Defining Gestational Diabetes
Gestational diabetes is a condition which only occurs during pregnancy where the mother suddenly enters a state of carbohydrate intolerance. This results in the mother becoming diabetic due to her blood sugar levels being higher than normal. Gestational diabetes happens typically in the third trimester. Associate professor Tan Lay Kok, senior consultant, department of Obstetrics and Gynaecology, Singapore General Hospital explains, “The rising pregnancy hormones cause the mother to become more resistant to the effect of her body’s natural insulin, and hence cause the blood sugars to be higher. This condition is specific to pregnancy.”
Diagnosing the Condition
Gestational diabetes usually has no symptoms. The test for gestational diabetes is usually done around 28 weeks. There are, however, certain circumstances in which your obstetrician may decide to perform the test earlier. These include the constant presence of glucose in your urine analysis, having gestational diabetes in your previous pregnancies or if previous obstetric outcomes suggest gestational diabetes. Assoc Prof Tan elaborates, “Some examples of such outcomes are a very large baby (more than 4kg for Asians), unexplained stillbirths and shoulder dystocia.” Gestational diabetes is then diagnosed through an abnormal oral glucose intolerance test. Dr Choo Wan Ling, obstetrician and gynaecologist, Gleneagles Hospital Singapore says, “The test requires the mother to fast overnight before doing a blood test, followed by drinking a 75g glucose drink and then a second blood test.”
Complications and Concerns
One of the biggest risks of gestational diabetes is developing preeclampsia which can develop into eclampsia. Preeclampsia is a condition whereby the mother experiences high blood pressure and high amounts of toxins in the urine while eclampsia can cause the pregnant mother to have seizures. Both preeclampsia and eclampsia are associated with a high mortality rate for both the mother and the infant. In poorly treated or controlled gestational diabetes, vagina yeast infections and urinary tract infections have a higher rate of occurrence.
Besides affecting the mother, gestational diabetes also affects the baby in several ways. Poorly controlled diabetes can result in an excessively large baby, which in turn leads to difficult labour and delivery. Another complication that can arise is shoulder dystocia. Assoc Prof Tan explains further, “Shoulder dystocia is an obstetric emergency in which the baby’s head is delivered but the rest of the body is stuck due to the baby’s broad shoulders being jammed against the top part of the pelvic outlet.” This can lead to birth injuries and asphyxia.
Another potential risk of poorly controlled gestational diabetes is the increased number of stillbirths. After birth, the babies also tend to have neonatal complications such as respiratory distress, hypoglycaemia (low blood sugar), hypocalcaemia (low blood calcium) and jaundice. In addition, there is excess amniotic fluid, which overstretches the womb and increases the chance of pre-term labour.
The ideal delivery date for such pregnancies is around 38 weeks. This would mean that some mothers may need to have their labours induced. In unsuccessful cases, a caesarean may then be necessary. However, Assoc Prof Tan says, “In terms of delivery, it is important to emphasise that gestational diabetes does not mean that a caesarean is an absolute must. Most babies are still born normally and naturally.”
Gestational diabetes can be controlled to a manageable level by using a multidisciplinary approach from the obstetrician, endocrinologist, dietician, the diabetic nurse counsellor and the neonatologist. However, Assoc Prof Tan stresses, “Patient education is the most important, as well as compliance to dietary management, and treatment which is ascribed according to the diabetic control.” The mother must monitor her condition daily diligently by keeping track of her glucose levels. This is done using a home glucose meter or strips. The results are then fed back to the team so that adjustments in treatments can be made accordingly.
Dr Choo says, “In gestational diabetes, your body is unable to metabolise the sugar fast enough. Hence, there would be more instances where the levels of sugar can be high for some time after a meal.” Having a well-planned diet is the first step to controlling your gestational diabetes. Instead of having a big meal at one go, divide your meals up into smaller portions with healthy snacks in between meals to spread out the sugar intake over a period of time. Also, to keep your blood sugar levels stable, it is crucial that you do not skip meals, especially breakfast. “Avoid sweets, deep fried food, and refined carbohydrates like sugar and starch,” Dr Choo advises.
Regular exercise is also important. Some studies have shown that mild to moderate exercise helps to improve the body’s ability to process glucose and this keeps the blood sugar levels in check. Your doctor will be able to best advise you regarding the best type of exercise for you and your bump. In more serious cases where diet control and exercise is insufficient to manage gestational diabetes, the obstetrician may prescribe insulin injections or oral medication.