Arjun Panesar, Director of Global Diabetes Community Diabetes.co.uk, talks to Female First about gestational diabetes which can develop during pregnancy, and wants to raise awareness for women who may not be aware and could be at high risk of this type of diabetes.
Gestational diabetes is a manageable issue
Gestational diabetes is a type of diabetes that can develop in pregnancy. Finding out you have gestational diabetes can be very frightening. Not only do you have to deal with all the emotions (the ups and the downs) and the questions that come with being pregnant, but also the uncertainty of this new-found condition. Fortunately, as with all types of diabetes, there are many well-informed health professionals to help answer your questions and to guide you through this very important time in your life. The more you know, the easier it is to accept and make the necessary changes for a successful and happy pregnancy.
How did I get gestational diabetes?
Somewhere between 24 and 28 weeks into your pregnancy your doctor most likely sent you to be screened for the presence of gestational diabetes. If you were at greater risk for getting gestational diabetes, your doctor may have sent you for a screening test before you reached 16 weeks. You may think this is too late in your pregnancy to be finding out about such a problem, but in most cases, screening before this time would be of little value.
Hormonal changes and insulin
It is the hormonal changes (hormones made by the placenta that resist insulin) in the second and third trimesters of pregnancy, along with the growth demands of the foetus, that increase a pregnant woman's insulin needs by two to three times that of normal. Insulin is needed to take the sugar from your blood and move it into your cells for energy. If your body cannot make this amount of insulin, sugar from the foods you eat will stay in your blood stream and cause high blood sugars. This is gestational diabetes.
How common is gestational diabetes?
Gestational diabetes means diabetes mellitus (high blood sugar) first found during pregnancy.
It occurs in 3-5% of all pregnancies (in other words, 1 in 20 pregnant women will develop gestational diabetes) so, you can take comfort in the fact that you are not alone.
Gestational diabetes is a form of diabetes that comes on during pregnancy. It is believed to affect as much as 1 in 7 pregnant women. Often diabetes will go away after your pregnancy but can come back later on in life as type 2 diabetes.
The most common risk factors for gestational diabetes are as follows:
- BMI over 30
- Having previously had a baby weighing 10lbs or more
- If a close relative has had type 2 or gestational diabetes
- If your ethnic background is South Asian, Middle Eastern or African-Caribbean
- Yours is high if you have had gestational diabetes previously. Because keeping blood sugar levels in check during pregnancy is very important, you should receive an antenatal screening for gestational diabetes which will pick up any abnormalities in blood sugar levels.
Should diabetes come on between screening appointments, the symptoms may be recognised as feeling thirsty; having a dry mouth, needing to frequently urinate, tiredness, having yeast infections. For the majority of women, a change of diet and getting more exercise will be enough to control gestational diabetes. For others, a form of medication such as tablets or even insulin may be required to keep blood sugar levels under control. As part of your treatment, you will need to monitor your blood glucose levels at various times through the day. Having well controlled diabetes however will greatly improve your chances of a successful birth and healthy child. In most cases, gestational diabetes is managed by diet and exercise and goes away after the baby is born.
Very few women with gestational diabetes require insulin to control this type of diabetes. If you do need insulin, it will ensure blood glucose stays in the acceptable range, thereby reducing the risks to you and your baby. Gestational diabetes should not be taken lightly. Immediate risks to the mother and foetus are very real; however, these risks can be minimized with good care and follow up.
Ante-natal care
- Ante-natal care should be hospital-based, from a multi-disciplinary team:
- Individualise insulin regimens and recommend 4-times daily glucose monitoring.
- Aim to maintain glucose 4-7 mmol/L and HbA1c within the normal non-diabetic range.
- Remember insulin requirements increase progressively from the 2nd trimester until the last month of gestation, when a slight fall-off may be noted
- Hypoglycaemia and loss of awareness is common in early pregnancy. Hypoglycaemia does not appear to have long-term adverse effects on foetal development
- Ketoacidosis can cause foetal death at any stage. All women should test urine for ketones if blood glucose is high, if vomiting occurs or if they are unwell.
Delivery
The timing of delivery is individualised; in women with good diabetes control and no complications, the pregnancy may be continued to 39-40 weeks. Caesarean section rates are often higher than in non-diabetic women.
Post-natal care
Insulin requirements fall dramatically after you have given birth, therefore reduce insulin doses immediately to pre-pregnancy levels, to avoid hypoglycaemia.
Encourage slightly higher blood glucose levels than during pregnancy.
In breast-feeding mothers, reduce insulin dose further once lactation is established.
Discuss contraception while the patient is still in hospital.
All women should be seen by the diabetes pregnancy care team six weeks after delivery.
Dr Hilary Jones comments:
"Up to 1 in 20 pregnant women will develop gestational diabetes which normally occurs in the last trimester of pregnancy after 28 weeks. Doctors screen for it between 24 and 28 weeks or carry out tests earlier if glucose is present in the urine. A woman with GD has increased insulin needs by two or three times that of normal which is caused by hormonal changes along with the growth and demands of the foetus. The condition is managed by exercise and diet but a few women will require insulin injections also. The condition should never be taken lightly as there can be immediate risks to the mother and baby unless treated. However with good care and follow up these risks can be minimised. Most women will not develop diabetes after the pregnancy but a few will develop type two diabetes in the future and should be aware of the risk. Anyone concerned about diabetes and how to manage it during and post pregnancy can get some great free advice and support by joining Diabetes.co.uk, Europe's largest diabetes patient to patient diabetes forum."
Tagged in Pregnancy Diabetes Pregnancy Health