Everything you need to know about diabetes during pregnancy

Increased awareness and lifestyle modification to beat diabetes have in recent times taken centre-stage, with many people adhering to dietary advice and physical activity to prevent the disease. However, women are still at risk of the disease, especially during pregnancy. Here are questions I often get asked by patients in my clinic relating to pregnancy-induced diabetes.

What is diabetes?
Diabetes is a medical condition where the body has abnormally high levels of blood sugar.
 
Can pregnant women get diabetes?
Diabetes can occur during pregnancy in two forms: Pre-existing/pre-gestational diabetes – This is diabetes that was present before the pregnancy. Sometimes the woman might have been aware that she had diabetes before getting pregnant, but at other times the pre-existing disease is detected in the early part of pregnancy for the first time.
Gestational diabetes –It develops during pregnancy. It is usually detected in the second half of pregnancy. It is caused by hormones produced by the placenta and the feotus over time – it happens when the hormones from the placenta block one’s ability to use or make insulin.

Who is at risk of getting gestational diabetes?

Any woman can develop gestational diabetes because there are times when it happens and the patient does not have any of the known risk factors for the disease. But these scenarios put one at a higher risk: Age (over 40 years), obesity (BMI over 30), high blood pressure, history of diabetes among your parents or siblings, previous gestational diabetes, previous unexplained stillbirth, previous birth to a baby who weighed over 4kg and polycystic ovarian syndrome.

How common is gestational diabetes?

It occurs in about two out of 10 people women although this varies in different parts of the world.

How can I know I have diabetes during pregnancy?

Most times you may not know when you have it until a test is done. This makes it quite dangerous as one may think they are in good health and their baby is safe when in fact the high sugar level is causing or has already caused harm.  We therefore encourage all pregnant women, regardless of their risk profile, to get tested for the disease. This test is called OGTT (oral glucose tolerance test) and is usually done at around 24-28 weeks (six-seven months). 

What will happen if I have gestational diabetes and it is not detected or treated?

Gestational diabetes can cause complications as grave as the loss of your baby.

The other complications include high blood pressure problems such as preeclampsia; excessive amniotic fluid; a large baby (over 4,500 grammes) that can make delivery difficult, increased chances of having a cesarean section or instrumental delivery, difficult birth because of shoulder dystocia (baby’s shoulders get stuck during delivery) and birth asphyxia; preterm birth; stillbirth; breathing difficulties in the baby; low blood sugar for the newborn; jaundice and increased chances of baby getting admitted in neonatal ICU.  There are also some long-term consequences such as a high risk of developing type 2 diabetes in the future, recurrence of gestational diabetes in future pregnancies, high blood pressure and having a baby who will get diabetes.

Is there treatment for gestational diabetes?

Once a diagnosis has been made, the doctor will discuss with you the way forward. The main goal of treatment is to keep the sugar controlled and to avoid complications. 

First, education of what gestational diabetes is, possible consequences, treatment options available, monitoring of sugars and a follow-up plan is done. A dietician will also discuss dietary adjustments that you will need to make, help you develop a meal plan and an exercise regimen. More often than not (in about eight out of 10 people), lifestyle adjustments (diet and exercise) will be enough to control the sugars. You will also be given a book to diarise the daily sugar checks so that treatment can be adjusted appropriately.

In situations where sugar is not well controlled by lifestyle adjustments, you may be given some pills or insulin injections if the sugar level is very high.

Being diagnosed with gestational diabetes means that your care and follow-up for your pregnancy will be different from the usual antenatal care. In this case you will be required to do more tests such as ultrasound to make sure your baby is safe. You will also need more frequent visits to hospital to make sure that your sugar control is satisfactory and monitor complications that can occur such as high blood pressure. 

If I had gestational diabetes, does it mean that I’ll be diabetic even after giving birth?

Gestational diabetes usually resolves after the baby is born and the placenta is out. Your sugar may be monitored briefly after birth but you are unlikely to require any further treatment. 

However, you will be advised to check your sugar after six weeks (by doing OGTT or a fasting blood sugar) to make sure all is well. Gestational diabetes also puts you at a high risk of developing type 2 diabetes in the future (about two out of three people) and recurrence of gestational diabetes in future pregnancies. It is therefore crucial that you keep checking your sugars about once in 1-2 years.

Is there anything I can do to prevent diabetes in future pregnancies?

Before getting pregnant again, you are advised to see a health professional for pre-conception care to ensure that you are in good health and help avoid complications in your next pregnancy. 

If you are overweight or obese, you are encouraged to lose weight before conceiving. Your blood pressure and sugars will also be checked. In case you develop diabetes, the sugar has to be strictly controlled before you conceive to help prevent miscarriages and abnormalities in the baby (both sometimes caused by uncontrolled diabetes). This may mean that at times you will be put on an effective family planning method until the sugar is well controlled and it is safe for you to get pregnant.

Consultant Obstetrician Gynaecologist at Aga Khan University Hospital, Nairobi