Mediscene

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.

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 gestational diabetes.

You are at risk, if you are:

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.

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 diabetes:

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 eat.

If you are using insulin remember:

To store it in a refrigerator

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 38 weeks.

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 with you.

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 after pregnancy.

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 diabetes later.

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.