’ll likely have a screening test during your second trimester — between 24 and 28 weeks of pregnancy. If your doctor suspects you’re at high risk of GDM, the test may be performed before the 13th week of pregnancy.
Glucose Tolerance Test
The test measures your body’s response to sugar (glucose). You’ll fast overnight, then have your blood sugar level measured. Then you’ll be given a sweet beverage – containing a high concentration of glucose – and your blood sugar level will be checked before and 2 hours after your drink. If any of the blood sugar readings are higher than normal, you’ll be diagnosed with gestational diabetes.
Prevention of GDM involves:
Consuming foods high in fibre and low in fat and calories. Focus on fruits, vegetables and whole grains. Strive for variety to help you achieve your diet goals without compromising taste or nutrition. For portion sizes, you can refer to the Malaysian Healthy Food Pyramid.
| Type of Food | Benefits for Pregnant Women |
|---|---|
| Whole grains Oatmeal, whole-grain bread, whole-wheat pasta or brown rice |
Fortified with folic acid, iron and fibre |
| Beans Black beans, white beans, pinto beans, lentils, black-eyed peas, and kidney, or soy beans. |
Protein, fibre, good sources of key nutrients, such as iron, folate, calcium, and zinc. |
| Fish Salmon, tilapia, sardine and mackerel |
Omega-3 fatty acids, protein, B vitamins and low in mercury. |
| Berries Blueberries, raspberries, and blackberries |
Packed with vitamin C, potassium, folate, and fibre. |
| Low-fat yoghurt | More calcium than milk, is high in protein, and no added sugar. |
Exercising before and during pregnancy. Aim for 30 minutes of moderate activity on most days of the week. Take a brisk daily walk, do some gardening, or have a swim.
If you’ve already been positively diagnosed with GDM, the same measures apply to help you manage your condition. However, doctors don’t advise losing weight or recommend vigorous exercises during pregnancy. Your doctor or dietician can help create a nutrition plan to help you manage your GDM. A customised diet plan works best because it considers your specific weight, height, activity level, stage of pregnancy and your glucose levels.
Your doctor will also decide whether you should be taking insulin shots or not. This is essentially based on your blood sugar levels monitored from time to time. Delivery of your baby may be earlier based on your blood sugar control as well as the dose of insulin required to manage your diabetes. You need to discuss with your doctor on the options available.
An educational collaboration with Obstetrical and Gynaecological Society of Malaysia.
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