Healthy before, diabetic when pregnant

Gestational diabetes affects one in every seven expectant women. With rising obesity rates among women, the risk is even higher. How can we combat this pregnancy complication? P4&5

When Faith Thuo discovered she was pregnant for a second time, the first three months were an emotional whirlwind. She had suffered a miscarriage the first time, and the joy of a new pregnancy was clouded with anxiety and fear.

As her pregnancy progressed, things took a worrying turn at six months when she developed a persistent headache that wouldn’t go away. “It was a throbbing headache,” she stresses.

Faith’s persistent headache prompted her to see a gynaecologist. The doctor prescribed medication but advised her to seek urgent medical care if the headache persisted. Days later,  the pain was unrelenting, waking her up and sending her back to bed.

“I didn’t wait for someone to tell me. I took myself to the hospital and was immediately admitted. I recall the doctors conducting many tests and them realising that my sugar levels were high,” she offers.

Test after test revealed that she was suffering from gestational diabetes. This is a medical pregnancy condition that affects one in seven pregnancies worldwide.

“Did you ever have a sugar problem before your pregnancy, the doctors asked me.  I told them a quick no amid a growing fear of what that meant for me and the baby growing in my womb.  They told me that I needed to start treatment for gestational diabetes immediately. The doctors acknowledged that it should have been detected earlier in my pregnancy. 

The journey became even more challenging, and due to complications, I had to deliver my baby prematurely,” she offers. Due to her condition, Faith's baby was born at 37  weeks weighing 3.9 kg. Macrosomia, or having a baby that’s significantly larger than average for their gestational age is often associated with gestational diabetes.

According to experts,  the condition predisposes expecting mothers to high blood sugar levels which can cross the placenta and enter the baby’s bloodstream. To regulate their blood sugar,  the foetus’ pancreas produces more insulin.

The extra insulin can stimulate the baby’s growth, leading to excessive weight gain and a larger-than-average birth size. “After delivery, my baby would cry uncontrollably every time I tried to breastfeed him. I didn’t know that my breasts were not producing enough milk. Although the doctors were closely monitoring his blood sugar levels, the fact that he was not feeding properly caused his sugar levels to plummet. The medical team had to intervene, supplementing his feeds with formula twice daily,” she says.

The condition persisted with subsequent pregnancies. Faith reveals that during her second pregnancy, she once again developed gestational diabetes.  “ Having experienced it with my firstborn,  I knew how to go about it so I managed the condition right from the start,” she explains.

“Even so,  I had to deliver the baby through caesarean section because my baby weighed four kilos,” says the mother of two. Although blood sugar levels often stabilise after delivery, Faith experienced ongoing challenges and continued managing the condition after her second child.

Dr John Ong’ech, Chief Medical Specialist in Gynaecology and Obstetrics at Nairobi Reproductive Health Services, explains that gestational diabetes develops specifically during pregnancy, often referred to as a pregnancy-induced condition.

“This type of diabetes differs from the rest (type 1 and type 2) diabetes because with pregnancy-induced diabetes after one delivers pregnancy, the body returns to normal.” Dr Ong’ech explains that a family history of the condition is a primary risk factor.

“Also, if you're obese, if you have had gestational diabetes in the previous pregnancy  then the mother stands a high chance of developing pregnancy-induced diabetes.”

In Kenya,  data from the Ministry of Health show that about four per cent of pregnant women develop gestational diabetes compared to the global rate of 14 per cent, according to the World Health Organization.

Dr Ong’ech believes that the numbers may be underreported, estimating that at least one in every 10 women has experienced gestational diabetes. This,  he says,  it is based on the number of patients he has diagnosed with the condition. 

Further, with obesity being a contributing factor for gestational diabetes,  experts say that the global rise of the condition is not surprising since the obesity numbers have also been escalating.  A  study conducted over three decades and published in 2022 by NCD Risk Factor Collaboration (NCD-RisC), a network of health scientists around the world reveals that the prevalence of obesity in women was 19. 3 per cent compared to 6.3 per cent for men.

The research found that women tend to have more bad eating habits and little physical activity compared to men. “Kepha Nyanumba, a Consultant Nutritionist at Crystal Health Consultants Limited cautions against sugar foods and drinks including sugary beverages, sweets, and desserts, which cause rapid spikes in blood sugar levels.
Detection

Gestational diabetes is typically detected in the second trimester, with most cases being diagnosed between 20 and 28 weeks, according to the gynaecologist.

The detection process involves various tests, including fasting blood sugar measurements. WHO states that fasting plasma glucose (FPG) levels are assessed after at least eight hours of fasting, with normal values ranging between 70 milligrams per deciliter and 100 milligrams per deciliter.

However, Dr Ong’ech explains that a more commonly used test, especially for high-risk patients, is the Oral Glucose Tolerance Test (OGTT). “With the OGTT, we challenge the body’s system by having the patient consume a high-glucose solution, followed by serial blood sugar measurements.

This test helps us see how effectively the body can manage glucose. If a woman has gestational diabetes, it will become evident as the system struggles to control the sugar levels.”

As with the first procedure, the doctor says that it is more straightforward in that, “it is easy to do the test just by a fingerprint. It's something which can be done in far-flung places like Turkana, it can be done anywhere else in the country,” he remarks.

Another test that can be done to detect gestational diabetes, according to Dr Ong’ech is the Hemoglobin AIC (HbA1c). This test shows how a body has been controlling sugar for the last three months.
Warning signs

“If it's very high, then already the patient is a typical gestational diabetes candidate,” says Dr Ong’ech.
Early warning signs of gestational diabetes, like any other diabetes, he offers, are women drinking a lot of water, passing a lot of urine, increased appetite and an increase in weight.

However, with gestation diabetes, he says, the symptoms could be advanced with one experiencing poor vision. “I have attended to many women who have the condition but they don't show the symptoms, so one does not need to rely on the symptoms. The moment they kick in, then the condition is already getting out of control, ” he remarks.

How likely is it that gestational diabetes will occur in subsequent pregnancies?  “ We are talking about 50 per cent. The rate of re-occurrence is that high,” he says. Nonetheless, managing gestational diabetes requires a multidisciplinary team.

Dr Ong’ech explains that there is a need for an endocrinologist (a doctor who is a diabetes specialist), a gynaecologist, and a nutritionist.

“We work collaboratively to manage sugar levels effectively. The first step is to prescribe medication to control the condition. In more advanced cases, patients may require insulin injections to stabilize their blood sugar.

However, some cases can be managed with oral hypoglycemic drugs, which are medications taken by mouth to regulate glucose levels,” explains Dr Ong'ech adding that beyond medication, addressing diet and weight control is also crucial to ensuring comprehensive management of gestational diabetes.

Since gestational diabetes affects a woman when she is pregnant, both of them are at risk of certain conditions if the disease is not properly managed. “The baby may grow too large, or develop congenital abnormalities, which can be multiple and severe, all as a result of poorly controlled blood sugar. Additionally, fluctuations in blood sugar levels can even lead to sudden fetal death," Dr. Ong'ech warns.

Additionally, Dr Ong’ech points out that if the mother goes into hypoglycemia shock (low blood sugar below 70 milligrams per deciliter) she may deliver a premature baby.

“Then, the other biggest challenge we usually have is the lungs of the baby delaying to mature (fetal distress syndrome). So, you can get a baby born four kilos, but the lungs are not mature. The baby can't breathe," he says.

In such a case, Dr Ong’ech explains that the baby is given some medicine, steroids, to mature the lungs. But on the flipside, these steroids, he says, make it difficult to control the blood sugar. So, you are in that catch-22 position.

This is the time that an endocrinologist comes in to increase the insulin levels plus monitor them.
For the mother, due to the condition, there is an increased chance of having a cesarean section delivery.

Additionally, the mother can also predispose them to complications, which could result in death if poorly managed. Dr Ong’ech elaborates, “Also, the condition can cause blindness (diabetic retinopathy), kidney problems (diabetic nephropathy) and it can affect the nerves.

There are also increased chances of getting hypertension, and pre-eclampsia. To manage the condition and ensure the baby’s well-being, regular fetal surveillance is conducted. This includes obstetric ultrasounds to assess the baby's health and development.

Additionally, the gynaecologist notes that the baby's condition can be monitored using a biophysical profile score, which evaluates various indicators of fetal health.

For the mother, doctors closely monitor her blood sugar level to ensure it is well-controlled, which in turn indicates the health situation of the baby. Dr Ong'ech explains that these tests can be conducted at home using a glucometer. Measurements are typically taken at different stages: fasting blood sugar levels before meals and postprandial levels two hours after eating.

"Test at least twice a day, and, if possible, six times a day and a monthly Hba1c with guidance from an endocrinologist on the frequency target of

Additionally, retinal screening at diagnosis is recommended in every trimester to rule out any cases of blindness. According to  Mr Nyanumba, expectant mothers should incorporate healthy fats into their diets to help stabilise blood sugar levels. “Food sources of healthy fats include avocados, nuts and seeds. Staying hydrated is important for overall health,” he says.
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