Understanding gestational diabetes

A guide to gestational diabetes

Pregnancy is the time when a woman has to take extra care about herself to avoid any harm to the growing fetus and herself too.  Among the many conditions to keep a watch on, diabetes during pregnancy is the most important. A high blood sugar is harmful to the pregnant woman and the growing baby, and may complicate the pregnancy and the birth process.

Understanding gestational diabetes

During pregnancy, the fetus gets all the nourishment from the mother through placenta, a structure which connects the baby with the uterus of the mother. Placenta also secretes various hormones, which may interfere with the normal functions of other hormones in the mother. Usually, pancreas secretes hormone insulin that helps the body use sugar for production of energy. In pregnant women, the hormones from placenta may interfere with function of insulin, thereby elevating the levels of blood sugar. As a result, a woman who was non-diabetic before pregnancy, may develop high blood sugar when pregnant. This condition is called gestational diabetes. Gestational diabetes, if untreated is harmful to the mother as well as the fetus. The sooner the treatment starts the better it is for the health of the mother and child. In most of the cases, the gestational diabetes disappears once the child is born.

The chances of getting gestational diabetes is more in people who are overweight, who are above 25 years of age, who have a family history of diabetes, who are Asian American, Hispanic/Latino, African American, American Indian or Pacific islander because of genes susceptible to gestational diabetes in these ethnic races, who have given birth to a baby before that was weighing more than nine pounds and who have a previous history of gestational diabetes, miscarriage and repeated infections.

 There are different tests that are done to diagnose gestational diabetes. The fasting blood sugar test is done when the patient is fasting, drinking only water for 8 hours. The random blood sugar test is done anytime of the day. In the screening glucose tolerance challenge test, the patient is given a sugary drink and then the blood glucose level is checked after an hour. This test can be done anytime of the day.

Another test for diagnosing gestational diabetes is the Oral glucose tolerance test. You are asked to fast for 8 hours before the testing. The blood is taken for the test during fasting. Thereafter, you would be asked to drink sugar water, and then blood sugar is tested every hour for 3 hours. A fasting blood sugar above 95mg/dl, at 1 hour above 180mg/dl, at 2 hours above 155mg/dl and at 3 hours above 140mg/dl, indicates gestational diabetes. All diagnostic tests are done generally between 24 to 28 weeks of pregnancy which is the time when gestational diabetes can occur in pregnancy.

Managing gestational diabetes

To manage gestational diabetes, firstly modifications in diet are essential. With the help of a dietician, a well balanced diet plan to lower the blood sugar has to be made. Foods rich in sugars like cookies, desserts, sweets, candies and sweet juices have to be avoided. Carbohydrates foods like pasta, bread, potatoes, cereal, and rice are good for the mother and the baby. They should however be taken in limited quantities. Eating many small meals at regular intervals are recommended to avoid rise in blood sugar level. Apart from diet planning, careful monitoring of sugar level is essential. You can use a home blood sugar monitoring device to check your blood sugar at least four times daily or as advised by your physician.

 In addition, physical activity is important to maintain normal blood glucose levels. Swimming and walking are good exercises and you can do them after the approval of your doctor. If the mother has any complications, then only upper body exercises are advised by the doctor that can be performed sitting on the chair. Aerobics in water is also a good exercise that is relaxing and fun.

Apart from diet planning and physical exercise some women with gestational diabetes will need to take insulin shots or oral medications depending on the test results. Insulin is not harmful to the baby and is given under doctor’s supervision.

Complications of untreated gestational diabetes

Untreated gestational diabetes leads to complications in the mother as well as the baby.  In mothers it may lead to a condition called preeclampsia, where there is excess protein lost in the urine, and high blood pressure that occurs in the 20th week of pregnancy. Due to excess sugar in urine, mothers with gestational diabetes have more chances of getting urinary tract infections than mothers in normal pregnancies. Mothers with history of gestational diabetes may develop it again during second pregnancy or may get diabetes in later years.

During pregnancy, the mother having gestational diabetes has more sugar in the blood which crosses the placenta and reaches the baby. The pancreas of the baby then starts producing more insulin to counter the glucose resulting in overgrowth of the baby. This condition is called macrosomia. Delivery of such large babies may need a caesarean section. 

The babies after birth may develop low blood sugar which may result in seizures of the baby. Careful monitoring and intravenous glucose are administered by the doctor under such circumstances. The infant’s blood sugar levels are carefully monitored by conducting blood sugar tests. If the infant is diagnosed with low blood sugar, then sugar water or glucose is administered to the baby intravenously or through a tube into the vein of the infant. Untreated gestational diabetes may result in birth of a baby with breathing problem which continues till the lungs become stronger. The baby in later life has a high risk of developing diabetes and obesity. The baby may also develop problems in walking and balancing. There can be disorders like hyperactivity or inattentiveness. If bilirubin (the yellowish pigment found in bile produced by liver) level is found to be high, then it is treated with light therapy. In this treatment the baby is placed under blue green spectrum of light that changes the structure of bilirubin molecules which are then easily excreted out in urine and stool of the baby. Plastic shield filters are used to protect the baby against any harmful rays. The baby is also given eye patches for eye protection during the therapy. The baby wears a diaper only during the treatment.

Your bundle of joy

By following the doctor’s advice and taking all the necessary precautions you can get over gestational diabetes. Awareness regarding gestational diabetes removes all fears and apprehensions regarding the safety of your baby. The health and safety of your ‘bundle of joy’ is in your hands!

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