Beyond the Bump: Why Diabetes in Pregnant Women Demands Your Attention Now

India is often called the ‘diabetes capital of the world’ with rising rates impacting men, women, and increasingly, expectant mothers. India has the second highest number of adults (20-79 years) with diabetes in the world, rising rapidly among expectant mothers.

While pregnancy is a time of joy and anticipation, diabetes in pregnant mothers can cast a shadow impacting maternal and child health before, during, and after birth.

Whether it is gestational diabetes or pre-existing type 1 or type 2 diabetes, the risks are real, and the numbers are alarming. What makes it even more dangerous is that diabetes during pregnancy symptoms often go unnoticed and silently put the mother’s and baby’s lives at risk.

We will help you unfold the growing concerns around diabetes in pregnant women, explain when gestational diabetes occurs, and highlight how much blood sugar is normal during pregnancy. We will also help you understand how diabetes affects pregnancy and provide clear insights on diabetes during pregnancy and how to control it.

Diabetes in pregnant women usually falls into two types:

Gestational Diabetes Mellitus (GDM): This generally occurs during pregnancy, typically after 20 weeks, mainly due to hormonal changes that affect insulin action in the mother’s body.

Pre-existing Diabetes: Pre-existing diabetes includes both diabetes during pregnancy, type, and type 2 diabetes in pregnancy. Women with either type may become pregnant and require rigorous medical management.

When does Gestational Diabetes Occur?

Gestational diabetes, in simple terms, means high blood sugar during pregnancy. But, it can be managed by eating healthy, well-balanced foods and exercising regularly. Gestational diabetes is a type of diabetes that develops exclusively during pregnancy when blood sugar levels get too high.

This usually happens when the hormones from the placenta block the mother’s ability to use or make insulin. Developing gestational diabetes does not necessarily mean you already had diabetes before pregnancy.

Gestational diabetes typically develops during the middle of pregnancy, usually between 24 to 28 weeks, though sometimes it can develop earlier.

Diabetes in Pregnancy Symptoms

Gestational Diabetes Mellitus is asymptomatic, which is why routine screening between 24-28 weeks is important. In some cases, symptoms like excessive thirst, frequent urination, fatigue or even blurred vision may be noticed, but they are generally dismissed as normal pregnancy signs.

How Much Blood Sugar is Normal During Pregnancy?

With or without pregnancy, maintaining optimal blood sugar levels is crucial. General guides for blood sugar levels during pregnancy are:

• Fasting sugar: 95mg/dL
• One-hour post-meal: 140mg/dL
• Two hours post-meal: 120mg/dL

Everybody and their body functions are unique. Follow personalised targets set by your doctor. Understanding your numbers early can be life-saving.

Women with pre-existing diabetes must approach pregnancy with even greater care. Whether it's diabetes pregnancy, type 1 or type 2, the focus should be on achieving stable blood sugar before conception and maintaining it throughout.

Diabetes Pregnancy Type 1

Managing diabetes pregnancy type 1 requires precision as these women already rely on insulin and must tread carefully as fluctuating hormones may cause blood sugar levels to rise. Frequent blood sugar checks may be needed. A continuous glucose monitor and insulin pump are often recommended.

Preconception planning is very crucial. High blood sugar levels in early pregnancy can increase the risk of congenital anomalies, so tight control before and after conception is non-negotiable.

Diabetes Pregnancy Type 2

Women with type 2 diabetes may manage with lifestyle changes or oral medications before conception. However, most women require switching to insulin during pregnancy as it offers safe glycemic control. It's essential to review all medications with a diabetologist since some anti-diabetic drugs may not be pregnancy-friendly.

Planning is Key

A healthy pregnancy begins before conception. Preconception counselling for women with diabetes helps minimise risks and improves outcomes.

Can Diabetes Affect Pregnancy Test Results?

This is one of the most asked questions, but the answer is: no, diabetes does not interfere with pregnancy test results. These tests detect the hCG hormone, which is unaffected by blood sugar levels.

Pregnancy with poorly controlled sugar levels poses a high risk. Here’s how diabetes affects pregnancy for both the mother and the developing baby.

Maternal Complications

Preeclampsia: This is an elevation of blood pressure, particularly with concomitant protein in the urine.

Increased chances of C-section: There are high chances of C-section either because of the large size of the baby or other complications.

Polyhydramnios: Too much amniotic fluid can lead to various complications like preterm labor or placental abruption.

Infections: There's an increased risk of urinary tract infections and vaginal yeast infections. Labor problems: A larger baby can lead to obstructed labor or shoulder dystocia.

Fetal and Neonatal Complications

Macrosomia: This increases the risk of birth injuries and C-sections, especially in babies larger than 4kg.

Neonatal Hypoglycemia: Refers to dangerously low blood sugar levels in newborns.

Respiratory Distress Syndrome: Causes delayed lung maturity, especially if the baby is delivered early.

Stillbirth: While rare with proper management, the risk increases with poorly controlled diabetes.

Long-term Risk: Babies born to mothers with diabetes have a higher chance of developing childhood obesity and type 2 diabetes later in life.

Congenital Anomalies: Seen in mothers, especially with uncontrolled type 1 or type 2 diabetes in early gestation.

Understanding the complications of diabetes during pregnancy isn't meant to cause fear but to drive action. With proper screening and regular check-ups and tight management, these risks can be significantly reduced.

Diabetes management, along with consistency, is the key to success. Here’s how diabetes is controlled during pregnancy:

Monitoring Blood Sugar Levels

• Monitoring blood sugar levels daily, sometimes four to six times, is necessary.
• Use a glucometer to track fluctuations.
• Maintain a logbook to review patterns.

Dietary Management

• Consult with a registered dietitian.
• Focus on complex carbohydrates such as millets, whole grains, lean protein like lentils and eggs, and healthy fats such as nuts, seeds, and oils.
• Take small and frequent meals to stabilize sugar levels.
• Fried snacks, junk food, and sweet beverages should be avoided at all costs.

Physical Activity

• Engage in a moderate day-to-day exercise like walking, prenatal yoga or swimming.

• Staying physically active induces sensitivity to insulin and fosters weight management.

Medication (if needed)

• The gold standard for pregnant women is insulin. It does not enter the placenta.

• Your doctor may prescribe some oral medicines.

• Changes ought to be carried out on a weekly basis, depending on the trends of blood sugar levels.

Medical Checkups

• Biweekly or weekly medical checkups should be followed.

• Regular visits to a diabetologist, gynaecologist, and nutritionist to ensure overall well-being.

• Conduct regular ultrasounds to monitor the baby’s growth and amniotic fluid.

Gestational diabetes typically resolves after birth, but the story does not end here. Here’s something to keep you aware:

• Resolution of GDM: Blood sugar usually normalizes within days of delivery. However, this doesn't mean the risk disappears. Conduct regular follow-ups with your doctors to decide on the further course of action.

• Future Risk: Women who experience GDM have a sevenfold higher risk of developing type 2 diabetes later in life.

• Postpartum Screening: A glucose tolerance test is recommended to avoid future complications. Continue screening for one to three years after delivery.

• Lifestyle Continuation: The lifestyle changes made during pregnancy – a balanced diet, physical activity, and regular doctor check-ups – should be continued. They are your best defense against diabetes after pregnancy.

Early control of diabetes among expectant women can spell the difference between danger and comfort. Being aware, conducting frequent screenings and following the medical recommendations of the medical experts can help even an Indian mother provide her baby and herself with the best life that is possible.

Don't wait. Be aware. Take control. Your future depends on it.