Diabetes being a very common disease can affect women with pregnancy also. Diabetes can occur during the first-time during pregnancy and is called gestational diabetes (GDM). Sometimes a lady with diabetes can become pregnant. It is then called pregestational diabetes. We have compiled this FAQ based on currently available information.
If you are at high risk for diabetes (older than 30 years, positive family history, obese, any past history of abnormal blood sugars etc), it is important that you confirm that you are not having diabetes before planning pregnancy. If you are already pregnant and have these risk factors, you need to confirm the status right now. If you do not have any of these risk factors, you can test the blood sugars by 24weeks. Even if you are negative for diabetes during the testing , it is suggested that you do another test by 28-30 weeks.
Most doctors use a glucose challenge test to screen for gestational diabetes. This is a screening test using 50 grams of glucose. Following the challenge test, the patient is advised a 2-hour glucose tolerance test to confirm the diagnosis of diabetes. Some doctors use the two-hour test to confirm diabetes. Your doctor will decide which is the best-suited test for you.
Usually GDM is may not cause any symptoms to the mother, but rapid weight gain, higher amounts of fluid (by ultrasound scan), bigger baby for dates are some findings that may be observed. Despite being asymptomatic, the disease can harm both the mother and baby.
Gestational diabetes by definition occurs later in pregnancy after the internal organs of the baby are formed. Hence it is not likely to cause any birth defects. However, it can cause macrosomia (a baby bigger than normal). In addition to macrosomia, gestational diabetes increases the risk of hypoglycemia (low blood sugar) in the baby immediately after delivery. Your baby’s blood sugar level will be checked in the new-bornnursery and if the level is too low, it may be necessary to give the baby glucose intravenously. Infants of mothers with gestational diabetes are also vulnerable to several other chemical imbalances such as low serum calcium and low serum magnesium levels. All these problems are preventable by good blood sugar control in the mother.
If the onset of diabetes is before pregnancy/or in early pregnancy, the raised blood sugars can harm the developing fetus and cause malformations. This is the importance of good blood sugar control before pregnancy in diabetic women.
In the mother gestational diabetes is associated with increased weight gain, increased risk of hypertension, caesarean delivery, hydramnios (increased fluids). Just because you have gestational diabetes does not mean that your obstetrician will resort to caesarean, but the threshold for waiting will certainly be lower.
Controlling blood sugars is one of the major interventions to avoid diabetes related complications for the mother and the baby. The major steps involved are glucose self-monitoring, balanced diet and insulin. One of the essential components in the care of a woman with gestational diabetes is a diet specifically tailored to provide adequate nutrition to meet the needs of the mother and the growing fetus. At the same time the diet has to be planned in such a way as to keep blood glucose levels in the normal range. Regular antenatal check ups are essential for monitoring the mother and baby.
Monitoring blood glucose at home using a glucometer is called self-monitored blood glucose (SMBG). This is important since blood glucose will vary from time to time with diet and exercise and without monitoring there is no way of knowing the exact levels.
Yes, you are free to do so. However, the recommended frequency of blood sugar monitoring is 3-4 times daily if not more. It is not practical to travel to the friendly neighbourhood lab 4 times for blood sugar checking. Further, glucometers are accurate and utilize only a small volume of blood for blood sugar checking.
You may need to test your blood several times a day. Generally, these times are fasting (first thing in the morning before you eat) and 1-2 hours after each meal (postprandial i.e. after breakfast, after lunch, after dinner). You will need to check during episodes of hypoglycemia and occasionally at night to make sure that you don’t have a night hypoglycemia.
It is suggested that you visit the endocrinologist every 2 weeks from the time of your diagnosis of GDM and weekly after 36 weeks till delivery. More frequent visits are planned if the blood sugars are not controlled.
Your endocrinologist and dietician will plan out a diet for you based on your weight, weight gain, current blood sugars etc. This diet will be modified according to various parameters recorded during each visit. A nutritionally balanced diet is always essential to maintaining a healthy mother and successful pregnancy. The foods you choose become the nutrient building blocks for the growth of the fetus. Careful attention should be paid to the total calories eaten daily, to avoid foods that increase blood sugar levels, and to emphasize the use of foods that help the body maintain a normal blood sugar. Try to eat a consistent amount of carbohydrate during each meal and snack.
General instructions like “eat more”, “eat more protein” or “eat more carbohydrate” are not encouraged. Although carbohydrates and proteins are required for your baby’s growth, consuming them in excess amounts (more than what is required) do not lead to improved fetal weight, but rather to high maternal (and fetal) blood sugars and nitrogenous products in the baby.
It is not necessary that all patients with GDM be treated with insulin. When dietary modifications and exercise fail to maintain normal blood sugars, insulin will be recommended. The only way to identify whether diet and exercise is working is based on SMBG.
It is recommended that you maintain the following blood sugar targets with diet, exercise + insulin. Please remember that fasting sugars as low as 60 mg/dl is not uncommon in normal pregnancy.
|Time of Blood Sugar Test||Healthy Target Levels (in mg/dl|
|Fasting glucose level||No higher than 95|
|One hour after eating||No higher than 130|
Note: these recommendations vary, but the one above is very acceptable.
Your doctor will make insulin dose adjustments and dietary changes to target these levels.
Occasionally, your blood sugar level may get too low if you are taking insulin. This can happen if you delay a meal or exercise more than usual. This low blood sugar is called “hypoglycemia”. Check your blood sugar if you can. If your blood sugar is less than 60 mg/dl, eat a sugar-containing food, such as ½ cup of orange or apple juice. Top it up with some glucose biscuits. If your meal or snack is due, please be sure to take it. Mark it in your blood sugar chart
Besides your routine tests, your endocrinologist may order a thyroid function test and HbA1c. The fetus, the umbilical cord blood flow and the amniotic fluids will be assessed by using an ultrasound scan. It is a standard practice to have an ultrasound early in pregnancy, at 20 weeks (for malformations) and at 36 weeks for fetal size and fluid volumes. More scans may be ordered if there is any suspicion. Monitoring fetal movements and non-stress test (NST) and biophysical profile other routinely used methods.
The mode of delivery (vaginal vs. caesarean) will be decided by your obstetrician based on the current risk profile. The blood sugars will be checked before and during delivery and the insulin will be adjusted to maintain normal sugars during delivery.
Your baby’s blood sugar level will be tested immediately after birth. If the blood sugar is low, your baby will be given sugar water to drink or by an intravenous tube in the vein. Your baby may be sent to a special care nursery for observation during the first few hours after birth to make sure he or she doesn’t have hypoglycemia.
Usually in gestational diabetes, the blood sugars will return to normal after delivery. The doctor will keep a check on it. However, it is essential that you check your diabetic status after discharge 6-8 weeks after delivery by an OGTT (2 hr, 75 gms glucose) to confirm whether diabetes has resolved.