DIABETES IN PREGNANCY - GESTATIONAL DIABETES

Diabetes in pregnancy can be a temporary disorder which needs special attention throughout the pregnancy. As diabetes in pregnancy does increase certain risks to you and the baby, you will be treated by a special management team includes the Neonatologist, Obstetrician, Nurse, Dietitian, Pharmacist and Physician.
Gestational diabetes usually develops after the 25th week of pregnancy but can occur earlier. It results from the effects of hormones produced by the placenta during pregnancy. These hormones can alter the way in which insulin works. Usually, gestational diabetes subsides after delivery. But a woman who has diabetes during pregnancy is more likely to develop diabetes again later in life or during subsequent pregnancies.

Some women are at high risk for developing this condition. The risk factors include:
* Age more than 30 years
* Obesity
* Family history of diabetes
* History of delivering a very big baby (weighing more than 4 kg at birth)
* History of delivering a dead infant or abnormal infant, miscarriages

Some of the health risks are:
* High blood pressure during pregnancy
* Hydramnios ( too much amniotic fluid in the sac surrounding the fetus)
* Infection of the bladder
* Macrosomia (very large baby)
* Birth defects
* Respiratory distress syndrome (RDS)
* Stillbirth ( a baby born with no signs of life)
In view of the health risks involved, it is very important to follow up with your obstetrician continuously throughout your pregnancy.

During Pregnancy
* Very high or very low blood glucose levels may marginally increase the risk of birth defects. So, it is important that you carefully monitor and control your blood glucose.
* You may need to do home monitoring of your blood glucose using a glucometer.
* Your blood glucose can be controlled by diet or insulin. The main goal is to return the blood sugar level to normal and maintain it. For some women, diet alone is not enough to achieve normal blood glucose levels. So, insulin injections are needed.

After Pregnancy
* After birth, your baby may need to be closely monitored in a special nursery and be treated for some conditions such as: Low blood sugar, Low calcium and magnesium levels, Too many red blood cells and Jaundice.
* These conditions are easily treated and are usually not life-threatening.
* Your diabetes will probably disappear after your baby is born, but it is important to do a glucose tolerance test 6 weeks after delivery to confirm that. However, you will have an increased risk of developing Type 2 diabetes later in life.
* To minimise this risk, you should achieve and maintain a suitable body weight, Exercise regularly, See your doctor annually to have your blood sugar checked.

* This is the most important form of treatment. Important aspects of your diet will include:
* Controlling carbohydrate intake
* Reducing fat intake
* Increasing fibre intake

Hypoglycaemia occurs when the blood glucose level is below the normal range and can be harmful or dangerous to you and your baby.
In the early weeks of your pregnancy, you may have more frequent hypos than normal. Also the usual warning symptoms may be different or even absent, and the development of the hypo may be much more rapid than usual.
Be Alert ! Treat Early !
If you think you are 'hypo'
* Check your blood glucose level if a glucometer is available
* Consume some form of glucose such sweets, fruit juice, soft drinks, sugar/honey/syrup.
* Recheck blood glucose after 15 minutes. If unable to check & still having symptoms of hypo
- take another portion of glucose
- if blood glucose is still low or if not feeling better, see doctor
If hypo occurs just before the next meal/ snack, take the meal/snack immediately, otherwise take 1 additional snack to avoid recurrence of hypo.
* Follow your diet plan carefully:
- Do not miss or delay a meal
- Be sure to include all the recommended servings of carbohydrate in your diet
- Eat 1 extra snack if exercising for more than 1 hour.

The signs of hypoglycaemia (low blood sugar) are: Tiredness, Weakness, Nervousness, Trembling or Shaking, Hunger, Rapid Heart Beat, Sweating, Dizziness/Headache, Blurred Vision, Change in Behaviour and Unconsciousness.
You may sometimes not fell some or all of these symptoms.

Breastfeeding
A history of gestational diabetes does not affect your ability to breastfeed. We encourage you to breastfeed because of the nutritional advantages to your baby.
It is usual to experience an increase in appetite whil breastfeeding. An extra 500 calories is usually required to support milk production. Strict weight reduction diets are not recommended during breastfeeding. You should wait till you have stopped breastfeeding, or until your baby has been fully weaned onto solids (usually by 6 months of age) before attempting to lose weight.

A Final Note
It is important that you see a qualified dietitian as soon as you are diagnosed with gestational diabetes, to plan your diet and follow your progress throughout your pregnancy.