All You Needed To Know About Diabetes And Pregnancy

Gestational diabetes (Diabetes during Pregnancy) usually manifests in second trimester of pregnancy and disappears after delivery. It may reoccur again in the subsequent pregnancies and they may become diabetic as age advances
says, Dr. V. Madhini, Consultant Obstetrician and Gynaecologist

World Health Organisation (WHO) indicates that the prevalence of diabetes has reached epidemic proportions and will continue to increase at a rapid rate. In 1995 an estimated 135 million people had diabetes. By 2025, the number is expected to rise to about 300 million. Changes in food consumption, decreased physical activity and increasing obesity have been implicated as the causes for this rapid rise in the incidence of diabetes.

Diabetes may be detected of during pregnancy or a known diabetic patient may become pregnant. In pregnancy there is decreased sensitivity to insulin with increasing gestation. This is due to the production of certain hormones (chemical substances) by the placenta like cortisol, human placental lactogen, oestrogen, progesterone, etc, which antagonize the action of insulin. So more insulin should be produced by the mother. Usually they have adequate reserve of pancreatic beta cell (Beta cell produces insulin). Defects in this function will make the pregnant woman a diabetic.

In a diabetic pregnant woman, urinary and vaginal infection is more common. They may develop hypertension and polyhydramnios (excess of water surrounding the fetus). Operative deliveries like caesarean sections, vacuum extraction and forceps are more common.
The baby might die in- utero suddenly or may result in a sudden neonatal death. The baby may be large, may have congenital abnormalities, result in respiratory problems immediately after birth. If the woman has been detected and treated properly most of these problems can be averted.
There are some women who are prone to develop diabetes and hence they should undergo tests to detect the same.
1.Family history of diabetes mellitus.
2.Pregnant woman who is 35 years or more.
3.Obesity.
4.Previous history of delivering babies more than 4 kg at birth.
5.Repeated pregnancy losses.
6.Unexplained stillbirth or early neonatal death.

Women who are already diabetic and contemplating pregnancy should go for preconception check up and the blood sugar levels should be maintained appropriately so that congenial abnormalities of the fetus and fetal macrosomia (large fetus) can be prevented. The diabetic patient should take proper diet, adequate exercise and should take insulin injections according to blood sugar levels.

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Do’s and Don’ts:

Do’s:

1.Preconeptional counselling.
2.Keep food ready before insulin injection.
3.Take small frequent food.
4.Go for regular antenatal check up as advised.
5.Book for delivery in a hospital where facilities are available for caesarean section.
6.Breastfeed the baby if needed.
7.Follow up after delivery.

Don’ts :

1.Don’t overeat.
2.Don’t starve.
3.Don’t take oral anti diabetic drugs in pregnancy.
4.Don’t neglect infections.
5.Don’t neglect vomiting and diarrhoea.
6.Don’t go by urine sugar tests (they are not reliable during pregnancy).
7. Do not postpone pregnancy if you are already a diabetic.

Screening for ( Gestational Diabetes Mellitus) GDM- Why?

Women with GDM are seldom symptomatic and hence all pregnant women have to be screened carefully for diabetes particularly in Indians considering the high prevalence of diabetes and the younger age at onset of non-insulin dependent diabetes mellitus in our country.

How to screen?

The lowering of the renal threshold during pregnancy, limits the usefulness of urine testing and hence blood tests. Initially, a spot glucose test can be done using 50 grams of oral glucose load administered irrespective of the time of the meal. If the venous plasma glucose after one hour exceeds 140 mgs%, this should be followed by a glucose tolerance test (GTT).
The O Sullivan and Mahan criteria still remains the most popular criteria for diagnosing GDM although the WHO criteria are also widely used.

What to screen?

Twenty to twenty four weeks would be the optimal time to scan for GDM. High risk women should obviously be scanned earlier.