Battling blood sugar during pregnancy: Gestational diabetes risks

Hi friends, here I am back again with yet another topic and this time i will be discussing some important facts on battling blood sugar during pregnancy and everything you need to know about gestational diabetes. . Some of you have commented that I tend to shock them in my articles but yes, the information is very very comprehensive and compact.

Hmmmmm …But is this the best combo possible? Sometimes a little wake-up call is what all of us need to realize that there is a problem and that it could be big. I do try and collate all the information that I can from all scientific sources including my limited brain and put them together in my blog and podcasts so that you won’t need any other resource for that information.

It is the most powerful creation to have life growing inside you, yes, there is no greater gift. And it is our collective duty to be aware of issues that can harm you or your baby during pregnancy and move heaven and earth to avoid those complications.

India is dubiously known as the Diabetes capital of the world. Thus it is only logical to assume that there will be many women who will be pregnant and will also develop gestational diabetes and will be battling Blood Sugar during Pregnancy. In this article will be discussing the testing, treatment, risks, and exactly how it might affect you and your baby. Before I move forward with statistics I must explain 4 terms to you.

Type 1 diabetes: This happens when there is little or no insulin production by the pancreas. More common in adolescents or younger people and has no correlation with lifestyle or diet meaning you can’t do anything to prevent this.

In type 2 diabetes, there is insulin but either it’s less or it’s ineffective. If you are an Asian or have a family background of diabetes or are above 40 yrs. of age or obese, you will have a higher chance of developing this. 

Gestational diabetes: happens for the first time in pregnancy because the changing pregnancy hormones cause insulin resistance i.e. the insulin is present but less effective. This sets in usually around the 6^th month of pregnancy. The women at higher risk of developing gestational diabetes are short women or women who already have glucose intolerance before pregnancy, women with PCOS, age above 35, overweight or obese, women who have a family history of diabetes or they have had gestational diabetes in one of their previous pregnancies. Women with excessive weight gain in pregnancy or those that had vitamin D deficiency in the first 3 months of pregnancy or those that develop high blood pressure in pregnancy will also be at a higher risk. Thus your past, present, and future affect your chances of developing gestational diabetes as you stand pregnant in the first weeks of the journey.

That brings us to the last term, that is 

Glucose intolerance:  this is a term that is applied to those people who are not frankly diabetic but sort of pre-diabetic. Imagine me standing at the edge of a cliff, perfectly balanced but if you were to give me the slightest of a push, I would fall over. These women too exhibit normal values of sugar when tested either in the fasting state but when they are given a glucose load, their sugars go over the normal limits. Why is it important for us to know about them? These women will develop gestational diabetes much earlier than 6 months into their pregnancy, probably even in their early pregnancy and thus this cluster of women need to be discovered to avoid complications.

I understand you must be wondering by now, am I trying to make a doctor out of you by teaching you meaningless jargon or is it just part of my scary routine. Worldwide less than 1 in 10 women have problems with sugars in pregnancy. In India, the incidence varies from 1 in every 10 to 1 in every 3 to 4 women depending on which part of India you belong to. Of all the women who battle blood sugars in pregnancy, about 1 % are Type 1 diabetes, 9% type 2 diabetes and the rest 90% is gestational diabetes. 

Ok, so we understand its common and commoner in India…. So, what’s the big deal…..

Lets first understand what it means for the mother

• 12% of such women will develop blood pressure in pregnancy because of the elevated sugars
• 10% of women with gestational diabetes will develop blood pressure after delivery and this will require lifelong treatment
• 50% of women who have gestational diabetes will develop Type 2 diabetes within 5 years of childbirth or after age 40

What does it mean for the child?

• Mothers with preexisting diabetes have a miscarriage risk of 12% 
• If the diabetes has been around for more than 10 years or with a poorly controlled diabetes with HbA1c of 11% or more, (I will explain HbA1c just a little later) the chances of miscarriage increases to 44%
• Increased risk of heart and brain, spinal corda, nerve and other defects. HbA1c is a blood test which tells us how good the sugar control has been in the last 3 months. The normal value should be less than 6.1% in the beginning of pregnancy. For every 1% rise in HbA1c above 6.3% the risk of abnormality also rises by 30%. the risk of problems is almost 44% if the HbA1c is goes beyond 11%. These figures are confusing, I know but they are important to impress upon you the fact that sugar control in early pregnancy is of paramount importance if you wish to prevent defects in the child. 
• Macrosomia or big babies. You have often heard of families jumping with joy when someone deliveries a very heavyweight baby, little realizing that most such babies are born to mothers who had undiagnosed, uncontrolled sugars. 
• Lesser chances of a normal delivery or a higher chance of an injury during delivery because of the big size.
• Lastly and in quite a scary manner, women are at higher risk of babies dying in their mother’s womb in the 3^rd trimester if the sugars are not well controlled.

Even after being born, the problems don’t cease:

• Higher risk of dangerously low sugars, respiratory problems, jaundice and low calcium levels immediately after being born
• Higher risk of obesity, blood pressure and diabetes later in life
• The intelligence quotient of these babies later in life is also lesser than others

If the problem is indeed so common, serious and with far-reaching consequences…..how do we deal with it?…….now I see I have your attention………

The golden rule is making sure you have a preconception counseling done before pregnancy to know your existing problems. Find out more about preconception counseling here or listen to my podcast on preconception counseling

Blood sugar during pregnancy becomes more relevant and important if you have risk factors like obesity and polycystic ovaries and other factors as mentioned at the beginning of this podcast. If you are found to have sugar issues get it sorted before you conceive.

Once pregnant one must remember that merely doing a fasting blood sugar test or doing a simple post-meal test is not good enough because this way, we miss those who have glucose intolerance.

Take 75gms of glucose, simple glucon D as sold in the market, on an empty stomach and without eating anything in between, give blood for sugar estimation after 2 hours. The value should be less than 140 mg /dl. 

• If the value is quite below this level, we are good, and you are safe
• If the value is only slightly below this level, then you need to be careful and make you engage a nutritionist and exercise regularly
• If the value is more than 140, speak to your doctor and he or she will guide you best by creating a team with a diabetes specialist and a nutritionist and the 3 of them managing the problem together

Even if the values are normal, those with a higher risk should get this test a few more times in pregnancy.

As I said earlier gestational diabetes normally sets in after the 6^th month of pregnancy and thus we repeat this test at that time again, for each and every patient. Depending on the values, the line of management will be the same as I mentioned before.

Another question I keep getting from patients and even doctors is that once a woman is diagnosed to have gestational diabetes and she has been put on diet and or medicines or even insulin, how do we monitor the blood sugar during pregnancy. Unfortunately, there is a lot of confusion in many minds regarding this but if one were to go by scientific guidelines, the advice is very clear and simple. Test your blood glucose levels by finger prick using a home glucose meter, 90 mins after breakfast, lunch, and dinner. All values should be less than 120. Remember after breakfast values are the most notorious for going up so watch those more carefully.

Before I end this discussion 3 more things you must remember are:

1. Women with gestational diabetes will have a higher risk of urine infections which in turn can lead to premature delivery. Keep a watch out for the infection by getting yourself tested frequently. They can sometimes be silent
2. Babies born to such mothers are notorious for having respiratory problems even if the delivery happens close to full term. 2 doses of steroids being given, largely take care of the problems and make it safe for the baby. Do not hesitate in discussing this with your doctor and taking the injection even though it may temporarily raise your blood sugar during pregnancy further
3. Lastly, the levels of blood sugar during pregnancy will drop to normal within hours of you delivering. Thus, you need not worry about continuing medicines or even insulin after birth. But yes, you need to change your lifestyle later to avoid it coming back into your life permanently.

Remember, your pregnancy goes by fast, enjoy every moment of it but enjoy it responsibly because you have the world’s future in your womb and I have the responsibility of that future on my shoulders. 

This brings me to the end of yet another discussion. This discussion is also available as a podcast – check out here.

This podcast is available on Apple and Google podcast as well as Spotify. Do subscribe and leave your comments and suggestions on the Apple podcast app. That’s the only way we can make this better. 😊 Looking forward to great interactions…. keep listening.

If you get a chance do look up my website www.drrajeevagarwal.co.in and YouTube channel in my name.

Do email me on fertilitywithoutborders@gmail.com if you have any queries or if you want me to create a podcast on any topic of your choice.