Diabetic and expecting

Gestational diabetes is diabetes that affects women only during pregnancy. According to recent studies, one out of seven pregnant women have diabetes in urban India. The Diabetes In Pregnancy Study Group, India (DIPSI), recommends diabetic screening for all pregnant women.

What causes it?
During digestion, the body breaks down carbohydrates from food like bread, chapatis , fruits and dairy products and turns them into various kinds of sugar, one of them being glucose, which is the main source of energy for the body. Glucose is directly absorbed into the bloodwith the help of insulin, a hormone produced by the pancreas.

Insulin's job is to unlock the cells to allow glucose in, and maintain a normal blood sugar level. During pregnancy, some hormones are produced by the placenta in the mother's body to help sustain the pregnancy. However, these hormones make cells resistant to insulin, resulting in a rise in blood sugar levels.

Normally, the pancreas respond by producing enough insulin to overcome this resistance. But sometimes the pancreas can't keep up.

When this happens, blood sugar rises and causes gestational diabetes. It usually occurs in the second and third trimesters of pregnancy, when there is an increase in placental hormones. A Glucose Challenge Test for gestational diabetes is therefore amust for all pregnantwomenand is usually recommended between 24 and 28 weeks of pregnancy.

Risk factors
Age: Women older than 30 years
Family history: Aclose familymember, say, a parent or sibling who has Type 2 diabetes.

Personal history:
One who has pre-diabetes or a precursor to Type 2 diabetes; one who has had gestational diabetes in a previous pregnancy; a previous pregnancywith a big baby (9 lbs or more); a previous stillbirth or early death of a child soon after birth. Weight: Increased risk if one is overweight before pregnancy.

Race:
Asians,Blacks,Hispanics and AmericanIndianshave a higher risk of gestational diabetes.

What it does to the baby
Excess growth:
Extra glucose can trigger the baby's pancreas to make extra insulin. This causes the babyto growtoo large. Very large babies are more likely to becomewedged in the birthcanal, sustain birth injuries or require a C-section delivery.

Low blood sugar: Babies develop hypoglycaemia because their own insulinproduction is large.Frequent feeds and sometimes intravenous glucose is required.

Respiratory distress syndrome: Difficulty in breathing, commondue to prematurity.

Physiological jaundice: Diabetes in later life: The babies have a higher riskof developing obesity and Type 2 diabetes.

Stillbirth: If gestational diabetes is untreated it results in stillbirth or early death of the baby.

Congenital malformations: Mothers with untreated diabetes are more likely to have babies with birth defects of the heart, limbs and spine.

Managing gestational diabetes
Controlling blood sugar is the cornerstone of treatment.
A team comprising an obstetrician, diabetic physician, diabetic educator, dietician, midwife and paediatrician should together provide good diabetic management to the ailing mother.
Blood sugar monitoring by laboratory test or glucometer.

Eating the right food: Exercise lowers blood sugar levels by transporting sugar to cells where it is used for energy.
Exercise also increases sensitivity toinsulin, sothe body needs less insulin to transport sugar to cells.
Walking, cycling and swimming are good exercises during pregnancy.

So are household activities, climbing stairs and gardening. Anti-diabetic insulin injections. Oral anti-diabetic tablets aremostly contraindicated as their safety for the baby has not yet been established.

Prevention
Eat healthy food: Choose foods low in fat and calories. Focus on fruits, vegetables andwhole grain.
Get more physical exercise: Aim for 30 minutes of physical activity a day.
Take a break from work, ride a bike, swima lap. If you can't tmanage a long workout, break it into smaller sessions spread through the day.

Lose extraweight:
Weight loss during pregnancy is not usually recommended, but if you're planning a pregnancy, losing weight will help prevent gestational diabetes.
Most women who have had gestational diabetes will develop Type 2 diabetes later in life, as pregnancy unmasks a latent diabetic.

That makes exercise and good nutrition powerful tools for a healthy pregnancy aswell as a healthy life.

(Dr Kiran Coelho heads the Department of Gynaecology at the Lilavati Hospital and Research Centre).