Pregnancy is an exciting time in a woman's life — a time of expectations and preparations, when her mind and body prepare for the joys and responsibilities of motherhood. Taking care of the mother's health during the gestation period is of utmost importance for the baby to grow normally and enter this world hale and hearty.
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Sometimes, especially around the 24th week of pregnancy, many women are diagnosed with high blood sugars- a term called gestational diabetes, even when they have had no history of diabetes. This may give rise to a lot of fear, apprehensions and anxiety. The diagnosis of gestational diabetes does not mean that the mother will remain a diabetic after delivery, although a susceptibility to develop diabetes in the future is certainly present.
Why gestational diabetes develops is very interesting. We are all aware that during pregnancy, the placenta supports the baby as it grows. Placental hormones are necessary for the baby to grow to and sustain the pregnancy, but these hormones also block the action of insulin in the mother's body — a term called insulin resistance. So, although the mother's body continues to produce insulin, it is not allowed to work properly and as a result her blood glucose levels start rising. Gestational diabetes develops when the mother's blood glucose levels rise above normal, thus, causing hyperglycaemia.
Gestational diabetes occurs at a later stage in pregnancy — when the baby has already formed but is still growing. The baby may not have developmental birth defects as seen in case of babies whose mothers had uncontrolled diabetes prior to pregnancy. But, if left untreated, the baby might be harmed. Rising blood sugar levels in the mother's body sends the pancreas into overdrive to produce more insulin, causing hyperinsulinemia, but this is not able to reduce the blood glucose due to increasing insulin resistance caused by placental hormones. The insulin cannot cross the placenta but the extra glucose can easily enter the baby's circulation through the placenta along with other nutrients. As a result, the blood glucose levels of the baby also start rising, sending the developing pancreas in the baby's body into overdrive to produce extra insulin to control them. As the baby receives more glucose, i.e., more energy than it normally needs for growth, this excess energy gets stored as fat in the baby's body, thus, leading to 'macrosomia' or 'fat baby'.
Babies with macrosomia face their own share of problems. Their large size can cause a difficult childbirth, mostly increasing the chances for a Caesarian delivery, and an attempt to normal delivery may even damage the baby's shoulder while passing through the birth passage. High levels of insulin in the baby's blood may lead to very low blood glucose levels and severe respiratory distress at birth. Also, such babies are at an increased risk of obesity and have a higher risk of developing type 2 diabetes in the future as adults.
Treatment for gestational diabetes should start immediately when the mother is diagnosed with high blood sugar levels after undergoing an Oral Glucose Tolerance Test.
A good treatment regime aims at keeping the blood glucose levels at normal throughout one's pregnancy. It starts with special customised meal plans for the expecting mother as well as scheduled physical activity. The blood glucose levels need to be monitored on a daily basis as well as insulin injections need to be taken if dietary and lifestyle measures alone are not able to normalise the blood sugar level. During pregnancy, doctors prescribe insulin injections and not oral tablets because in pregnancy all oral tablets cross the placenta and can harm the baby but insulin does not cross the placental barrier and, therefore, is very safe. Abiding strictly by the prescribed treatment plan will not only ensure a healthy pregnancy and easy delivery, but will also make the baby develop normally and avoid future health problems.
Gestational diabetes usually goes away after pregnancy, but there are chances that in 2 out of 3 cases that it might return in future pregnancies too. In fact, in a small section of women it may unmask Type 1 or Type 2 diabetes! Such women may need to continue their diabetes treatment regimes even after pregnancy. As gestational diabetes and Type 2 diabetes are both linked to insulin resistance, it is very important to continue with basic dietary and lifestyle measures especially in overweight women to prevent future Type 2 diabetes after gestational diabetes. Losing a few kilos of weight, adopting healthy eating habits, exercising regularly and staying fit go a long way in preventing future diabetes.
(The writer is Senior Consultant, Action Diabetic Centre, Sri Balaji Action Medical Institute.)
Sometimes, especially around the 24th week of pregnancy, many women are diagnosed with high blood sugars- a term called gestational diabetes, even when they have had no history of diabetes. This may give rise to a lot of fear, apprehensions and anxiety. The diagnosis of gestational diabetes does not mean that the mother will remain a diabetic after delivery, although a susceptibility to develop diabetes in the future is certainly present.Why gestational diabetes develops is very interesting. We are all aware that during pregnancy, the placenta supports the baby as it grows. Placental hormones are necessary for the baby to grow to and sustain the pregnancy, but these hormones also block the action of insulin in the mother's body — a term called insulin resistance. So, although the mother's body continues to produce insulin, it is not allowed to work properly and as a result her blood glucose levels start rising. Gestational diabetes develops when the mother's blood glucose levels rise above normal, thus, causing hyperglycaemia.
Gestational diabetes occurs at a later stage in pregnancy — when the baby has already formed but is still growing. The baby may not have developmental birth defects as seen in case of babies whose mothers had uncontrolled diabetes prior to pregnancy. But, if left untreated, the baby might be harmed. Rising blood sugar levels in the mother's body sends the pancreas into overdrive to produce more insulin, causing hyperinsulinemia, but this is not able to reduce the blood glucose due to increasing insulin resistance caused by placental hormones. The insulin cannot cross the placenta but the extra glucose can easily enter the baby's circulation through the placenta along with other nutrients. As a result, the blood glucose levels of the baby also start rising, sending the developing pancreas in the baby's body into overdrive to produce extra insulin to control them. As the baby receives more glucose, i.e., more energy than it normally needs for growth, this excess energy gets stored as fat in the baby's body, thus, leading to 'macrosomia' or 'fat baby'.
Babies with macrosomia face their own share of problems. Their large size can cause a difficult childbirth, mostly increasing the chances for a Caesarian delivery, and an attempt to normal delivery may even damage the baby's shoulder while passing through the birth passage. High levels of insulin in the baby's blood may lead to very low blood glucose levels and severe respiratory distress at birth. Also, such babies are at an increased risk of obesity and have a higher risk of developing type 2 diabetes in the future as adults.
Treatment for gestational diabetes should start immediately when the mother is diagnosed with high blood sugar levels after undergoing an Oral Glucose Tolerance Test.
A good treatment regime aims at keeping the blood glucose levels at normal throughout one's pregnancy. It starts with special customised meal plans for the expecting mother as well as scheduled physical activity. The blood glucose levels need to be monitored on a daily basis as well as insulin injections need to be taken if dietary and lifestyle measures alone are not able to normalise the blood sugar level. During pregnancy, doctors prescribe insulin injections and not oral tablets because in pregnancy all oral tablets cross the placenta and can harm the baby but insulin does not cross the placental barrier and, therefore, is very safe. Abiding strictly by the prescribed treatment plan will not only ensure a healthy pregnancy and easy delivery, but will also make the baby develop normally and avoid future health problems.
Gestational diabetes usually goes away after pregnancy, but there are chances that in 2 out of 3 cases that it might return in future pregnancies too. In fact, in a small section of women it may unmask Type 1 or Type 2 diabetes! Such women may need to continue their diabetes treatment regimes even after pregnancy. As gestational diabetes and Type 2 diabetes are both linked to insulin resistance, it is very important to continue with basic dietary and lifestyle measures especially in overweight women to prevent future Type 2 diabetes after gestational diabetes. Losing a few kilos of weight, adopting healthy eating habits, exercising regularly and staying fit go a long way in preventing future diabetes.
(The writer is Senior Consultant, Action Diabetic Centre, Sri Balaji Action Medical Institute.)