Tackling diabetes amongst pregnant women

Dr Anil Bhoraskar, a senior diabetologist and Dr Alka Kumar, a consultant obstetrician and gynaecologist from SL Raheja Hospital inform us on how to tackle diabetes in a pregnant woman

Tackling diabetes amongst pregnant women
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Diabetes mellitus is a chronic metabolic disorder caused due to either insulin deficiency or decreased sensitivity to the action of insulin.

In pregnancy, this condition exists in a few varieties:

  • A known diabetic woman becomes pregnant.
  • A woman, who has a history of pre-diabetes, becomes diabetic during pregnancy.
  • Gestational Diabetes Mellitus (GDM) when woman becomes diabetic during pregnancy and after the pregnancy is over, her diabetes disappears.

However, GDM is thought to be a forerunner of type-2 diabetes, and almost 25% of GDMs eventually turn out to be diabetic.

Pregnancy induces progressive changes in maternal carbohydrate metabolism. As pregnancy progresses, because of certain placental hormones, there is a compensatory increase in insulin secretion.

When this compensation is inadequate, gestational diabetes develops. The pregnancy in a diabetic woman is known as pre-gestational diabetes mellitus.

The magnitude of complications is lesser in women with GDM than pre-gestational diabetes mellitus. Ideally, all pregnant women should undergo diabetes test during 24-28 weeks of gestation. However, it is best to screen once during all trimesters.

The women at risk of GDM are:

  • Women who have a history of diabetes in their family.
  • A pregnant woman, who herself was an overweight baby.
  • Previous history of repeated pregnancy loss or stillbirth.
  • Obesity
  • Being over 30 years of age, while attempting to get pregnant.
  • Frequent candida infections.
  • Polyhydramnios – Accumulation of amniotic fluid that surrounds the baby in the uterus

Effect of pregnancy on diabetes

Pregnancy can worsen diabetes. Vascular changes like retinopathy, nephropathy and coronary artery disease worsen during pregnancy.

Effects of diabetes on the mother during pregnancy

Diabetes increases the risk of abortion, preterm labour, Urinary Tract Infection (UTI), Vaginal Candidiasis. Also, there is a high risk of Preeclampsia (High Blood Pressure during pregnancy) and a high chance of delivering a big baby. Worsening of lungs, kidney and heart disease may also occur.

During labour:

There are very high chances of facing difficulty during labour as well as of developing a post-partum haemorrhage or sepsis.

Foetus

The risk of Foetal Congenital Malformation is high, especially renal, cardiac, and skeletal. Also, this may cause a delay in pulmonary maturity. It increases the risk of Intrauterine Foetal Death (IUFD) and Intrauterine Growth Restriction (IUGR); birth injuries, hypoglycaemia, respiratory distress syndrome and jaundice in the post-natal period.

GDM not only influences immediate maternal health but, also increases the future risk of Type-2 diabetes in the mother and the baby.

Prevention

Preventive medication starts before birth. Every woman should undertake pre-pregnancy consultations, where doctors advise following actions:

To increase the intake of folic acid, vitamin B12, and supplements to lower the risks of congenital malformations.

Control the weight and diet, coupled with regular exercises.

Those women, diagnosed with diabetes, should have good control over their sugar level. And should use oral anti-diabetic drugs or intake Insulin.

A regular antenatal visit to doctors, monitoring sugar levels, conducting serial lab tests, and an ECG for vascular changes to be done. It is important to involve a Cardiologist and Dietician in the management of diabetes.

Conduct tests for foetal well-being. A Nuchal Translucency (NT) scan in the first trimester for screening Down syndrome is a must.

A woman should be treated, and the baby should be delivered in a hospital having facilities of LSCS and NICU, as GDM plays a high-risk factor during pregnancy. A Neonatologist should attend to labour and baby in the post-natal period.

GDM treatment reduces the risk of perinatal complications. Lifestyle modification and Pharmacological Therapies can help reduce diabetes development by 50%. Also, breastfeeding can reduce childhood obesity.

Medical nutritional therapy and lifestyle intervention:

Nutrient intake plays a significant role in the health-related outcomes for pregnant women. Calorie restrictions can help control glucose level, but, severe restrictions are undesirable. Limit carbohydrate intake to 35-45% of total calories. Self-monitoring of blood glucose, particularly post-meal, is recommended. For women who are unable to achieve target glycaemic goals or show signs of excessive foetal growth, insulin is recommended.

  • Overfeeding: Excessive rich food, laden with harmful fats, must be avoided.
  • Omega 3 Fats and vitamin supplements can help overcome pregnancy-related depression.
  • Remember, the foetus is an obligate parasite; the foetus will suck every single nutritional element of the mother’s diet, required for its growth and development. It can deplete the mother of vital substances.
  • The doctors recommend regular consumption of milk, green vegetables, fruits, nuts, iron-containing foods, and at least two tablespoons of homemade ghee.
  • Avoid consumption of chivda, bhajiyas, sev, vadas gathiyas, and sweets.
  • Reasonable physical activities such as careful walking or yogic exercises can be taken under supervision if permitted by the obstetrician.