Gestational diabetes can cause preterm labour

Gestational Diabetes Mellitus (GDM) affects about two to five percent of all pregnancies. While it may be a temporary condition, gestational diabetes should not be taken lightly.

Definition

Gestational Diabetes Mellitus is characterised by high blood sugar level. This condition usually develops between the 24th and the 26th week of pregnancy.

GDM is a disorder characterised by high blood glucose (sugar) levels that is first diagnosed during pregnancy. In a nutshell, the hormones produced by the placenta interfere with the mother’s insulin efficiency. Usually, the pancreas remedies to the situation by producing more insulin. When this doesn’t happen, blood glucose levels rise, resulting in GDM.

Although this condition would not cause your baby to born with diabetes, but it will affect your child’s health if GDM is not under control.

Dr. Shobha Gupta, medical director and IVF specialist, Mother’s Lap IVF Centre, New Delhi, shares advice on this condition.

“The science behind this condition is that it is caused by excessive production of hormones that reduce the body’s capability to use insulin as well as it should. Nearly four to six percent of Indian women only develop gestational diabetes during their pregnancy,” says Dr Gupta.

She adds that gestational diabetes is usually temporary and automatically disappears once the baby is born.

Gestational diabetes mellitus is characterised by high blood sugar level caused by insulin-blocking hormones

Signs and Symptoms

The symptoms of gestational diabetes are rare and not easily detectable. Dr Gupta of Mother’s Lap IVF Centre, New Delhi, says, “This condition is usually diagnosed from screening tests before any symptoms develop. That’s why doctors recommend an antenatal test during the 24^th through the 28^th week.”

You must also remember that a woman may live for the longest time without knowing that she has diabetes. Therefore, if diabetes isn’t detected and or treated, you may develop the following symptoms during pregnancy:

• You may feel thirsty more often than usual
• You may feel the need to urinate more often
• You may develop infections that affect the urinary tract

Although these aren’t sure-shot symptoms of gestational diabetes, if you do notice any of these, you must visit the doctor.

Causes

Although researchers have not been able to point at the exact cause of gestational diabetes, it has to do with body’s mechanism of glucose processing.

Your body processes food to produce glucose and in response to this action, your pancreas release the insulin hormone. This insulin then produces energy by moving glucose from the bloodstream into the body’s cells.

The placenta produces a number of hormones that somehow impair this insulin hormone, thereby raising blood sugar in the body causing gestational diabetes and labour sometimes before time.

During pregnancy, the placenta produces a number of hormones that somehow impair this insulin hormone, thereby raising blood sugar in the body. This insulin-blocking mechanism can put you and your baby at risk during pregnancy.

Risk Factors

If you are diagnosed with gestational diabetes there is a likely chance that it will affect the growth of your baby. But how would you know if you are at a high risk of developing gestational diabetes?

Dr Gupta of Mother’s Lap IVF Centre, New Delhi, lists the following observations that indicate whether or not a mother is at high risk of developing gestational diabetes.

• If your body mass index is over 30 and you are considered obese
• If you’ve had gestational diabetes during your previous pregnancy
• If you have sugar in your urine
• If you have a family history of diabetes

Some practitioners will also screen you early if you have other risk factors like:

• You’ve previously given birth to a big baby. Dr Gupta explains, “Some experts use 4,000 gm or 4 kilos as the benchmark; others use 4,500 gm or 4.5 kilos.”
• You’ve had an unexplained stillbirth
• You’ve delivered a baby with a birth defect
• You have high blood pressure
• You’re over 35 years of age

If you identify with any of the aforementioned categories then you must consult with your gynaecologist immediately. Being at high risk can create many complications for you and the baby apart from affecting general well-being.

Complications

While most women who develop gestational diabetes often deliver healthy babies, you are still susceptible to certain health complications. She lists the following complications other than type-2 diabetes (which is more common in Singapore) that might affect you and the baby.

Complications that may affect your baby

• Excessive birth weight: When your body creates extra glucose but is not able to use it to create energy, your baby’s pancreas do the job for you. This increases the size of the baby. Such babies can weigh up to 4,082 gm and may require a C-section or sustain birth injuries.
• Preterm birth: Gestational diabetes that results in increase blood sugar of the mother may increase the chances of early labour. In such a situation the doctors usually recommend a C section because this condition may increase the size of the baby.

Gestational diabetes that results in increase blood sugar of the mother may increase the chances of a preterm baby

• Respiratory distress syndrome: A baby may suffer from respiratory distress syndrome, which makes breathing difficult. He may need assistance to breathe till his lungs mature completely. Babies who are born at their due date may also experience this syndrome.
• Low blood sugar: Because of gestational diabetes in mothers, the babies may develop low blood sugar because they had been producing more insulin even before birth. In severe cases, low blood sugar in a baby can also prompt seizures. However, it can be brought under control with constant feeding and injections.
• Development of type 2 diabetes in future: A baby whose mother has developed gestational diabetes can themselves develop type 2 diabetes and obesity in later stages of their lives.

Complications that may affect you

• Diabetes in the future: Gestational diabetes can cause diabetes in the future. Dr Gupta of Mother’s Lap IVF Centre, Delhi says, “Gestational diabetes usually goes away after pregnancy. But once you’ve had gestational diabetes, your chances are two in three that it will return in future pregnancies. Many women who have gestational diabetes go on to develop type 2 diabetes a few years later.”
• High blood pressure: Gestational diabetes increases the chances of women developing high blood pressure which can later cause serious health problems.

When to call the doctor

Ideally, your gynaecologist would schedule antenatal exam in your 24^th week of pregnancy. And if you feel that you can notice the symptoms of gestational diabetes, then that’s the time to discuss the problem with your doctor. Make sure you write down the issues and take a family member along for the appointment.

You should also make a list of the questions to ask your doctor. In case you are struggling to understand the subject and question it, you can take a cue from those listed below:

• How can I bring gestational diabetes under control?
• What should be my meal plans and diet chart for the day? Do you recommend any changes in my current diet?
• Is there any medicine I need to take to control this condition?
• Which level of severity drives the use of medications?
• How will it affect my baby? Is there anything I can do to help him be safe?

If you are diagnosed with gestational diabetes then you must take precautions as recommended by the doctor.

Tests and Diagnosis

Towards the end of the second trimester, your doctor will recommend routine antenatal tests. There are two types of tests usually done in Singapore – Glucose Screening and Glucose Tolerance Test

• Glucose Screening: You will be required to fast the night before, i.e. no food or water after 10pm. On the day of the test, you will given a sweet syrupy glucose mix. After an hour, you will be checked (blood test) for sugar level in your body. If the level is below 130 to 140 milligrams per deciliter (mg/dL), or 7.2 to 7.8 millimoles per liter (mmol/L), then it is usually considered normal. However, if the test comes above normal, then you will tested for its confirmation through the follow-up second test.

• Glucose Tolerance Test: In this follow-up test, you will be screened for confirmation of gestational diabetes. Post an overnight fast, your sugar level in the body will be tested. Here, you will again be given a syrupy solution with higher concentration of glucose to drink. Thereafter, your blood sugar will be tested every hour for three continuous hours, and some practitioners include a urine test as well that are done at the same intervals. If more than two readings are above normal you will be diagnosed with gestational diabetes.

The syrupy glucose solution will determine if you have gestational diabetes and the doctor will suggest treatments accordingly

If you test positive for gestational diabetes, you will be recommended frequent checkups. Dr Gupta of Mother’s Lap IVF Centre, Delhi says, “If gestational diabetes is difficult to control, then it may affect the placenta and impair the delivery of oxygen to the baby.

The doctor will also check you for blood sugar once you have delivered. This will determine if your blood sugar has returned to normal in the 6th till the 12th week after delivery.

Treatments and Drugs

Although gestational diabetes is not a permanent condition, there are certain precautions that you can take to make sure that you do not end with type 2 diabetes in the future. But before that there are certain points to remember in order to control rising blood sugar during pregnancy.

• Monitoring blood sugar: In case gestational diabetes is detected, you must monitor the blood sugar at least four to five times a day. You can use the various diabetes testers available in the market. These draw a drop of blood from your finger and analyse it for sugar level in the blood.
• Monitoring diet: Certain basic lifestyle changes may help prevent diabetes after gestational diabetes. “These include making healthy food choices eat a variety of foods including fresh fruits and vegetables, limiting fat intake to 30 percent or less of daily calories. Healthy eating habits can go a long way in preventing diabetes and other health problems,” says Dr Gupta.
• Exercise: Regular exercise allows your body to use glucose without extra insulin. This helps combat insulin resistance and is what makes exercise helpful to people with diabetes. But never start an exercise program without checking with your doctor first.
• Medication: If you have been prescribed medications to keep the blood sugar under control, then you must stick to the schedule. Some women are also prescribed insulin injections, so make sure that you do not miss them.
• Monitoring the baby: Apart from yourself, you also need to monitor the development of the baby through ultrasounds. This will reduce the possibility of analysing a preterm delivery situation.

Prevention

Remember, that if you have gestational diabetes, you are at higher-than-normal risk for developing type 2 diabetes later in your life. Dr Gupta says, “Type 2 diabetes, like gestational diabetes, occurs when the body doesn’t use its insulin properly. Keeping your weight within a healthy range and keeping up regular, moderate physical activity after your baby is born can help lower your risk for type 2 diabetes.”

She also adds that following a healthy diet and physical activity program, maintaining a healthy weight, or taking certain medicines can help people control type 2 diabetes in the future and gestational diabetes during pregnancy.

Republished with permission from: theIndusparent

Have you been diagnosed with gestational diabetes during pregnancy? Do share tips on how you managed to cope and overcome it!