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NOVEMBER-DECEMBER , 2021 | THE HEALTH
35
Diabetes in pregnancy
Being diagnosed with gestational diabetes can be disturbing emotionally in pregnancy , but with early screening and detection , the condition can be well managed
RESEARCH states that gestational diabetes is high blood sugar ( glucose ) that develops during pregnancy and usually disappears after giving birth . Diabetes can cause problems during pregnancy for women and their developing babies .
Poor control of diabetes during pregnancy increases the chances of birth defects and other problems for the pregnancy . Proper health care before and during pregnancy can help prevent birth defects and other health problems . But the risk can be reduced if the condition is detected early and well managed .
Gestational Diabetes Mellitus ( GDM ) is a type of diabetes that is first seen in a pregnant woman who did not have diabetes before she was pregnant . It usually shows up in the middle of pregnancy .
It occurs because the body cannot produce enough insulin which is a hormone important in controlling blood glucose to meet its extra needs in pregnancy . This results in high blood glucose levels . GDM usually starts in the middle or towards the end of pregnancy .
During pregnancy , a women ’ s body undergoes hormonal changes and physical changes such as weight gain . Because of these changes , the body ’ s cells don ’ t use insulin well , a condition called insulin resistance .
All pregnant women have some insulin resistance during late pregnancy . Most pregnant women can produce enough insulin to overcome insulin resistance , but some cannot .
These women develop GDM . As for prevention , before embarking on a pregnancy , if a woman is overweight , losing weight with regular physical activities may help prevent gestational diabetes .
Managing diabetes in pregnancy
Usually , gestational diabetes has no symptoms . If a woman does have symptoms , they may be mild , such as being thirstier than usual or urinating more often .
A woman is more likely to develop gestational diabetes if she is overweight with a BMI of 27kg / m2 or higher , previously have had gestational diabetes , has a history of giving birth to a large baby , has a first-degree family member with diabetes or with the presence of sugars in a urine test done during routine follow up .
Assessment of sugar levels in a pregnant woman with pre-existing diabetes is vital . Women already on medication would either be advised to continue current medication , or they may need to start on insulin injections . Low dose aspirin will also be given in addition to folic acid , calcium carbonate and vit D3 tablets .
Additional blood tests to look at kidney function would need to be done . An appointment for eye assessment by an ophthalmologist will be organised to look for eye-related complications secondary to pre-existing diabetes .
The woman will also be given a consult with the dietician for relevant advice in maintaining a healthy diet . Her pregnancy follow-ups would further be under combined care with the endocrinologist .
All pregnant women with risk factors will need to be screened for GDM . Women at risk of developing GDM will be advised to screen early in pregnancy . Women aged 25 and above with no risk factors will be advised screening between 24 and 28 weeks of gestation .
Complications during pregnancy
In some women , GDM will respond to a healthy diet and exercise . The majority will need oral medication or insulin . Followups with the obstetrician will be on a regular basis . The women will be advised to monitor their blood sugar levels frequently and any abnormal results will require immediate attention by the obstetrician .
Most women who develop GDM have healthy pregnancies and healthy babies , but occasionally gestational diabetes can cause serious problems , especially if it is not recognised or treated . With gestational diabetes , a woman is more likely to develop a condition called preeclampsia , which is when you develop high blood pressure and too much protein in your urine during the second half of pregnancy .
BY DR PRAKASH M CHANDRAKANTHAN
Gestational Diabetes Mellitus ( GDM ) is a type of diabetes that is first seen in a pregnant woman who did not have diabetes before she was pregnant . It usually shows up in the middle of pregnancy .”
Uncontrolled sugar levels can also result in a woman having a stillbirth . In terms of delivery , gestational diabetes may also increase your chances of having a cesarean section as your baby may be large . In the long term , the chance of developing Type 2 diabetes later in life also increases .
Most of the developmental anomalies or birth defects are seen in women with pregestational diabetes in pregnancy . The anomalies include problems with the development of the heart , central nervous and skeletal system . These anomalies are usually the result of poorly controlled diabetes during preconception up to the first trimester .
The prevalence of diabetes in pregnancy in Malaysia is quite common , ranging from 18 to 24 per cent . The global rapid increase of GDM is alarming .
Diabetes can be a common endocrine disorder in pregnancy , which is detected in weeks 24 to 28 . In certain occasions , the condition can develop earlier as well .
Being diagnosed with gestational diabetes can be disturbing emotionally in pregnancy . But with early screening and detection , the condition can be well managed to avoid any complications during pregnancy and delivery . The prevalence of diabetes has been associated with lifestyle changes , environment and increasing urbanisation .
Lifestyle and eating routines play an important role in keeping your blood sugar levels within a healthy range . — The Health
Dr Prakash M Chandrakanthan is Consultant Obstetrician & Gynaecologist at Sri Kota Specialist Medical Centre , Klang .