Diabetes Mellitus is characterized by elevated blood sugar levels in the body. This condition can happen to anyone, including pregnant women, that is called Gestational Diabetes.3 This type of diabetes is first noticed in pregnant women who did not have diabetes previously.1

This can occur when the body does not produce enough insulin, which helps regulate blood sugar levels when the body has to meet additional needs during pregnancy. Gestational diabetes can strike at any time during pregnancy, although is generally more common during the second and third trimester of pregnancy.2

Gestational diabetes can cause complications for both the mother and the baby in the womb, even after delivery.2 Although blood sugar levels will return to normal in postpartum period, however, there is an increased risk of developing type 2 diabetes mellitus later in life.3

The complications that arise include the baby growing bigger, the mother having to undergo a caesarean section during childbirth so that the recovery time will be longer, high blood pressure (preeclampsia) which can cause the baby to be born earlier and the mother may experience seizures or strokes during delivery. In addition, a mother who takes diabetes drugs or insulin therapy is prone to hypoglycaemia or low blood sugar levels which can be fatal for mother and baby.1 There’s also other problems that can occur including an excessive amount of amniotic fluid, also called polyhydromnios,2 increasing risk of developing type 2 diabetes mellitus in the future for both mother and baby, early birth causes respiratory distress syndrome.4

Most women with gestational diabetes have no noticeable symptoms. Increased thirst and frequent urination are possible symptoms.4 In addition, some women become hungry more easily so that they eat more portions,3 dry mouth and often feel tired.2

Risk factors for gestational diabetes in pregnant women, often associated with being overweight (obesity) before pregnancy,3 history of giving birth to a baby weighing ≥4.5 kg, having gestational diabetes in previous pregnancy, having a family member with diabetes mellitus, are of south Asian, Black, Africa-Caribbean or Middle eastern.2,4 In addition, the risk will also increase in women with a history of prediabetes, ie sugar levels are higher than normal, but not high enough to be categorized as diabetes mellitus, have polycystic ovary syndrome (PCOS) or other health conditions related to insulin, high blood pressure, cholesterol, heart disease, and previous miscarriage,3 including lack of physical activity or exercise.4

Screening for gestational diabetes during pregnancy should be done around 8 to 12 weeks of gestation. A series of questions will be asked by health professionals to determine risk factors, followed by blood tests for oral glucose tolerance tests. You will fast for 8-10 hours in previous day, the blood will be drawn the next morning, then you would drink glucose water, rest for 2 hours, and take a second blood draw.2

The following are general criteria for results of blood test performed:4

  • Blood sugar levels 190 mg/dl or 10,6 mmol/L is an indication of Gestational diabetes.
  • Blood sugar levels below 140 mg/dl or 7,8 mmol/L are normal standard.

 

Treatment for gestational diabetes includes lifestyle changes, control of blood sugar levels during pregnancy, if needed, pharmacology therapies. Below are things you can do to be aware of diabetes in pregnant women: 1,3,4

  1. Healthy eating

Eat three small meals along with 2 or 3 snacks at almost the same time every day, reduce sugar intake, increase consumption of foods with a low glycaemic index (such as whole wheat pasta, brown rice, beans, etc.), fruits and vegetables, as well as lean protein sources (such as fish and cheese).

  1. Regularly exercise at least 30 minutes of moderate-intensity physical activity, five days a week, such as walking, swimming, or sports recommended by your health care provider for pregnant women.
  2. Regularly monitor blood sugar levels

If blood sugar levels are uncontrolled, health practitioners may give insulin or oral drug therapy after considering the risks and benefits for pregnant women.

Monitor your pregnancy by performing an ultrasound (USG) at 18 – 20 weeks of gestation to be aware of any abnormalities in the baby, as well as at 28, 32 and 36 weeks to monitor the baby's growth and the amount of amniotic fluid, also regular health checks on 38th week and so on.2

The ideal time to give birth for mothers with gestational diabetes is usually around weeks 38 to 40. If your blood sugar is uncontrolled, your health care provider will suggest an induction of labour or a Caesarean section. After delivery, it is very important to immediately feed your baby within the next 30 minutes, continued every 2-3 hours at more frequent intervals until the sugar level in the baby stabilizes. The baby's sugar level is checked 2-4 hours after birth. Your baby may need to be fed through a tube or IV if the sugar level is low. When the baby is unwell or requires close monitoring, intensive care will be given at the neonatal unit. If the baby and mother are in good health, both can go home after 24 hours

References:

  1. Centers for Disease Control and Prevention. Gestational Diabetes and Pregnancy. CDC. Last reviewed: July 14, 2020. Available at: https://www.cdc.gov/pregnancy/diabetes-gestational.html
  2. National Health Services. Gestational Diabetes. NHS-UK. Last reviewed: August 06, 2019. Available at : https://www.nhs.uk/conditions/gestational-diabetes/
  3. Michael Dansinger. Gestational Diabetes. MD Last reviewed: December 08, 2021. Available at : https://www.webmd.com/diabetes/gestational-diabetes
  4. Mayo Clinics Staff. Gestational Diabetes. Mayo Clinics. Last reviewed: April 09, 2022. Available at: https://www.mayoclinic.org/diseases-conditions/gestational-diabetes/symptoms-causes/syc-20355339

 

 

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