Diabetes In Pregnancy – Should I worry?


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Evidence Based - Facts Checked

This content is medically reviewed by Dr. Akanksha Bansal and written by Puneet Utreja

Last Medical Review Date - 12th October 2020


A woman's body undergoes a plethora of hormonal changes during pregnancy due to which she gets to experience some weird changes in the body. One such change is a tendency to have increased blood sugars (hyperglycaemia). It is weird because some women who never had a history of diabetes may get diagnosed with diabetes in pregnancy (a.k.a Gestational Diabetes)1Rodriguez, B. S. (2020, August 23). 'Gestational Diabetes.' Source-PubMed while in some women,  diabetes is diagnosed for the first time during pregnancy (Diabetes mellitus type 2).

Is Diabetes in Pregnancy Common?

Diabetes in pregnancy is becoming a common condition and affects around 14% of pregnancies globally, i.e., about 18 million births annually2Plows, J. F., Stanley, J. L., Baker, P. N., Reynolds, C. M., & Vickers, M. H. (2018, October 26). 'The Pathophysiology of Gestational Diabetes Mellitus.' Source-PubMed

It is important to diagnose and treat diabetes during pregnancy as uncontrolled blood sugars just prior to conception or during first trimester can cause congenital malformations in the baby. Even during the second and third trimesters, raised blood sugar levels can cause multiple problems like macrosomia (huge size for gestational age baby), polyhydroamnios (increased amniotic fluid volume), increased incidence of shoulder dystocia (baby gets stuck during vaginal delivery), increased incidence of intrauterine fetal death and also increased incidence of infections in the mother.

What Causes Diabetes in Pregnancy?

What Causes Diabetes in Pregnancy?

During pregnancy, hormone release undergoes a paradigm shift. The placenta produces HPL hormone (Human Placental Lactogen Hormone), also called HCS (Human Chorionic Somatomammotropin Hormone), which is required for the growth of the fetus. This hormone makes the pregnant woman's body resistant to insulin leading to a rise in the blood glucose levels, which is a normal adaptation of the body to make more glucose available in the mother for the baby. In majority of women, this mechanism is well controlled by the body.

In some women who are predisposed to diabetes (those who have family history and genetic predisposition to diabetes or obese women or women with other metabolic disorders and PCOS), this mechanism is unable to control blood sugar levels in mother and this leads to Gestational Diabetes. It can happen any time during the pregnancy; however, it is more common during the second or third trimester of pregnancy3Buschur, E. (2018, January 17). 'Diabetes In Pregnancy' Source-PubMed

Quick Note

Insulin  - is a hormone in the body that helps in controlling the sugar levels in the body.


Placenta - is a temporary organ/structure in a pregnant lady's body that attaches itself to the uterus via the umbilical cord and helps provide oxygen and nutrients to the fetus and, at the same time, also helps in removing the waste from the baby.

Symptoms of Diabetes in Pregnancy?

Following are the symptoms experienced by women during diabetes in pregnancy4Mumtaz, M. (2000, January). 'Gestational diabetes mellitus' Source-PubMed:-

  • Fatigue or tiredness
  • Presence of sugar in the urine ( is detected with a urine test which usually is ordered by a gynecologist)
  • A feeling of thirst - more than usual
  • Increase in the frequency of urination
  • Baby’s growth shall be more than average for the gestational age of the baby and  amniotic fluid volume may be more than the normal range

What is the normal sugar level during pregnancy?

Normal Blood Sugar During Pregnancy

During pregnancy,  your gynecologist will ask for an oral glucose tolerance test (OGTT) to screen for diabetes. Following are the cutoff levels for diagnosing gestational diabetes as per

a- American Diabetes Association

b - International Association of Diabetes and Pregnancy Study Groups

c - American College of Obstetrics and Gynecology

d - World Health Organization

Am I at a risk of Suffering from Diabetes in Pregnancy?

You might be at risk of suffering from Diabetes in pregnancy in the following conditions5Plows, J. F., Stanley, J. L., Baker, P. N., Reynolds, C. M., & Vickers, M. H. (2018, October 26). 'The Pathophysiology of Gestational Diabetes Mellitus.' Source-PubMed,6Rodriguez, B. S. (2020, August 23). 'Gestational Diabetes.' Source-PubMed

  • If you are obese
  • No or decreased physical activity
  • Have a family history of Diabetes
  • You are in an advanced maternal age
  • The weight of previously born infant was more than 4000 grams
  • Medical history of cardiovascular disease
  • Had Diabetes in a previous pregnancy
  • Low HDL (High Density Lipoprotein) – Less than 35 mg/dL
  • Family history of Diabetes
  • Polycystic ovarian syndrome
  • Triglycerides above 250 mg/dL
  • Abnormal glucose oral tolerance test

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Is Diabetes harmful during pregnancy?

Yes, Diabetes during pregnancy can be harmful if it is not appropriately managed. However, it has been seen that pregnant women who follow a prescribed regime for the management of Diabetes give birth to a healthy baby.

Following are some of the ill effects (during and after pregnancy) of pregnancy on the fetus and the mother:-

How does Diabetes affect the baby during and post-pregnancy?

Most of the fetal development, like heart, brain, lungs, kidney, etc., come into shape during the first eight weeks of the pregnancy. Uncontrolled Diabetes during fetal development can result in congenital disabilities affecting the baby's heart, spine, or brain7Mitanchez, D., Yzydorczyk, C., & Simeoni, U. (2015, June 10). 'What neonatal complications should the pediatrician be aware of in case of maternal gestational diabetesSource-PubMed

Further, Diabetes during pregnancy can lead to the overgrowth of the fetus, also called as macrosomia. In such a condition, the cesarean section is the most preferred way of delivery8Mokkala, K., Tertti, K., Rönnemaa, T., Vahlberg, T., & Laitinen, K. (2017, March 20).  Source-PubMed,9Scifres CM;Feghali M;Dumont T;Althouse AD;Speer P;Caritis SN;Catov JM;. (2015).  Source-PubMed

Post-birth, the baby remains at a high risk of suffering from metabolic syndrome, obesity and Diabetes. 

Can you have a healthy baby if you have Diabetes?


Yes, it is possible to have a healthy baby while you have diabetes during pregnancy. Following are some of the ways to do so:-

  • Monitor your blood glucose level, regularly
  • Stay active during pregnancy. Go for at least 15 minutes of walk daily after your meals. This will help in burning glucose in your body.
  • Follow a diabetes meal plan. Talk to your gynecologist for a detailed meal plan
  • Consume diabetes medication or insulin in a disciplined manner if you have been prescribed one.
Fetus
  • Plan regular visits to your gynecologist for checkups. Your gynecologist will perform the following tests to make sure, the fetus is healthy:-

    -Ultrasound – helps in monitoring the internal organs of the fetus, its growth, and the flow of blood through the blood vessels.
    -Fetal Echocardiography is recommended during 24th week in all women with diabetes to rule out heart defects in the baby.
    -Fetal Movement Counting  is a test done to check the number of kicks or movements over a certain period and notice any change in the activity
    -Non-Stress Testing – is a test to measure to fetus' heart rate--Biophysical Test Profile- is a combination of ultrasound and non stress test to check fetus’ heart rate, movement, and amniotic fluid.


How does Diabetes affect the mother during and post-pregnancy?

Diabetes during pregnancy can affect the mother in the following ways:-

- Antenatal Depression is a kind of depression that a woman suffers from during pregnancy. A correlation has been seen between women who have Diabetes during pregnancy and antenatal depression10S;, B. M. (2015). 'The relationship between gestational diabetes and antenatal depression'  Source-PubMed

- Pregnancy Complications like preeclampsia, premature birth and in some cases, surgical intervention may be required for the delivery of the baby11SZ;, T. P. (2008). 'The 50-g glucose challenge test and pregnancy outcome in a multiethnic Asian population at high risk for gestational diabetes'  Source-PubMed

Also Read - Preeclampsia During Pregnancy                       

- Diabetes Mellitus Type 2Women who have gestational Diabetes during pregnancy are at a higher risk of developing diabetes mellitus type 2, post-pregnancy12SZ;, T. P. (2008). 'Long-term diabetogenic effect of single pregnancy in women with previous gestational diabetes mellitus.'  Source-PubMed 

- Cardiovascular diseases – As per a study, 63% of women who have Diabetes during pregnancy are at risk of developing cardiovascular disease post-pregnancy13Shostrom DCV;Sun Y;Oleson JJ;Snetselaar LG;Bao W;. (2017). 'History of Gestational Diabetes Mellitus in Relation to Cardiovascular Disease and Cardiovascular Risk Factors in US Women'  Source-PubMed 

What Can a Pregnant Diabetic Eat?

The palatable taste might change during pregnancy however, if suffering from diabetes, it becomes essential to ignore the taste and focus more on following a diet that will help in controlling the blood sugar levels.

Following is the breakup of what and how much you should have if suffering from diabetes during pregnancy:-

Carbohydrates

Avoid eating simple carbohydrates like candy, potato, white rice, fries, sweets as it leads to a steep increase in the blood glucose levels14Holesh, J. E. (2020, August 25. 'Physiology, Carbohydrates'  Source-PubMed 

Complex carbohydrates are better than simple carbohydrates. Some of the examples of complex carbohydrates are grains, beans, yogurt, milk, wheat, brown rice, oats, corn etc. These carbohydrates break slowly in the body and thereby the increase in the blood glucose level is not steep15Holesh, J. E. (2020, August 25. 'Physiology, Carbohydrates'  Source-PubMed 

Vegetables

Try including as many vegetables as possible in your diet. 3 – 5 servings in the form of cooked leafy green vegetables, vegetable juice, vegetable soup or vegetable salad. Prefer using fresh vegetables if preparing salad using broccoli, spinach, carrots, lettuce and peppers.

Fruits

Try taking fruits after each meal. Oranges, apple, banana are some of the handy fruits that you can enjoy during pregnancy which will also help you in controlling your blood sugar levels. Avoid fruit like mango, dates and grapes which are very high in sugars.

Protein

Two to three servings of protein in a day which may include chicken, fish, egg, beans, or peanut butter.

Dairy Products

Three to four servings of milk, processed cheese or yogurt shall help you in controlling your blood sugar levels

Quick Note 

Avoid yogurt which contains preservative or artificial sweeteners.

Fats

Avoid taking fats like butter, hamburger, bacon, cheese as it increases your blood sugar levels. This doesn’t mean that you should entirely remove fat from your diet. Consume healthy fat, such as peanut oil, olive oil, groundnuts, almonds, egg yolk, peanut butter.

Sweets

Avoid consuming sweets as it affects your blood sugar levels considerably. In case of cravings, try keeping portions as tiny as possible.

Quick Note 

Avoid taking any of the above mentioned food items, if you might already have a known allergy.

We know that being diagnosed with diabetes in pregnancy can be stressful but taking these small steps towards a healthy diet and lifestyle along with prescribed medications would definitely keep you and your baby healthy!

References

  1. 1
    Rodriguez, B. S. (2020, August 23).
    Gestational Diabetes.
    Retrieved October 13, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK545196/
  2. 2
    Plows, J. F., Stanley, J. L., Baker, P. N., Reynolds, C. M., & Vickers, M. H. (2018, October 26).
    The Pathophysiology of Gestational Diabetes Mellitus.
    Retrieved October 13, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6274679/
  3. 3
    Buschur, E. (2018, January 17).
    Diabetes In Pregnancy.
    Retrieved October 13, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK279010/
  4. 4
    Mumtaz, M. (2000, January).
    Gestational diabetes mellitus.
     Retrieved October 13, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3406210/
  5. 5
    Mitanchez, D., Yzydorczyk, C., & Simeoni, U. (2015, June 10).
    What neonatal complications should the pediatrician be aware of in case of maternal gestational diabetes?
    Retrieved October 13, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4458502
  6. 6
    Mokkala, K., Tertti, K., Rönnemaa, T., Vahlberg, T., & Laitinen, K. (2017, March 20).
    Evaluation of serum zonulin for use as an early predictor for gestational diabetes.
    Retrieved October 13, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5380900/
  7. 7
    Scifres CM;Feghali M;Dumont T;Althouse AD;Speer P;Caritis SN;Catov JM;. (2015).
    Large-for-Gestational-Age Ultrasound Diagnosis and Risk for Cesarean Delivery in Women With Gestational Diabetes Mellitus.
    Retrieved October 13, 2020, from https://pubmed.ncbi.nlm.nih.gov/26444129/
  8. 8
    S;, B. M. (2015).
    The relationship between gestational diabetes and antenatal depression.
    Retrieved October 13, 2020, from https://pubmed.ncbi.nlm.nih.gov/25712378/
  9. 9
    SZ;, T. P. (2008).
    The 50-g glucose challenge test and pregnancy outcome in a multiethnic Asian population at high risk for gestational diabetes.
    Retrieved October 13, 2020, from https://pubmed.ncbi.nlm.nih.gov/19154997/
  10. 10
    TA;, P. R. (1996).
    Long-term diabetogenic effect of single pregnancy in women with previous gestational diabetes mellitus. Retrieved October 13, 2020, from https://pubmed.ncbi.nlm.nih.gov/8551882/
  11. 11
    Shostrom DCV;Sun Y;Oleson JJ;Snetselaar LG;Bao W;. (2017).
    History of Gestational Diabetes Mellitus in Relation to Cardiovascular Disease and Cardiovascular Risk Factors in US Women.
    Retrieved October 13, 2020, from https://pubmed.ncbi.nlm.nih.gov/28694789/
  12. 12
    Holesh, J. E. (2020, August 25).
    Physiology, Carbohydrates.
    Retrieved October 13, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK459280/

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This content is only for educational purpose and should not be considered as a substitute for your Physician's/Doctor's clinical judgement

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