Diabetes in Pregnancy – part one

Diabetes is a disease in which your blood sugar levels are too high. When you are pregnant, high blood sugar levels are not good for you and your baby.

The prevalence of this disease is increasing in the younger generation, so now more women are affected during pregnancy.

According to an estimate, 21 million women or 16.2% of mothers have some form of high sugars in pregnancy.

Another 54 million women are affected by impaired glucose tolerance test(IGT). They have a potential to develop GDM if they become pregnant.

Factors that increase chances of Diabetes in Pregnancy 

  • Stress of urbanization: we have a busy schedule in today’s lifestyle, we grab anything within reach to eat during our busy day (especially fastfood)
  • Sedentary lifestyle: lack of exercise, no walk after meals, sleeping till late hours
  • Bad eating habits:  irregular hours or late hours of eating, unbalanced diet, lots of biryani (rice), burgers (bread), nihari (red meat), sugary drinks, and fried food many times a week.
  • Increasing age of marriage and high parity (no. of children)
  • The highest incidence of diabetes in pregnancy is in South East Asia (SEA) and Middle East North Africa (MENA) leading up to about 46% affecting 10.4 million mothers who give birth to live babies.
  • Globally 88% of women who have high blood glucose during pregnancy are from low and middle income countries.

Why does this matter?

There are problems for mothers:

  • Later in life, women may develop Type 2 (frank DM)
  • The mother is at risk of developing high blood pressure during pregnancy and at the time of delivery.
  • Recurrent fungal infections: mothers suffer from repeated fungal infections and smelly discharge from vagina during pregnancy
  • Operative delivery: they end up in caesarian sections or forceps deliveries due to the big size of the baby and may have injuries to their birth canals.

gestational-diabetes-mellitus-13-638

There are problems for baby:

  • The babies are bigger in size. They are swollen due to high insulin levels in their mothers.
  • The babies may suffer from obesity and other disorders like diabetes in adolescence and childhood
  • Congenital Anomalies: the babies may have ASD (that is a defect in heart chamber). There are also chances of defects in spinal cord.
  • Repeated miscarriages
  • Premature delivery as the water bag leaks before expected date due to infections caused by diabetes
  • Hydramnios: the water in the bag around the baby increases, causing discomfort and early rupture of membranes.
  • The problems faced by baby around birth time:
    The baby will have difficulty in breathing due to difficult delivery due to its size (in addition the material that helps in breathing develops late in GDM babies).  The baby’s sugar level falls as soon as baby is born, these babies will have jaundice more than the normal babies, there calcium level falls and they can have fits.

fcf-013

Who is at Risk?

What will your doctor be looking for in the first visit?

  • If the mother had pregnancy diabetes in previous pregnancy
  • If the woman is in the pre-diabetic range (pre-diabetes i.e. HbA1C is more than 5.7) A cut-off of > 5.7 % is considered at risk of developing sugar in pregnancy.
  • BMI > 30 kg/m2 at the first antenatal visit, personal history of metabolic syndrome, PCOS, obesity
  • Ethnicity: South or East Asian, Hispanic, African-American, Native American, Pacific Islander.
  • Diabetes in first degree relatives e.g. mother, father, mamoo, chacha, khala, phuphi, nani, dada – (maternal and paternal relatives)
  • Big baby in previous pregnancy – 9 pounds or more (4.1 kg)
  • If the mother had unexplained death of baby just before or immediately after delivery or birth of an abnormal baby.
  • If the mother is on cortisone tablets or has high blood pressure.
  • Overt Diabetes i.e. diabetes before pregnancy – Patients with confirmed fasting sugar levels of ≥7.0 mmol/L (≥126 mg/dL) or random glucose levels ≥11.1 mmol/L (≥200 mg/dL) in the first trimester receive a diagnosis of overt rather than gestational diabetes (meaning during pregnancy)

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