Diabetes in Pregnancy
Diabetes can be either pre-existing or develop de novo during pregnancy. This article will describe all the feature of the diabetes developing de novo in pregnancy.
Approximately seven women in hundred develop diabetes during pregnancy. Having a family history of gestational diabetes (Diabetes in pregnancy) in your mother or sister increases your chances of developing diabetes in pregnancy. Other conditions which are a high risk for developing diabetes in pregnancy are obesity, history of previous child birth with child weighing more than 4.5 kgs, obese women and women suffering from poly cystic ovary disease.
Causes of Diabetes in pregnancy
Causes of diabetes in pregnancy are poorly understood and this is an active area of research. However it will suffice to know that during pregnancy due to the action of many hormones, your body’s ability to use glucose decreases. This is called as insulin resistance. Your body now has to produce more insulin to keep your blood sugar under control. Diabetes develops when your body is unable to produce more insulin.
Maternal Effects
Diabetes in pregnancy does not cause any immediate harm to your body, but it does affect your pregnancy and labour. Women with diabetes in pregnancy have a higher chance of difficult labour. They also have a higher chance of infections, premature labour, excess amniotic fluid and pre-eclampsia(High B.P with proeinuria).
Foetal Effects
Diabetes in pregnancy causes a plethora of foetal effects. Due to the excess blood sugar in mother, the baby produces excess of insulin. This insulin causes deposition of fat and makes your baby big. Big babies can cause problems in labour. One common complication is shoulder dystocia. This happens when the baby’s shoulder gets jammed at the pelvic inlet. It is then very difficult to deliver the baby in these circumstances. Shoulder dystocia can cause serious problems to the baby in form of nerve injuries to shoulder plexus, or fracture of arm or shoulder.
Diabetes in Pregnancy also leads to a increase in birth defects. Common birth defects are cardiac abnormalities and respiratory distress syndrome.
Babies born to diabetic mothers are also very prone to develop low blood sugar. Hence they should be breast fed within 30 minutes of birth. You must also ensure to feed them at regular intervals.
Diabetes in Pregnancy also increases the chances of still birth and abortions.
Symptoms of Diabetes in Pregnancy
Like Diabetes at any other time, diabetes in pregnancy does not cause any symptoms. In some cases it may cause excessive thirst and urination. However this is also seen in normal pregnancy.
Diagnosis of Diabetes in Pregnancy
Diabetes in Pregnancy is diagnosed by blood tests. Your doctor will prescribe a glucose tolerance test to diagnose diabetes in pregnancy.
Glucose tolerance test consists of multiple samples of blood analysed for blood sugar at various time after a oral glucose load. You will be asked to come empty stomach after an overnight fast. A fasting blood sample will be taken and you will be asked to drink 75grams of glucose mixed with lemon water or something like that.
Thereafter serial paired blood and urine samples are drawn every 30 min till two hours. Then all the samples are assayed for sugar and a graph is plotted with all the sugar values.
If your values lie above a particular point in the graph, then you are suffering from Diabetes in Pregnancy.
Treatment of Diabetes in Pregnancy
Diabetes in Pregnancy hardly ever requires drugs and it can easily be controlled with simple measure like diet and exercises.
Diet plays a important role in control of diabetes. Diabetic mothers should consume complex carbohydrates like whole wheat bread, brown rice, beans, potatoes etc. These have a low glycemic index and hence are absorbed slowly.
Diabetic women who are pregnant should also consume lean proteins like fish and eggs. You should also include at least five portions of vegetables and fruits in your daily diet. Also ensure that your diet is fresh, healthy and wholesome.
Exercise is a very good way to keep your diabetes in control. Exercise will also enhance your general physical fitness and you will have a uncomplicated delivery. You must aim to exercise at least 30 min every day. This may consist of brisk walking, light aerobics or yoga.
Diabetes in pregnancy will require use of insulin if your blood sugar is not controlled by these measures. Oral tablets cannot be used for treatment of diabetes in Pregnancy because they cross the placenta and cause harmful effects on the baby. But it is unlikely that you will ever require insulin.
Prognosis
Most women regain their normal glucose homeostasis after delivery. However in up to 20% of patients with diabetes in pregnancy, average blood sugars may remain high and they should be evaluated and treated for diabetes. The bottom line is, given the appropriate care Diabetes in Pregnancy can easily be vanquished.