While you are happy learning you are carrying a little one (or two) inside you, you may be dismayed when you hear you have gestational diabetes (GDM). Suddenly, everything doesn’t seem as rosy anymore. Well, that was how I felt. And when the nurses and doctors warned me on the dangers and reprimanded me on my diet made it even worse.
Feeling so inadequate, I tried to control my diet and exercise daily to avoid taking insulin. In the end, though, I had to bow to the inevitable and take insulin for the next few months. I was so afraid of the doctor’s warning that I may have even went overboard in my diet control. By taking only three tablespoons of rice, vegetables and some meat for my meals, I struggled to maintain my blood sugar level within the acceptable range. Sometimes I won, sometimes I lost.
The thing I dreaded most was checking my blood sugar level. Checking glucose level for up to eight times (when I wake up, before breakfast, after breakfast, before lunch, after lunch, before dinner, after dinner, before sleep) a day was no fun. Sometimes, I lost count which finger I haven’t poked yet. Injecting insulin was also a dreaded affair. I had needles poked into my stomach, thigh and butt areas.
Ouch! And in the end, my little baby was born at 2.5kg at 38 weeks. A far cry from the large baby scare I got from the doctors and nurses. He, however, had low blood sugar and had to be fed formula milk as my milk hadn’t kicked in. The only silver lining I got from GDM was the frequent ultrasounds I had. Seeing my little one moving about and growing bigger was the highlight of my fortnightly checkups. So, what did this experience teach me? First, eat healthily. Two, exercise regularly. Three, be happy. And most importantly, be informed. Learn about GDM and how to go about it.
What Is GDM?
Gestational diabetes develops during pregnancy. It causes high blood sugar that can affect your pregnancy and your baby’s health. Pregnant mothers can control GDM by eating healthy food, exercising and taking insulin. Usually, your blood sugar will return to normal soon after delivery.
When Do You Check for GDM?
Any woman can develop GDM during pregnancy but you are at a higher risk if you have the following:
- overweight; body mass index (BMI) above 30
- previously had a baby who weighed 4.5kg (10lbs) or more at birth
- previously had GDM
- one of your parents or siblings has diabetes
- your family origins are South Asian, Chinese, African-Caribbean or Middle Eastern
- older than 25 years old
- if you had an unexplained stillbirth
During your first antenatal appointment (usually around Weeks 8 to 12 of your pregnancy), you will be asked questions to determine whether you’re at an increased risk of gestational diabetes. If you have one or more risk factors (see above), you would be offered a screening test. The screening test is called an oral glucose tolerance test (OGTT), which takes about two hours. First, you would have to fast the night before the test. In the morning, you will take a blood test and after that given a glucose drink. You will have to finish it and not throw up. After resting for two hours, another blood sample is taken to see how your body is dealing with the glucose. A blood sugar level below 130 to 140 milligrams per deciliter (mg/dL), or 7.2 to 7.8 millimoles per liter (mmol/L), is usually considered normal on a glucose tolerance test, although this may vary by clinic or lab.
Usually, the OGTT is done between 24 and 28 weeks but if you have more risk factors, you’ll be offered an OGTT earlier and another OGTT at 24 to 28 weeks if the first test is normal. Once you have GDM, you may need more-frequent checkups. You will need to meet additional health professionals like an endocrinologist, a registered dietitian or a diabetes educator. They will teach you how to manage your blood sugar level, what to eat or don’t eat, how to inject insulin, etc.
What Causes GDM?
It is not your fault. Researchers don’t even know why some women get it and some do not.
Your body digests the food you eat to produce sugar (glucose) that enters your bloodstream. In response, your pancreas — a large gland behind your stomach — produces insulin (a hormone that helps glucose move from your bloodstream into your cells to be used as energy).
When you are pregnant, the placenta, which connects your baby to your blood supply, produces high levels of various other hormones. All those hormones will affect the action of insulin in your cells, raising your blood sugar. As your baby grows, the placenta produces more and more insulin-counteracting hormones. In GDM, those hormones will create a rise in blood sugar to a level that can affect the growth and welfare of your baby.
Should I Be Worried About GDM?
Most women who have GDM deliver healthy babies. However, spikes or uncontrolled blood sugar levels and cause problems, including an increased likelihood of needing a C-section to deliver.
When you have GDM, your baby may be at increased risk of:
- macrosomia or excessive birth weight — the extra glucose in your bloodstream crosses the placenta, which triggers your baby’s pancreas to make extra insulin. This can cause your baby to grow too large and more likely to become wedged in the birth canal, sustain birth injuries or require a C-section birth.
- pre-term birth and respiratory distress syndrome — your high blood sugar may cause early labor before the baby’s due date. Or your doctor may recommend early delivery because the baby is large. Babies born too early may experience respiratory distress syndrome (a condition that makes breathing difficult). Babies with this syndrome may need help breathing until their lungs mature and become stronger. Babies of mothers with GDM may experience respiratory distress syndrome even if they’re not born early.
- low blood sugar (hypoglycemia) — babies of mothers with GDM develop low blood sugar (hypoglycemia) shortly after birth because their own insulin production is high. Severe episodes of hypoglycemia may provoke seizures in the baby. Prompt feedings and sometimes an intravenous glucose solution can return the baby’s blood sugar level to normal.
- Type 2 diabetes later in life — babies of mothers with GDM have a higher risk of developing obesity and type 2 diabetes later in life.
When you have GDM, you may be at increased risk of:
- high blood pressure and preeclampsia — GDM raises your risk of high blood pressure, as well as preeclampsia (a serious complication of pregnancy that causes high blood pressure and other symptoms that can threaten the lives of both mother and baby).
- future diabetes — if you have gestational diabetes, you’re more likely to get it again during a future pregnancy. You’re also more likely to develop Type 2 diabetes as you get older. However, making healthy lifestyle choices such as eating healthy foods and exercising can help reduce the risk of future Type 2 diabetes.
If you have trouble controlling your blood sugar, you may need to take insulin. If you have other pregnancy complications, you may need additional tests to evaluate your baby’s health. These tests assess the function of the placenta, the organ that delivers oxygen and nutrients to your baby by connecting the baby’s blood supply to yours. If your GDM is difficult to control, it may affect the placenta and endanger the delivery of oxygen and nutrients to the baby.
What Can I Do if I Have GDM?
Your doctor may tell you to:
- monitor your blood sugar — you may be asked to check your blood sugar level four to five times a day — first thing in the morning and after meals — to make sure your level stays within a healthy range. To test your blood sugar, you draw a drop of blood from your finger using a small needle (lancet), then place the blood on a test strip inserted into a blood glucose meter (a device that measures and displays your blood sugar level).
- eat healthily and control diet — eating the right kinds of food in healthy portions is one of the best ways to control your blood sugar and prevent too much weight gain. Doctors do not advise losing weight during pregnancy as your body is working hard to support your growing baby. A healthy diet focuses on foods that are high in nutrition and fiber and low in fat and calories. No single diet is right for every woman. You may have to consult a registered dietitian or a diabetes educator to create a meal plan based on your current weight, pregnancy weight gain goals, blood sugar level, exercise habits, food preferences and budget.
- exercise — regular exercise plays a key role in every woman’s wellness plan before, during and after pregnancy. Exercising stimulates your body to move glucose into your cells, where it will be used for energy. It also increases your cells’ sensitivity to insulin, which means your body produces less insulin to transport sugar. As an added bonus, regular exercise can help relieve some common discomforts of pregnancy like back pain, muscle cramps, swelling, constipation and sleepless nights. And most importantly, exercising will help get you in shape for the hard work of labor and delivery. Aim for moderately vigorous exercise on most days of the week. If you haven’t been active for a while, start slowly and build up gradually. Walking, cycling and swimming are good choices during pregnancy. Everyday activities such as housework and gardening also count.
- take insulin — if diet and exercise aren’t enough, you may need insulin injections to lower your blood sugar. Between 10 and 20 per cent of women with GDM need insulin to reach acceptable blood sugar levels.
- monitor your baby closely — an important part of your treatment plan is close observation of your baby. Your doctor may monitor your baby’s growth and development with repeated ultrasounds or other tests. If you don’t go into labor by your due date, your doctor may induce labor. Delivering after your due date may increase the risk of complications for you and your baby.
Finally, follow your doctor’s advice (not blindly; learn to ask questions) and take good care of yourself by eating healthy food, exercising and learning as much as you can about gestational diabetes. From one mummy to another, good luck and be happy!