Diabetes In Pregnancy

Hi,

I am Dr. Puja Sharma, Gynaecologist, Delhi. Today I will talk about diabetes in pregnancy. As you all know that diabetes is a very common disease. There is the hormone in our body by the name of insulin which regulates blood sugar. So, what happens in pregnancy? Changes in insulin lead to changes in blood sugar. For a lady who is already diabetic and has conceived or a lady who has been diagnosed as the diabetic first time in the pregnancy, in both these condition, the change in insulin sensitivity causes a high risk both to the mother and baby. It has been generally acknowledged that tight glycemic control means good blood sugar control during pregnancy can reduce these complications to a large extent.

Now let me first begin with diabetes before pregnancy. So, in a lady who is diabetic before pregnancy and she is planning to get pregnant, what all things she should think? 3 things she should remember what medicines is she taking, what is her blood sugar level before conception and the third important thing is blood pressure. She should get her blood sugar level done before a month planning for pregnancy. 2nd category is those girls who have had a history of diabetes in a previous pregnancy. There are 30-50% chances of getting diabetes in 2nd pregnancy. They should be cautious. They should get their blood sugar done before a month planning for pregnancy. They should get their HbA1C done. 3rd category is gestational diabetes mellitus. When you go for a pregnancy check, diabetes is one of the tests which you have to get done.

Gestational diabetes has some consequences on both mother and child. What can happen to a mother? Mother can have high blood pressure because of diabetes, an increase in the water around the baby. She can have difficulty in delivery and more chances for landing in c-section. Other complications like retinopathy, the effect on kidneys. Coming to the baby, gestational diabetes is a higher risk for the baby. There are chances of death or abortion. There are chances of many malformations in the baby like any deformity. High blood sugar can cause a deformity in the baby. Baby can be larger than normal babies. Baby's weight can be more than 3.5 kgs.

How do we diagnose diabetes in pregnancy? As I told you certain tests are required. If they are negative then we repeat the tests after 24-28 weeks again. If any of the tests comes positive then you are subjected to frequent tests and blood sugar monitory. How do we manage diabetes? We try to manage the patient on medical nutrition therapy and exercise. We give a proper diet plan to the patient and exercise schedule of 30 mins per day. Diet is given as per your height, weight, and BMI. After 2 weeks again blood sugar test repeated. If with all precautions, blood sugar is still not under the control then we put the lady either on insulin or oral medications. Coming to the mode of delivery. Diabetic mother usually requires early intervention. We have to take a decision for the delivery before 40 weeks of pregnancy. 2nd is the mode of delivery either vaginal or c-section. There are certainly more chances of c-section in diabetic women.

After delivery the glycemic control is important. Even after the delivery, we need to check the lady for diabetes test after 6 weeks. This is to see whether she is diabetic or she was diabetic only during pregnancy. Even when the lady develops diabetes, they have more chances of diabetes in later life. Diabetes in pregnancy is a high-risk pregnancy but it can be well managed by proper glycemic control. Certain tips for a diet to be taken like carbs increase the blood sugar level-so it should be taken in the split meals. Rather taking 3 big meals, you can take 6 small meals. Fried foods have to be restricted. Protein intake has to be neutral. Eat complex carbs like jawar, bajra, raagi, oats, salads. So, I wish you a very healthy pregnancy. And if there are any signs of diabetes in pregnancy if you are facing then consult your gynecologist.

Thank You.