8 September 2011

High blood sugar levels during pregnancy can occur because of the hormonal changes that a woman goes through.

I HAVE been pregnant since January this year. During my most recent medical check-up, the doctor told me that I have high blood sugar levels. I am naturally very frightened for the baby. Do I have diabetes?

What you have is gestational diabetes. This is a disease characterised by high blood sugar (glucose, specifically) that is first diagnosed when you are pregnant. It occurs in 4% of all pregnancies.

There is a difference between having impaired glucose tolerance and gestational diabetes. Almost all pregnant women have some degree of impaired glucose tolerance due to the hormonal changes that occur. But this does not mean they have gestational diabetes yet.

In impaired glucose tolerance, your blood sugar levels are higher than normal, but not high enough to be diagnosed as diabetes.

It is during the third trimester (last three months) of pregnancy that a woman is most at risk of gestational diabetes.

How do my hormones induce this impaired glucose tolerance?

During pregnancy, your placenta makes certain hormones. The placenta is the organ that connects your baby via the umbilical cord to your womb. This placenta produces certain hormones that help prevent you, the mother, from developing low blood sugar, because at this crucial time, you need to feed your baby.

These hormones act by retarding the actions of insulin, the hormone produced by your body that works to store sugar, proteins, fats, etc.

This also means you have higher blood sugar levels during pregnancy. This in turn stimulates your pancreas to produce even more insulin. During pregnancy, your pancreas works overtime and is able to produce three times its normal amount of insulin to combat these hormones produced by the placenta.

However, if your pancreas should in any way fail to produce enough insulin during your pregnancy to overcome the placental hormones, this leads to gestational diabetes.

Why am I among the 4% of pregnant women who get gestational diabetes? Is it because of something I did, something I ate?

Many mothers who get gestational diabetes have no known risk factors. However, there are some factors that make you more at risk of developing gestational diabetes than other women. Being Asian is one of them.

Other factors include being overweight before you got pregnant, or having impaired glucose tolerance diagnosed earlier in your pregnancy. If your mother or sister had diabetes during pregnancy, you are more likely to have it as well.

If this is not your first pregnancy, then you have to recall what happened during your previous pregnancies. In your last pregnancy, did you have gestational diabetes? Did you have a baby over nine pounds? Have you ever given birth to a stillborn baby?

All these are factors that will indicate you are very likely to have gestational diabetes during this pregnancy as well.

How will I know if I have gestational diabetes? Will I feel dizzy? Sick? Will I vomit more than normal?

Very likely, you will have no symptoms. This is usually a diagnosis by blood screening. That is why it is so important to have regular medical check-ups with your obstetrician from the 24th week of pregnancy and henceforth.

If you have any of those risk factors I mentioned above, your obstetrician will ask you to screen regularly even earlier during your pregnancy.

You need to screen for high blood pressure and high blood sugar, and to make sure the baby is growing normally and that you are gaining weight normally.

Is having gestational diabetes dangerous for my baby?

Yes. In the first trimester of your pregnancy, having diabetes carries a risk of miscarriage and giving your baby certain birth defects involving his heart and brain.

During the second and third trimester, diabetes can lead to excess growth of your baby because of too much sugar flowing through the placenta. Large babies are difficult to deliver normally, and often require a Caesarean section.

When these babies are delivered, the baby’s blood sugar can also drop to very low levels. This is because your poor baby has all this time been producing very high insulin for himself in the womb to combat the high sugars flowing into him, and when this supply of sugar is suddenly cut off after birth, his insulin causes his blood sugar levels to drop.

Will I have to inject insulin if I have gestational diabetes?

This depends on your blood sugar levels. You will have to monitor your blood sugar levels three to four times a day, and that means pricking your fingertips and testing your blood on a glucometer.

You will have to watch your diet very strictly as instructed by your doctor, and to eat more frequently and less each meal. And you will have to take insulin if necessary, as no oral hypoglycaemic drugs will be allowed during pregnancy.

This article was published in www.thestar.com.my on 3 August 2011