Diabetes in pregnancy may be looked at as a window of opportunity to intervene and start paying attention to lifestyle habits
Dr T.W Ngwenya Changamire
In previous articles on The Sunday Express we spoke about Obesity and how it increases your risk of other diseases. One such prevalent condition is Diabetes in pregnancy. Diabetes in pregnancy may be looked at as a window of opportunity to intervene and start paying attention to lifestyle habits to prevent onset of Type 2 Diabetes and other lifestyle related conditions.
This condition is also referred to as pregnancy induced diabetes. This is a condition that occurs during pregnancy and it often resolves after the baby is born. It is important to mention that women who have had gestational diabetes have a higher risk of developing Type 2 Diabetes. These women need to take precautionary measures to prevent progression to Type 2 diabetes after the pregnancy.
These measures include diet modification and increasing exercise levels together with weight reduction in overweight and obese individuals.
How does diabetes develop during the pregnancy?
During pregnancy the placenta is responsible for supplying blood from the mother to the growing foetus. Blood contains oxygen and nutrients. The placenta is also responsible for releasing hormones that are important for maintaining the pregnancy.
These hormones make the body become insulin resistant. If you remember from our previous article where I explained the different types of diabetic conditions, Type 2 diabetes is a condition where the body fails to respond adequately to circulating insulin, insulin is the hormone that is responsible for the regulation of blood sugar, and so if the body does not respond to insulin, blood sugar levels remain high. This is insulin resistance and this is how mothers get diabetes during pregnancy.
This insulin resistant state is intended to ensure that blood sugar levels remain up so that enough blood sugar can reach the growing foetus. However, if these blood sugar levels become higher than the normal levels gestational diabetes develops.
After the delivery of the baby when both baby and placenta have been removed from the mother, these hormones that were originally coming from the placenta are no longer in circulation, so we expect the body to revert from being insulin resistant to becoming sensitive to insulin again with subsequent regulation of blood sugar levels.
Effects of high blood sugar
High circulating blood sugar levels can affect both mother and baby negatively. In the early stages of the pregnancy high circulating sugar levels may lead to birth defects in the growing baby. Stillbirth is more likely to occur in pregnant women with diabetes.
Pregnant women are screened between 24 and 28 weeks of the pregnancy. If levels are found to be high they are put on medication to control levels and to also prevent complications that may arise from being a Diabetic mother.
The mother is at risk for developing pre-eclampsia during pregnancy compared to non-diabetic mothers. Pre-eclampsia is pregnancy induced high blood pressure.
Women who develop pre-eclampsia need to be followed up closely as they can complicate even further and this may result in preterm delivery of the baby or seizures and stroke in the mother.
Gestational Diabetes babies become larger than normal. The circulating high blood sugar “over feeds” the baby. Delivery of larger than normal babies is expected to be difficult. Complications may occur from bruising and tearing of the vaginal and perineal area to heavy bleeding after delivery in the mother.
Prolonged labour may be anticipated and the baby may also sustain injuries during delivery as it struggles to pass through the birth canal.
To avoid these complications Caesarean section delivery maybe indicated. This means that these babies can only be delivered by the Caesarean section method (C-section).
So the mother has to opt for C section delivery which has a longer recovery period compared to normal vaginal delivery.
Larger than normal babies have to stay in the hospital a bit longer after delivery. They are at a risk of developing hypoglycaemia (low blood sugar) which may have detrimental effects to the baby.
This occurs because before delivery the growing foetus is exposed to high sugar levels circulating and it has adapted to the high sugar levels by producing a lot of insulin. In the early phases after delivery this may become a problem because the high blood sugar from the mother has been withdrawn but the baby still has high insulin levels.
This may lead to a drop in the baby’s blood sugar level. These babies have to monitored for some time post-delivery. Larger than normal babies may also develop jaundice post-delivery which also has to monitored.
Actions to take
To prevent trauma to baby and complications arising women with diabetes during pregnancy are advised to;
1. Eat healthy, Diabetics are encouraged to have a higher proportion of foods rich in fibre like wholegrain pasta, rice, bread and oats, nuts and seeds, vegetables, fruits like berries, watermelon and oranges in conjunction with healthy portions of meat, dairy and vegetables.
2. Exercise moderately but avoid lifting heavy weights. Aim for 150 minutes of low to moderate intensity activity per week.
3. Monitor your blood sugar levels.
4. Avoid excessive weight gain during pregnancy, an overweight mother is likely to have a larger than normal baby. It is also advised that overweight women must strive to lose weight before pregnancy so as to prevent diabetes in pregnancy.
These actions will help to prevent complications arising from the high sugar levels and complications arising from having a larger than normal baby.
After the pregnancy
1. Check your blood sugar at 6 to 12 weeks post-delivery,
2. Routinely screen for Diabetes yearly if you haven’t progressed into Type 2 Diabetes.
Remember, a healthy eating habit, regular exercise and weight reduction will prevent progression to Type 2 Diabetes.
Contact All In 4 Health – By Dr TW Ngwenya Changamire – for General Medical Consultation, health screening, medical check-up, health education and promotion. The Glen Marais Shopping Centre, 57 Veld Street, Glen Marais, Kempton park 1619