Gestational Diabetes – the Issue
Pregnancy is associated with changes in insulin sensitivity, which may cause increases in blood sugar levels. In about one in 20 women the blood sugar will rise to diabetic levels and usually resolves after the baby is delivered. This is called gestational diabetes and more often than not, arises in the second and third trimesters of pregnancy. Doctors will often test blood sugar levels of pregnant women between 24 and 28 weeks as a screening measure.
Increased blood sugar levels can impact on pregnancy outcomes. Risks associated with gestational diabetes include:
1. Increased likelihood of bigger babies
2. Earlier deliveries and increased likelihood of inductions or caesarian sections
3. Increased risk of an early miscarriage and increased risk of having a baby with malformations particularly with higher HbA1c levels
4. The mother developing type II diabetes later on
5. The baby developing disorders later in life such as type 2 diabetes
Gestational diabetes is more likely to occur in people who over overweight, have a family history of diabetes, and are older.
Gestational diabetes is also more common in certain cultures namely, Aboriginal and Torres Strait Islanders, Polynesians ,Indians, Vietnamese, Chinese, and Middle Easterners.
Women with diagnosed diabetes, type I or type II, those with a history of gestational diabetes and people who have been diagnosed with gestational diabetes need to follow the guidelines outlined below to optimise pregnancy outcomes. Take particular note that women with diabetes prior to pregnancy can worsen diabetic complications if they do not manage their blood sugar levels during pregnancy.
Recommendations
1. The following categories are encouraged to consult a doctor and perhaps other health care professionals prior to pregnancy:
- Women with known diabetes
- Women who have been told they have elevated blood sugar levels
- Women with a history of gestational diabetes because they are 30-50% more likely to develop gestational diabetes in a subsequent pregnancy
- Women on medication. For example cholesterol lowering drugs should not be taken during pregnancy
2. All pregnant women should be taking folate
3. Prior to pregnancy aim for a HbA1c of <6.5% if you are Type I diabetic, and <7.0% if you are Type II.
4. If your HbA1c is >8.0%, improve diabetic control and your HbA1c level before becoming pregnant
5. Measure HbA1c levels every 4 to 8 weeks
6. Aim for BSL of <6.5mmol/l (<117mg/dl) before meals
7. Aim for BSL of <8.5mmol/l (<153mg/dl) after meals
8. Pregnant women with diabetes should measure blood sugar levels 1 hour after a meal and aim for <7.8mmol/l or <140mg/dl.
9. Women with diabetes or gestational diabetes should consult a dietitian for the following reasons:
- Ensure their folate intake is adequate
- Review the type, quality, quantity and distribution of carbohydrate, particularly when insulin doses or levels of oral hypoglycaemic drugs are changed. Ensure a low GI diet.
- Obtain nutritional guidelines on managing nausea during pregnancy
- Obtain nutritional guidelines on energy needs during pregnancy, and ensure energy intakes are not reduced below 30% f their normal food intake
- To obtain guidelines for the intake of protein and nutrients such as calcium
- To obtain guidelines on reducing total fat intake and to optimise the qualify of fat that is eaten
10. A minimum of 30 minutes exercise most days, but tailor exercise to previous exercise habits. Exercise is associated with preventing gestational diabetes and also improving insulin sensitivity
11. Breastfeeding is preferred. However, diabetic mothers have a higher concentration of blood sugar making their breast milk higher in energy. To prevent babies from gaining excess weight mothers need to maintain good diabetic control. After the babies birth, and particularly if breast feeding, blood sugar levels need to be monitored closely. Insulin requirements drop immediately after delivery, highlighting the need for dose adjustments to insulin if it is being given and to ensure appropriate dietary management.
12. Women who have developed gestational diabetes are at higher risk of developing diabetes at a later stage and should consult health professionals in relation to prevention strategies. Guidelines after the baby is born include:
Continuing a healthy eating plan that is low in saturated fat, contains a predominance of low GI foods, has small regular meals and controlled portion sizes, at least 2 litres of water a day and no alcohol if breastfeeding and sugary drinks or juices.
Maintain physical activity for 30 minutes a day
Aim for a healthy weight.
Reference: Global Guideline: Pregnancy and diabetes (2009). International Diabetes Federation. http://www.idf.org/webdata/docs/Pregnancy_EN_RTP.pdf
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