baby and you
With diabetes in pregnancy increasing in our country
like an epidemic, it's important to keep a tab on blood glucose
levels, advises Dr.J.M. Kumarasiri, a Consultant Obstetrician and
Gynaecologist at the Castle Street Hospital for Women. Here he talks
to Melanie Amarasooriya about diabetes in pregnancy.
Why is it important to know whether I have
diabetes when I am pregnant?
Diabetes in pregnancy unless managed properly
can lead to a number of problems for both the baby and mother.
It can result in:
- Unnecessarily large babies causing a difficult
and complicated delivery.
- Growth retardation of the foetus
- Pregnancy-induced hypertension
- Increased amount of fluid in the water bag leading
to other complications
If the mother is diabetic even before the pregnancy,
the foetus is affected from its early days and the chances are that
there can be congenital heart, nervous system and skeletal system
defects or even miscarriage.
Can I have diabetes during pregnancy although
I did not have it before?
Yes. Pregnancy is a state where a number of hormonal
changes occur and this predisposes one to diabetes. Diabetes once
diagnosed for the first time during pregnancy is called gestational
diabetes. If you have the risk factors the chances are high of getting
You are at risk, if you are:
- Have a parent or a sibling having diabetes
- Over 35 years of age
- Have a history of diabetes during a past pregnancy
- Have given birth to a baby over 3.5 kg of birth
- Have had previous stillbirths or miscarriages.
How would I know whether I have diabetes
in pregnancy or gestational diabetes?
You can check your blood glucose levels. The blood
glucose level after 10 hours fast and not more than 14 hours is
a good indicator. The Oral Glucose Tolerance Test (OGTT) is a better
alternative where you are given a standard amount of glucose to
drink following a 10 hour fast and your blood glucose levels checked.
You have to have a normal diet for the three days before the OGTT.
However requesting these tests without the advice
of the doctor is not wise. Fasting during pregnancy can have its
risks especially if you are diabetic and only the doctor is able
to judge whether and when it is really necessary. Also the cut-off
values of the blood glucose vary according to the method it's measured
by and it is best to go by the reference range indicated in the
laboratory report as well as your doctor's opinion.
What do I need to do if I have diabetes?
Prevention is better than cure. Think about reducing
the modifiable risk factors like weight before pregnancy. Regular
physical activity and exercise improve glucose tolerance and reduce
the risk of diabetes.
If you are diagnosed with diabetes in pregnancy
you have to be careful about your diet. Fasting is not at all good
for your child. So is overeating.
Prepare a diet plan with the advice of your doctor.
You will have to:
- Limit sweets, and food containing refined sugars
- Take foods rich in fibre like fresh fruits and
- Have three main meals and three snacks
- Reduce the variation of blood glucose levels
in the body by spreading out your calorie intake through the day.
How do I know whether my blood glucose
is under control?
You may be asked to check your blood glucose with
a glucometer (if you are able to buy one) once you wake up and just
before and after meals. This is called the blood sugar series and
it helps to get an idea as to whether your blood glucose levels
are normal throughout the day. The following chart shows blood glucose
targets for most women with gestational diabetes. Talk with your
doctor about whether these targets are right for you.
Blood glucose targets for most women with gestational
On awakening not above 110
1 hour after a meal not above 140
2 hours after a meal not above 120
Each time you check your blood glucose, write
down the results in a record book. Take the book with you when you
visit your doctor. If your results are often out of range, your
doctor will suggest ways you can reach your targets. But buying
a glucometer is not essential. The doctor will keep you on a healthy
diet and monitor whether your blood glucose levels are satisfactory.
This needs hospitalization and serial blood glucose checks before
and after meals for one or two days. If it is not responding you
may need to start on insulin. This is given as injections and you
will be trained to get your dose of insulin on your own. However
remember that insulin injection is not a panacea. Good diet control
alone may help you to attain good blood sugar control. Even if you
need insulin at some point you have to be careful about what you
If you are using insulin remember:
To store it in a refrigerator
- Not to alter the dose as you feel.
- Take the recommended dose and do not omit doses
if you are sick or miss meals.
- Not to miss meals.
However the most important message is to maintain
the kick count chart; if there is the slightest suspicion that the
baby's movements are fewer, see your doctor immediately. Diabetes
is known to cause unexplained foetal deaths during the latter part
of pregnancy. Urgent attention can prevent such disasters.
Can I have a normal delivery?
If you have gestational diabetes or the type that
occurs in pregnancy and it is well under control with dietary modifications
alone, you can have a normal delivery at term. But if you were treated
with insulin it is advisable that you have a planned delivery at
Your doctor will decide whether to have a caesarean
section considering the other factors like the size of the foetus
and its position. An early delivery at 38 weeks prevents unexpected
sudden foetal deaths which are known to occur with diabetes. It
also prevents complications of the delivery like the baby having
various birth traumas. However baby has to be sufficiently mature
to be delivered and the doctor will decide on this after discussing
Will I have diabetes even after delivery?
If you had diabetes that occurs in pregnancy it
will settle after the delivery. But you are at increased risk of
diabetes in a subsequent pregnancy and also in later life. However
if you were diabetic even before the pregnancy it will not settle
But after the delivery you can start on safe oral
drugs if your blood sugar is not under control.
Even if you have normal blood sugar levels after
delivery you are at an increased risk of developing diabetes later.
Therefore healthy diet and regular physical activity is important.
Could my child get diabetes?
Not immediately after birth. But the baby can
have low blood glucose levels after birth. Thus breastfeeding is
important. However he/she is genetically susceptible to developing
Remember to breastfeed your baby and introduce
him/her to a healthy diet so that his/hers risk of diabetes will
be low in later life.