Sheetal (name changed) ,a 30-year-old Primigravida ,went for a blood test called an OGTT with 75 glucose load at 24 weeks pregnancy and was appalled when the results showed high blood sugars. She had a family history of Diabetes in both parents but prior to her pregnancy, she never had high blood sugars.
Sheetal is a typical case of Gestational DM, which is diagnosed for the first time during pregnancy. There is good news though. This affects your health and your baby’s but you can control it easily by diet, exercise, lifestyle modifications and occasionally medication. The bad news however is that it may lead to Type 2 Diabetes later in life and your baby too may suffer from childhood obesity and Diabetes.
RISK FACTORS
- Obesity
- Family history of DM
- Race: We Asians are at a higher risk compared to Whites
- If you’ve had a previous pregnancy with GDM or Prediabetes
- If you’ve delivered a baby with a birth weight of 4.1 kg or more
WHAT ARE THE SYMPTOMS OF GDM?
There aren’t many symptoms except maybe increased thirst or urination. Most times it’s only detected when we test for sugars at 24-28 weeks or in the case of high-risk patients, at the first antenatal visit.
COMPLICATIONS:
Let’s divide these into complications for you and for your baby
For your baby, it may lead to
- Increased birth weight
- Birth injuries like shoulder dystocia and collar bone fractures etc.
- 3 times greater risk of a Caesarean delivery
- 4 times greater risk of NICU care
- Hypoglycemia and some other biochemical derangements after delivery
- Breathing difficulties, Respiratory Distress Syndrome
- Stillbirths
- Greater chance of obesity and DM later in life
For you, it may lead to
- Increased chance of difficult vaginal delivery owing to a big baby
- Vaginal and perineal tears
- Caesarean delivery
- Future DM
PREVENTION OF GDM:
As with most lifestyle illnesses prevention and first-line treatment is by lifestyle changes. Eating a healthy diet rich in green vegetables and fruits
lean meat, whole grains high in nutrition and low in calories and fats. Simple carbohydrates like sugars and desserts are to be limited. Regular meals and snacks with small portion sizes are desired. Talk to your nutritionist or doctor to help you with a diet chart.
Exercising 5-6 times a week for at least 30-45 minutes, unless contraindicated by your doctor is most vital.
Cutting alcohol and smoking completely is required and maintaining a healthy weight even before you become pregnant is vital to ease your journey with GDM.
You should not gain more weight than recommended.
TREATMENT
As mentioned above , lifestyle modifications are crucial to controlling high blood sugars in GDM, which in turn reduce the complications of the disease.
You will need to buy a glucometer and monitor your blood sugar levels 4 or more times a day.
Medication like Insulin or oral hypoglycaemic drugs may be needed depending on your blood sugar control or lack of it; the dose being adjusted accordingly.Most times it is only 10-20% patients who need medication.
Your baby’s growth is monitored by serial ultrasounds and other tests including checking for the amniotic fluid volume and Dopplers to determine blood flows.
Delivery is done at around 38 weeks or even later if all is well; your doctor is the best judge of it and you must have a frank and detailed chat with her about the birth plan . Sometimes, however a preterm delivery may happen owing to complications of the disease.
Following delivery ,your blood sugars will be checked , one OGTT will be repeated 6 weeks later and then you will need follow up at least every 2-3 years if not more frequently .
REMEMBER GDM IS EASILY CONTROLLED WITH DIET,EXERCISE, HEALTHY LIVING AND MEDICINES AND PREVENTION IS ALSO BY LIFESTYLE CHANGES. LETS STAY FIT AND BEAT THESE LIFESTYLE ILLNESSES -LETS BEGIN BEFORE PREGNANCY;IN FACT,LETS BEGIN NOW!
