Q

A

Males and females are affected by diabetes similarly. Some women may develop diabetes during pregnancy that disappears after delivery. This is called Gestational Diabetes Mellitus (GDM). This is a special form of diabetes seen only in women. Many women with gestational diabetes go on to develop Type 2 diabetes later on.

Q

A

Women with diabetes can have children. In case the woman with diabetes has major complications, she must discuss it with her doctor before becoming pregnant. In case there are no complications or minor complications, there is no problem in having babies. It is important to improve control before contemplating pregnancy. The best outcome is achieved when good control is obtained even before becoming pregnant. During pregnancy it is very important to control diabetes meticulously to deliver a healthy baby.

Q

A

Gestational diabetes is a condition in which some women become diabetic during pregnancy and recover completely after delivery. These women are unable to increase insulin secretion to overcome the effects of hormones produced by the placenta that oppose the effect of insulin. This results in high blood sugar and gestational diabetes. Placenta is the organ that anchors the baby to the womb of the mother. When the baby is born the placenta is detached from the womb and is delivered out. Women with gestational diabetes are at an increased risk of developing gestational diabetes during subsequent pregnancies and 25-30% will within ten years develop full-fledged diabetes.

Q

A

As stated above pregnancy is a stressful state. During pregnancy the placenta produces hormones that oppose the effect of insulin. If the pregnant woman cannot increase insulin secretion to match the increased insulin requirement, it leads to diabetes. Post delivery, when the placenta is removed, and the effect of insulin normalized, normal blood sugar values are attained.

Q

A

The following factors increase the chances of developing gestational diabetes:

Maternal Age > 25 years
Obesity
Bad obstetric history in previous pregnancies e.g., delivering a large baby, stillbirth (dead baby) delivery or an abortion.
History of diabetes during previous pregnancy.
Family history of diabetes.
Belonging to an ethnic group with high prevalence of diabetes

Q

A

To confirm diagnosis, a 100 g glucose load is given in the morning, after an overnight fast. Venous plasma glucose is measured at fasting, at 1, 2, and 3 hours respectively after the glucose drink.

For positive diagnosis 2 or more of the following venous plasma results must be raised above normal.
Fasting 95 mg/dl
1 hr. 180 mg/dl
2 hr. 155mg/dl
3 hr. 140 mg/dl

Q

A

Maternal diabetes can affect the foetus by causing defects or congenital malformations. There is higher risk for stillbirths in pregnant women with uncontrolled diabetes. High blood sugar level in the mother causes the pancreas of the forming baby to produce insulin, resulting in high fat deposition in the baby, giving rise to large flabby babies. The babies may develop respiratory problems or suffer from hypoglycaemia at birth or soon after. These children are at an increased risk of being fat in adult life and developing diabetes when they grow up.

Q

A

A diabetic pregnant woman has higher chances of developing pre-eclampsia and toxaemia - conditions that cause swelling of the body and puffiness, high blood pressure, kidney damage and convulsions. She may also go into earlier than due date labour, leading to increased risk of complications. There is also an increased chance of obstructed labour and caesarean delivery or birth canal injuries. Pregnancy worsens some of the existing diabetic complications such as eye problems.

Q

A

Yes, a person with a family history of type 2 diabetes or gestational diabetes in the mother has a higher risk to develop diabetes than those with no family history.

Q

Are overweight children more likely to get diabetes later in life?

A

Q

Is low birth weight a risk factor for diabetes?

A

Babies born with low birth weight who subsequently grow into normal or overweight adults are considered to be at a high risk of diabetes. It is believed that poor nourishment of the developing baby programs the baby to survive in an environment of deprivation. When this baby after birth is brought up in an environment of over-nutrition and grows into overweight adult he/she has a high risk of diabetes.

Q 

What happens to diabetes after pregnancy?

A

In most case diabetes, which occurred during pregnancy, may disappear after delivery. Immediately after delivery, the insulin requirements will fall. It is then important to change over to the treatment advised before the pregnancy. In case insulin was started only during pregnancy, the chances are it may be stopped altogether post pregnancy. Women who develop gestational diabetes have a higher risk of developing permanent diabetes. About 25-30% of women with gestational diabetes develop diabetes within 10 years. 

 Q

What are long-term complications of gestational diabetes?

 A

As stated above women with gestational diabetes have a higher risk of developing type2 diabetes later on in life. It is very important for them to keep their blood sugar levels and body weight within the normal range.

 Q

What special care is required for pregnant women with diabetes?

 A

Pregnancy is a delicate state and in women with diabetes it is all the more delicate, because improperly controlled diabetes can harm both the mother and the child. Therefore it is essential that whenever a woman with diabetes decides to become pregnant she must consult her doctor before, so that the proper advice regarding the importance of good blood glucose control during pregnancy can be given to her.

High blood glucose level during early pregnancy [first 3 months] can often cause irreversible harm to the unborn child. Therefore if a woman has become pregnant while her blood glucose was not well controlled it is essential that she consults her doctor immediately and ask his opinion on the next course of event.

During pregnancy women who cannot control their diabetes with diet and exercise should be given insulin, preferably human insulin to ensure good blood glucose control and to minimise risk of immune complications.

Insulin requirements fluctuate as pregnancy advances therefore it is best that pregnant women who have diabetes perform home blood glucose monitoring so that insulin doses can be adjusted as required. Her doctor should educate her on how this should be done. If this is not possible, weekly blood glucose tests at a good laboratory recommended by the doctor is advised. The doctor should be met at least every 15 days.

The doctor may recommend some tests, usually ultrasonography for assessing that the child is growing properly.

With the above precautions, pregnant women with diabetes can carry out normal routine just like other women without diabetes.

 Q

Will diabetes affect the child in the womb?

A

If the blood sugar level is kept under control, the chance of diabetes affecting the baby in the womb is extremely low. Uncontrolled diabetes increases the risk of malformation, defects, other complications and / or stillbirth.

Q

Is the risk of miscarriage in diabetic pregnant woman high?

 A

Uncontrolled diabetes increases the risk of miscarriage. It is very important that the woman understands the importance of tight control on diabetes and to tries to achieve near normal blood sugar levels.

 Q

Will taking insulin affect the child in the womb?

 A

Taking insulin will not affect the child in the womb. On the contrary not taking insulin and continuing to have high blood sugar could seriously harm the developing baby.

 Q

What should be the diet for a  pregnant woman with diabetes?

A

The caloric and protein requirement for a pregnant person with diabetes remains the same as a pregnant person not suffering from diabetes.

An extra 150 Kcal/day is needed for 1st trimester
An extra 350 Kcal/day is needed for 2nd trimester
An extra 350 Kcal/day is needed for 3 rd trimester
An extra 10 g of protein per day over and above the normal requirement is needed during pregnancy.
An extra dose of folic acid is also needed during pregnancy.
The person is advised to restrict refined carbohydrate rich foods and food high in saturated fats.
Consult your doctor or your dietician for more specific information.

Q

Can women with diabetes during pregnancy exercise?

 A

Generally women with diabetes with no major existing complications can do the same exercises as other non-diabetic pregnant women. The exception is women with existing diabetic retinopathy or high blood pressure where certain forms of exercise are contraindicated.

Q

Why women with gestational diabetes cannot take oral drugs, why insulin?

A

Oral drugs are generally not advised in gestational diabetes. Oral drugs are unable to achieve good glycemic control, especially in the face of worsening insulin resistance in pregnancy. Insulin instead has been shown to also reduce foetal complications. Furthermore oral drugs like sulphonylureas cross from the mother to the foetus and stimulate insulin secretion in the foetus leading to fat and fluid deposition and formation of large-sized babies (who are difficult to deliver).

Q

Do pregnant women with diabetes have a greater risk of infections? What extra precautions need to be taken?

A

Pregnant women with diabetes have greater risk of infections particularly of the urinary bladder and the genital area. Maintenance of proper hygiene, drinking plenty of fluids, emptying the bladder more frequently to avoid urine stagnation and good diabetes control will prevent these complications. Ensure that at the earliest sign of problem you consult your doctor.

 Q

Can a mother with diabetes breast-feed her child?

A

A mother with diabetes can breast feed her baby, if she wishes to. However, extra carbohydrates need to be taken at meals and with snacks to compensate for the loss of glucose in the breast milk. If nursing at night, take extra carbohydrate at night. It would be good to feed oneself and the baby around the same time.