Diabetes in Pregnancy

Diabetes in pregnancy (gestational diabetes) is a serious medical condition that affects many expectant mothers. These diabetes symptoms in pregnancy can be subtle, so attending regular check-ups is essential. Understanding what causes diabetes in pregnancy, such as genetics or weight, can help women take steps to reduce their risk. With proper care and management, most women with diabetes in pregnancy can have healthy pregnancies and babies. 

What is Diabetes in Pregnancy? 

Diabetes in pregnancy, or gestational diabetes, is a condition that develops during pregnancy when a woman's body cannot secrete enough insulin to meet the extra needs of carrying a baby. This results in high blood sugar levels, affecting both the mother and the unborn child. Gestational diabetes typically appears in the second or third trimester, usually between the 24th and 28th week of pregnancy. 

Gestational diabetes is a temporary disease that usually disappears after giving birth. However, women with gestational diabetes history have a higher chance of developing type 2 diabetes mellitus later in life. 

Causes and Risk Factors of Diabetes in Pregnancy 

During pregnancy, hormonal changes make it harder for the body to utilise insulin effectively, leading to insulin resistance. This resistance means more insulin is needed to keep sugar levels within the normal range. In most cases, the pancreas can increase insulin production to meet this demand. However, the pancreas can't keep up in some women, resulting in elevated blood sugar levels. 

Several factors can increase the susceptibility to developing diabetes in pregnancy. These include: 

• Being overweight or obese before pregnancy 
• Having a family history of diabetes 
• Being over 25 years old 
• Having a history of gestational diabetes in a previous pregnancy 
• Having previously given birth to a large baby (over 4.5kg or 10lb) 
• Being of South Asian, Black, African Caribbean, or Middle Eastern background 
• Having polycystic ovary syndrome (PCOS) 
• Having prediabetes (higher-than-normal blood glucose levels) 

Symptoms of Diabetes in Pregnancy

Gestational diabetes often doesn't cause noticeable symptoms. Many women are surprised to learn they have this condition, as it's typically discovered during routine screening tests. 

Common diabetes symptoms in pregnancy include: 

• Increased thirst and frequent urination 
• Feeling more tired than usual 
• Genital itching or thrush 
• Blurred eyesight 
• Nausea 

Complications 

Diabetes in pregnancy can lead to various complications for both the mother and the baby. These complications can have serious consequences if not properly managed. These include: 

• Pre-eclampsia, a condition characterised by dangerously high blood pressure 
• Polyhydramnios, a serious condition characterised by too much amniotic fluid surrounding the baby. 
• Trouble breathing at birth 
• Higher risk of developing low blood sugar (hypoglycaemia) and jaundice in newborns. 
• Macrosomia, where the foetus grows larger than average, causes difficulties during delivery, increasing the chances of needing a caesarean section or experiencing birth injuries. 
• Higher chance of developing obesity or diabetes later in the baby's life 
• Learning and behavioural issues in the baby 

Diagnosis 

Diagnosing diabetes in pregnancy typically involves blood tests to check how well your body uses glucose. 

Oral Glucose Tolerance Test (OGTT): This primary test is generally conducted between 24 and 28 weeks of pregnancy. It involves having a blood test after fasting for 8 to 10 hours and drinking a glucose solution. After resting for two hours, another blood sample is taken to see how your body handles the glucose. 

You'll usually be diagnosed with gestational diabetes if your fasting plasma glucose level is 5.6mmol/L or more or if your 2-hour plasma glucose level is 7.8mmol/L or more. 

Treatment for Diabetes in Pregnancy 

Managing diabetes in pregnancy involves a combination of lifestyle changes and medical interventions: 

• For many women, dietary changes and physical activity are enough to keep blood sugar levels in check. 
• If blood glucose levels remain high despite lifestyle changes, it's essential not to over-restrict food intake, as this can lead to undesirable weight loss. Instead, medication may be necessary to support a balanced diet and healthy pregnancy. 
• Two main medications are used to treat diabetes in pregnancy: metformin and insulin. 

When to See a Doctor 

During pregnancy, regular check-ups are essential for monitoring your condition and addressing any changes that could affect your or your baby's health. If you develop gestational diabetes, you may need more frequent appointments, especially during the last three months of pregnancy. 

Seek urgent medical advice if you experience symptoms of high blood sugar, like increased thirst, frequent urination, or a dry mouth. Don't wait for your next scheduled test. 

Prevention 

Preventing diabetes in pregnancy starts with adopting healthy habits before conception. While there are no guarantees, taking proactive steps can lower the risk of gestational diabetes. These include: 

• Balanced Diet: Focus on foods high in fibre and low in fat and calories. Include plenty of fruits, vegetables, lean protein, dairy products, and whole grains in your meals. It's essential to watch portion sizes and limit the intake of processed, fried foods and sugary snacks. 
• Regular Physical Activity: Do at least 30 minutes of moderate-intensity exercise 5 to 6 days a week. Activities like brisk walking, swimming, or prenatal yoga can improve insulin sensitivity and control weight. 
• Maintaining a Healthy Weight: If you're planning to conceive, losing extra weight beforehand can lead to a healthier pregnancy. Work with your doctor to customise a healthy weight gain plan during pregnancy. 
• Staying Well-hydrated: A proper hydration level can help stabilise blood sugar levels. 
• Stress-reducing Activities: Deep breathing activities or meditation can contribute to overall well-being. 

Conclusion 

Diabetes in pregnancy poses challenges, but with proper care and management, most women can have healthy pregnancies and babies. Early detection, regular check-ups, and following medical advice are key to keeping blood glucose levels in check. Regular physical activity, a balanced diet, and sometimes medicines significantly manage this condition. Being aware of the signs of diabetes in pregnancy and knowing your risk factors can help you take action early. 

FAQs 

1. How can I control my diabetes during pregnancy? 

Controlling diabetes in pregnancy involves maintaining blood sugar levels within a safe range. This can be achieved through a combination of diet, exercise, and medication if necessary. It's crucial to regularly monitor your blood sugar levels, as your doctor recommends. Aim for a balanced diet with controlled portions of carbohydrates, and stay physically active. Regular exercise or walking after meals can help lower blood sugar levels. If diet and exercise alone aren't enough, your doctor may prescribe insulin or other medicines to help manage your blood sugar. 

2. What happens if you have diabetes while pregnant? 

Having diabetes during pregnancy can lead to various complications if not properly managed. It may increase the risk of having a large baby (macrosomia), which can make delivery more difficult. There's also a higher chance of needing a caesarean section or having your labour induced. Diabetes in pregnancy can also increase the risk of miscarriage and stillbirth. Additionally, your baby may be at risk of developing low blood sugar (hypoglycaemia) shortly after birth. However, with proper management and care, most women with diabetes have healthy pregnancies and babies. 

3. What is the normal sugar level in pregnancy? 

For women with diabetes in pregnancy, the target blood sugar levels are typically: 

• Fasting (before eating): below 5.3 mmol/L 
• One hour after meals: below 7.8 mmol/L 
• Two hours after meals: below 6.4 mmol/L 

4. Can diabetes affect having a baby? 

Yes, diabetes can affect having a baby, but with proper management, most women with diabetes have healthy pregnancies and babies. Diabetes in pregnancy may increase the risk of certain complications, such as having a large baby or experiencing preterm labour. It can also affect the baby's health, potentially leading to low blood sugar after birth or an increased risk of obesity and type 2 diabetes later in life. However, you can significantly lower these risks by maintaining good blood glucose control before and during pregnancy.

Dr. Neha V Bhargava

MS, DNB (obgyn), MNAMS, Fellow (Gynae Oncology)
Ganga CARE Hospital Limited, Nagpur

To Book an Appointment, call:

+91 406 810 6585