By: Dr. Syeda Arzinda Fatima

Gestational Diabetes

It is the type of diabetes that is diagnosed for the first time during pregnancy. It starts usually after 24 weeks of pregnancy. And in most cases it disappears after child birth. In some women it may continue to stay after delivery. These women go on to develop diabetes type 2. There is 30-50% chance of getting type 2 diabetes later in life if you have had gestational diabetes. It is highly likely that you will have gestational diabetes in the next pregnancy as well if you had it once. Gestational diabetes is diagnosed in 18% of all pregnancies .

What is the underlying problem: During pregnancy, placenta produces certain hormones that can block the action of mother’s insulin. This leads to a buildup of blood glucose (hyperglycemia). It is a type of insulin resistance. After delivery, placenta is gone and insulin starts working properly again.

Effect of gestational diabetes on the baby: Gestational diabetes does not cause any birth defects. But excess glucose from mother’s lood passes to the baby through the placenta, it leads to over size baby ( macrosomia…large size baby). Large size of baby can cause difficulty in delivery, obstructed labour or shoulder injuries. After birth baby may have very low blood glucose as a reaction. These babies tend to be obese when they grow up and have higher chances of developing type 2 diabetes in adult life.

How to diagnose: As a rule all pregnant women should have their blood glucose level checked at start of pregnancy and at 20-24 weeks. If a women has high blood glucose at start of pregnancy then she may be having type 1 or 2 diabetes previously un diagnosed. If initial blood glucose is normal and she gets high blood glucose after 20 weeks of pregnancy then she is labeled as having gestational diabetes. Urine glucose test is not very reliable in pregnancy as there maybe traces of glucose in urine in non-diabetic women as well.

How to manage gestational diabetes: Start treatment as early as possible to prevent complications in the baby. The target blood glucose level is: Fasting upto95mg/dl 2 hour post-prandial upto 120mg/dl This can be achieved by following simple steps:

  1. Diet restriction: follow a healthy balanced meal plan, with frequent small snacks. Eat plenty of fruits and vegetables, limit fat intake to 30% of total daily calories
  2. Watch your weight: avoid excessive weight gain during pregnancy by following a diet plan and exercise routine. Average weight gain during pregnancy should be 15 pounds.
  3. Exercise: follow a simple exercise program, remain active. Walk and aerobic exercises are best. Avoid the exercises that cause pressure on the belly.
  4. Regular blood glucose check: During pregnancy you may have to check your blood sugar 4-6 times a day and maintain a record. Before and after meals and after exercise because we want a strict control during pregnancy
  5. Medication: gestational dibetes is mostly managed by diet and exercise. In some cases medication may be required. Doctor will prescribe sort acting insulin for you.
  6. Regular medical checkup: initial monthly checkup and then twice weekly or weekly checkup to monitor your blood glucose and growth of your baby to avoid any serious complications
  7. Stress reduction: stress can raise blood glucose level, so try to relax and stay calm at all times.

Even after delivery, patient should have yearly checkup to detect development of type 2 diabetes in future.