Pregnancy and gestational diabetes

By Dr Ujwala Parashar, an obstetrician at North Shore Private Hospital

What is gestational diabetes?
Diabetes which occurs when you are pregnant is known as gestational diabetes (GD or GDM) and is known to affect somewhere between 6 – 9 per cent of women during pregnancy.

Please be assured, that with the right monitoring, treatment and care – women who develop gestational diabetes can still have a safe and healthy pregnancy that is not harmful to either the mother or the baby.

When does gestational diabetes occur and what are the causes?
Gestational diabetes typically develops between week 24 and 28. During pregnancy if you develop gestational diabetes, your placenta hormones can block insulin-action which prevents your body’s ability to effectively regulate the increased blood sugar caused by your pregnancy.

Who is at risk of developing gestational diabetes?
Although it is not entirely certain why some women develop gestational diabetes, some factors known to increase risk include:

Being overweight with a BMI of 30 or over.
Pregnancy when you are over the age of 40.
A family history of gestational diabetes.
Ethnicity plays a role. Aboriginal women and Torres Strait Islanders have a greater risk as do Asian and Hispanic women.
Previous pregnancy with gestational diabetes.
Multiple pregnancy.
Complications in a previous pregnancy such as still birth, low or high birth weight.
Slightly elevated blood sugar levels before pregnancy may mean you are at a higher risk of developing gestational diabetes.
PCOS (polycystic ovarian syndrome)

What are the symptoms of gestational diabetes and how is it diagnosed?
Most women who develop gestational diabetes don’t have symptoms and are often diagnosed as part of the routine care during pregnancy. However, if you have any of the known risk factors listed above, I may arrange for my clients to have a test at an earlier date in their pregnancy. The usual diagnosis is by a glucose tolerance test.

What are the effects of gestational diabetes?
If you have gestational diabetes and it is not effectively managed or if it is left untreated, your body produces excessive amounts of sugar which circulates through yours and your baby’s blood. This can have potentially serious adverse health risks that include:

The baby being too large. This make a natural delivery more difficult and often requires the baby to be delivered by Caesarean or “C” section.
Development of preeclampsia. This is high blood pressure during pregnancy that can result in the death of the mother as well as stillbirth of the baby.
The baby having post birth complications such as jaundice, low blood sugar or breathing difficulties. It can also be a potential risk for obesity and type 2 diabetes.

What steps can be taken to prevent gestational diabetes?
If you have risk factors that are from a family history, a previous gestational diabetes pregnancy or an older age pregnancy, there is no preventative action available to minimise your risk.

However, if you are overweight, have a poor diet and don’t undertake regular exercise, adopting new healthy habits prior to becoming pregnant and during pregnancy can make a big difference and reduce your risk.

If you are planning on becoming pregnant, take the following steps before conception and during your pregnancy:

Keep active! Just a 15-minute walk after lunch and again after dinner allows your body to burn glucose. Build this into your daily regime.
Adopt a healthy, well-balanced diet that includes a variety of fruit and vegetables, lean protein, fish, legumes and complex carbohydrates. Be conscious of your fat intake and limit the amount of saturated and trans fats (such as butter, palm and coconut oils). Also limit your intake of cheese, and processed meats like ham. Avoid processed and sugary foods and watch your portions.
Determine with your family doctor or your obstetrician a normal pregnancy weight and BMI – watch the scale and make an effort to lose any extra kilos before you conceive.

How do we manage and treat gestational diabetes?
If you have been diagnosed with gestational diabetes, your health during pregnancy – and your baby’s health – will need ongoing treatment and management for best outcomes.

As a qualified obstetrician, Dr Parashar is an expert in the treatment and management of gestational diabetes. Please ask your family doctor for a referral and call 1300 811 827 to arrange for an appointment. At your consultation, Dr Parashar will discuss your condition in detail, review your history and pregnancy, and will then be able to develop a management and treatment plant to ensure you and your baby remain healthy.