Tackling diabetes in pregnant women

Some women can develop diabetes during pregnancy, which usually resolves itself after delivery. This type of diabetes — diagnosed for the first time during pregnancy —is called gestational diabetes.  Pregnant women have to undergo what is called a Glucose Tolerance Test (GTT), a blood test done after overnight fasting of  six to eight hours. 

They will be given a glucose drink and administered a blood test at one- to two-hour intervals. If the results are abnormal, it points to the onset of gestational diabetes. The incidence of gestational diabetes is on the rise. 

At present 10-17 per cent of pregnant women are developing diabetes during pregnancy. The chances of this are more if the woman is obese, or if she had gestational diabetes in her previous pregnancy, or a big baby earlier, or if there is a family history — mother, father or siblings — of diabetes. 

This can be prevented to a great extent if a woman has a healthy lifestyle.  Exercising regularly and maintaining her body weight before and during pregnancy will minimise the risks of having diabetes in pregnancy. If blood sugar control is good throughout pregnancy, the mother can have a healthy pregnancy and healthy baby. If blood sugar control is not good there can be problems. 

The baby can grow big. The water around the baby can become too much. The chance of premature delivery increases. There is also a greater risk of the baby having breathing problems and low sugar after delivery. These problems result in prolonging the baby’s stay in the hospital. Babies born to women with gestational diabetes can have obesity problems. 

The chances of the child developing diabetes later in life are also greater. These problems are greatly reduced if the pregnant mother has good control of blood sugar during her pregnancy. An expectant mother with gestational diabetes can have difficulty during delivery due to the baby’s large size. The chances of her having a Caesarean section are also higher. There is also a greater likelihood of her developing diabetes in her next pregnancy and later in life. 

Gestational diabetes can be managed by diet and exercise alone. If blood sugar control is not adequate then it will be treated by insulin or tablets or both. What women need to feel reassured about is that normal delivery is possible in such cases, if they have good blood sugar control and if the baby is not big. If the blood sugar control is good, she will be allowed to wait till her expected due date for spontaneous onset of labour. 

If blood sugar control is below ideal, she might need to go in for induction of labour a week or two before the due date. Most cases of gestational diabetes disappear after delivery. The mother will need to take the GTT a few weeks to three months after delivery. If it is normal, she will be advised to check her blood sugar every year. She will be advised a healthy lifestyle (diet and exercise) to reduce her chance of having diabetes later in life. 

At least 30-60 per cent of women develop gestational diabetes in their subsequent pregnancies. If women want to modify their risk of contracting gestational diabetes, they should eat healthy, exercise regularly and maintain a non-obese weight between pregnancies.