PREGNANCY DAYS For most pregnant women, carrying a baby to term is largely a mysterious process. This section helps new parents answer some of the most important questions about pregnancy and childbirth.

Gestational Diabetes in Pregnancy

• what is gestational diabetes?
• How is it diagnosed?
• How will affect me and my pregnancy
• Will it affect my baby?
• Who is at more risk of developing gestational diabetes?
• How can it be treated?
• Role of exercise in diabetes
• What if I am already a diabetic?
• Will I continue to have diabetes after delivery also?
• What should be my nutrition?

What is gestational diabetes?

Gestational diabetes is a condition that develops during pregnancy in 2-3 % of  all pregnancies. 90% of these is gestational and it is a condition in which  mother has an abnormally large amount of sugar in her blood. It usually resolves itself after the baby is born - unlike other types of diabetes which are lifelong conditions.

In pregnancy, because of increased insulin resistance in the body, to maintain the blood sugar, more insulin is released than a normal non pregnant female. If the body cannot meet up with this increased amount of insulin, the blood levels of sugar is high and this is the condition termed as gestational diabetes. Your blood sugar levels may also rise because the hormonal changes of pregnancy interfere with insulin function.

This high sugar crosses the placenta but not the insulin.  fat produces its own insulin and the high levels of sugar in the fetus induce more insulin and the child born becomes large in size.

HOW IS IT DIAGNOSED?

It can be diagnosed accidentally in the prenatal check up.

It can be picked up by GLUCOSE TOERANCE TESTS if it done based on symptoms like POLYPHAGIA, POLYURIA, DECEASING WEIGHT, POLYDIPSIA (increased thirst).

Random blood sugars anytime more than 200mg% indicates development of diabetes.

BASED ON THE SUGAR LEVELS AND SEVERITY GESTATIONAL DIABETES HAS BEEN CLASSIFIED INTO GROUPS.

How will having diabetes affect me and my pregnancy?

Complications would depend on the level of control that has been maintained.

• PREECLAMPSIA 
• PRETERM DELIVERY
• SPONTANEOUS ABORTIONS AND STILL BIRTHS
• Polyhydramnios (increased amniotic fluid levels)

How will having diabetes affect my baby?

• CONGENITAL MALFORMATIONS: cardiovascular and central nervous system anomalies are up to 8 times greater. Caudal regression syndrome, though rare is seen exclusively in diabetic pregnancies. Also intestinal malformations are known in this condition.
• PERINATAL ASPHYXIA; this is because of two reasons. Fetal depression and also large for weight babies.
• METABOLIC DISORDERS AFTER BIRTH  LIKE hypoglycemia, hypocalcemia and hypomagnesemia
• HYPERBILIRUBENEMIA
• RESPIRATORY DISTRESS SYNDROME

Who is at risk of developing gestational diabetes?

Women who have had gestational diabetes in a previous pregnancy, or who have previously given birth to one or more large babies are at risk of gestational diabetes. Other women who are at greater risk of developing the condition include:

• Obese women (BMI greater than 30)
• Older mothers (everyone's tendency to develop diabetes increases with age)
• Women with a parent or sibling who is an insulin-dependent diabetic

How is gestational diabetes treated?

• Treatment of diabetic mothers is focused on diet and this counseling is very important. A diet chart also can be given to the mother keeping in mind her caloric requirements, food cravings and gastric problems like acidity, gaseousness and morning sickness if any.
• If diet alone does not control then INSULIN can be added in the treatment regime.
• ORAL HYPOGLYCEMICS ARE NOT INDICATED IN PREGNANCY.

FETAL SURVEILLANCE THROUGHOUT THE PREGNANCY IS ALSO A MUST IN THE TREATMENT PROGRAMME.

CAN EXERCISE HELP?

EXERCISE IS IMPORTANT IN THE TREATMENT OF DIABETICS, NOT ONLY IN PREGNANCY BUT OTHERWISE ALSO.

Exercise increases receptors for insulin and may help decrease the insulin resistance.

What can I do if I am already diabetic?

If you have diabetes and are planning to become pregnant, try to make sure that your blood sugar levels are well under control before you conceive.

High blood sugar in the first three months of pregnancy increases the risk of your baby not developing properly.

Your pregnancy will probably be considered high-risk, but that doesn't necessarily mean that you will have problems.

If the sugars remain uncontrolled, certain conditions may get aggravated in pregnancy. These are -

• Retinopathy (changes in the eye). A consulting by the ophthalmologist should be done in this condition
• Nephropathy
• Neuropathy
• Cardiovascular disease
• Ketoacidosis
• Hypoglycemia

Will I continue to have diabetes after my baby is born?

No, Gestational diabetes gets treated on its own a few months after the delivery. But it has been shown that these mothers are also more prone to develop diabetes later in life. It wouldn’t be a bad idea to monitor your blood levels regularly after that.

WHAT SHOULD I EAT DURING GESTATIONAL DIABETES?

In gestational diabetes, the sugars in the blood are high because of which the diet has to be altered.

• The first step would be to minimize eating sugars in any form. sugar. Honey, syrups, jams, sweets top the list. Even food items bought from outside contains lactose, sucrose etc are with sugar. ice-creams, cakes, cookies etc are a no-no too.
• Even fruit juices with no sugar added can increase the blood sugar, but eating fresh fruit is not so harmful because it has additional fibre which slows down the sugar absorption.
• Also avoid too much of refined starches like white rice, bread, potatoes etc because these raise the blood sugars quickly. Rather take complex carbohydrates which decrease the insulin needs and release the sugars very slowly in the blood. These are whole grains, beans, vegetables, spinach, carrots, chicken. Some of them also have the metal CHROMIUM which again improves the glucose tolerance.
• Also keep the fat intake in control because it decreases the insulin efficiency
• Try to keep the weight under control and also eat frequent well balanced meals.