Gestational diabetes mellitus (GDM) is one of the commonest medical complications of pregnancy and its association with immediate pregnancy complications including excess foetal growth and subsequent risk of birth trauma which puts the health of the mother and newborn at risk are well recognised in most health systems.
However, less attention has been given to the longer term health outcomes for mother and baby including risks of obesity, pre-diabetes and cardiovascular disease prompting gynaecologists and obstetetricians to call for urgent action on the part of health systems worldwide to address these important issues affecting mother and baby.
As the theme for this year’s upcoming World Breastfeeding Week is “Enabling Breastfeeding makes a difference for working mothers” the Sunday Observer asked the Medical Coordinator of Suwa Divya which has been in the forefront of saying No to diabetes, how her organisation will achieve this goal in relation particularly to those at risk of Gestational Diabetes.
Dr. Chamari Warnapura Pandithage discusses the innovative approach used by Suwa Diviya to prevent and manage diabetes in women at risk of developing gestational diabetes by offering counselling and support groups to motivate such mothers to manage their sugar levels more effectively.
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 Dr. Chamari Warnapura
Pandithage
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Q: Many Sri Lankan pregnant women are still in the dark concerning a common medical complication which could put both the mother and baby at risk-namely Gestational Diabetes Mellitus. (GDM). What is Gestational diabetes and how does a pregnant mother develop this condtion?
A: When you eat, your pancreas releases insulin, a hormone that helps move a sugar called glucose from your blood to your cells, which use it for energy. During pregnancy, your placenta makes hormones that prevent insulin from working properly. Usually, your pancreas can send out enough insulin to handle it. But if your body can’t make enough insulin or stops using insulin as it should, your blood sugar levels rise, and you get gestational diabetes
Q: What are the risk factors that drive this condition in general?
A: Eight have given birth to a large baby (weighing more than 9 pounds) in the recent past.
You’re more likely to get gestational diabetes if you:
1. Were overweight before you got pregnant
2. Are Black, Asian, Hispanic or Latinx, Alaska Native, Pacific Islander, or Native American
3. Have blood sugar levels that are higher than they should be but not high enough to be diabetes (this is called prediabetes)
4. Have a family member with diabetes
5. Have had gestational diabetes before
6. Have polycystic ovary syndrome (PCOS) or another health condition linked to problems with insulin
7. Have high blood pressure, high cholesterol, heart disease, or other medical complications
8. Have given birth to a large baby (weighing more than 9 pounds)
9. Have had a miscarriage
10. Have given birth to a baby who was stillborn or had certain birth defects
11. Are older than 25
Q: What are the symptoms to look out for? Are they visible at the onset?
A: Most of the time, gestational diabetes doesn’t cause noticeable signs or symptoms. Increased thirst and frequent urination are possible symptoms. It is advisable to seek health care early especially when you first think about trying to get pregnant. Your doctor can check your risk of gestational diabetes along with your overall wellness. Once you’re pregnant, your doctor will check you for gestational diabetes as part of your prenatal care. If you develop gestational diabetes, you may need checkups more often.
These are most likely to occur after the first three months of pregnancy when your doctor will monitor your blood sugar level and your baby’s health.
Q: What are the complications of Gestational Diabetes?
A: Gestational diabetes can lead to high blood sugar levels. High blood sugar can cause problems for you and your baby, including an increased likelihood of needing a C-section delivery. If you have gestational diabetes, your baby may be at increased risk of excessive birth weight, early (preterm) birth, serious breathing difficulties, low blood sugar (hypoglycemia), and stillbirth. The child will be at risk of obesity and Type 2 Diabetes later in life. Gestational diabetes may also increase the mother’s risk of high blood pressure and preeclampsia, having a surgical delivery (C-section) and getting Type 2 diabetes later on in life.
Q: How is GDM diagnosed? What are the usual tests carried out to confirm if a mother -to- be has the condition or likely to develop it?
A: Gestational diabetes usually happens in the second half of pregnancy. Your doctor will check for it between weeks 24 and 28, or sooner if you’re at high risk. Your doctor will give you a glucose tolerance test: You’ll drink 50 grams of glucose in a sweet drink, which will raise your blood sugar.
An hour later, you’ll take a blood glucose test to see how your body handled all that sugar. If the results show that your blood sugar is higher than a certain level, you’ll need a 3-hour oral glucose tolerance test. For this test, you’ll take a blood glucose test after you have fasted for at least 8 hours (your doctor’s office will tell you exactly how long to fast for) and then drink a beverage containing 100 grams of glucose.
After that, you’ll take a blood glucose test every hour for the next 3 hours. Your doctor can also test you by having you fast for at least 8 hours, take a blood glucose test, drink a drink containing 75 grams of glucose, and then take a blood glucose test once an hour for the next two hours.
If you’re at high risk, but your test results are normal, your doctor might test you again later in your pregnancy to make sure you still don’t have it.
Q: Can one prevent it? If so,how?
A: The more healthy habits you can adopt before pregnancy, the better. If you’ve had gestational diabetes, these healthy choices may also reduce your risk of having it again in future pregnancies or developing Type 2 diabetes in the future. Eat healthy foods. Choose foods high in fiber and low in fat and calories.
Focus on fruits, vegetables and whole grains. Watch portion sizes. Keep active. Exercising before and during pregnancy can help protect you from developing gestational diabetes. Aim for 30 minutes of moderate activity on most days of the week. Take a brisk daily walk. Start pregnancy at a healthy weight. If you’re planning to get pregnant, losing extra weight beforehand may help you have a healthier pregnancy.
Focus on making lasting changes to your eating habits that can help you through pregnancy, such as eating more vegetables and fruits. Don’t gain more weight than recommended. Gaining some weight during pregnancy is typical and healthy. But gaining too much weight too quickly can increase your risk of gestational diabetes.
Q: If a mother has been diagnosed as having gestational diabetes, how soon should she get herself treated?
A. If you have gestational diabetes, you’ll need treatment as soon as possible to keep yourself and your baby healthy during your pregnancy and delivery. Your doctor will ask you to:
1. Check your blood sugar levels four or more times a day
2. Check your urine for ketones, chemicals that mean that your diabetes isn’t under control
3. Eat a healthy diet
4. Make exercise a habit
Q: What is the treatment?
A. Treatment for gestational diabetes includes lifestyle changes, blood sugar monitoring and medication if necessary. Managing your blood sugar levels effectively helps keep you and your baby healthy. Personal changes in your lifestyle and diet, how you eat and move is an important part of keeping your blood sugar levels in a healthy range and are very important in reducing risks of gestational diabetes.
Close management can also help you avoid complications during pregnancy and delivery.
Q: Does it include losing weight? Eating less? Elaborate please
A: Lifestyle changes include a healthy diet. Doctors usually don’t advise losing weight during pregnancy as your body is working hard to support your growing baby. But your doctor can help you set weight gain goals based on your weight before pregnancy.
Q: So what is a healthy diet ? What are the foods that make up a healthy diet which we should focus on?
A: A healthy diet focuses on fruits, vegetables, whole grains and lean protein. Foods that are high in nutrition and fibre and low in fat and calories. Limit highly refined carbohydrates including sweets. A dietitian can help you create a meal plan based on your current weight, pregnancy weight gain goals, blood sugar level, exercise habits, food preferences and budget.
Q: What about exercise? Is it safe for a mother with this condition to exercise? What are the benefits to the mother and baby?
A: It is also important to stay active. Regular physical activity plays a key role in every wellness plan before, during and after pregnancy. Exercise lowers your blood sugar. As an added bonus, regular exercise can help relieve some common discomforts of pregnancy, including back pain, muscle cramps, swelling, constipation and trouble sleeping.
Q: How long should pregnant women exercise and what exercises do you recommend?
A. With your doctor’s consent, aim for 30 minutes of moderate exercise on most days of the week. If you haven’t been active for a while, start slowly and build up gradually. Walking, cycling and swimming are good choices during pregnancy. Everyday activities such as housework and gardening also count.
Q: Any other important Do’s and Don’ts?
A: Careful Blood sugar monitoring is critical. While you’re pregnant, your doctor may ask you to check your blood sugar four or more times a day. First thing in the morning and after meals to make sure your level stays within a healthy range.
Q: If the blood sugar and hypertension of the mother continues despite a healthy diet and exercise,what are the options in managing these conditions? Medication?
A: If diet and exercise aren’t enough to manage your blood sugar levels, you may need insulin injections to lower your blood sugar. A small number of women with gestational diabetes need insulin to reach their blood sugar goals. Some doctors prescribe an oral medication to manage blood sugar levels. Others believe more research is needed to confirm that oral medications are as safe and as effective as injectable insulin to manage gestational diabetes.
Q: As the baby is also at high risk, what are the precautions taken to prevent any harm to the baby?
A. Close observation and monitoring of your baby is an important part of your treatment plan. Your doctor may check your baby’s growth and development with repeated ultrasounds or other tests.
If you don’t go into labor by your due date or sometimes earlier, your doctor may induce labour. Delivering after your due date may increase the risk of complications for you and your baby.
Q: After the delivery are these mothers followed up?
A: Yes. The usual practice is for their doctor to check their blood sugar level after delivery and again in 6 to 12 weeks to make sure that its level has returned to within the standard range. If the tests are back in this range and most are, they’ll need to have their diabetes risk assessed at least every three years. If future tests indicate Type 2 diabetes or prediabetes, then they should talk with their doctor about increasing your prevention efforts or starting a diabetes management plan.
Q: Can and how does a mother with gestational diabetes breast feed her baby?
A: Breastfeeding is a simple and natural process that helps give your baby a head start to a healthier life. Even if you have diabetes, you can and should plan to breastfeed for at least six months. If you have gestational diabetes, you’re at greater risk of developing Type 2 diabetes later in life. But the good news is that breastfeeding can reduce your risk because it helps your body process glucose and insulin better.
How long you breastfeed also affects your chance of developing type 2 diabetes. It has been found that breastfeeding for longer than two months lowered the risk by almost half. Breastfeeding beyond five months lowered it even more. Some babies whose mothers have diabetes or experience gestational diabetes are born with low blood sugar.
This doesn’t mean they need formula supplementation or cannot be breastfed. An infant’s low blood sugar is often best treated by early breastfeeding. Most diabetes medications, including insulin and metformin, are safe to use while breastfeeding. But check with your doctor, as the amount of insulin you need may change.
Q: Breastfeeding tips for new mothers with diabetes?
1. Breastfeed as soon as you can after delivery.
2. Get lots of skin-to-skin contact with your baby and nurse several times a day in the beginning.
3. Stay relaxed, and be patient while your milk comes in.
4. Have a snack before or during nursing and keep something nearby to raise your blood sugar quickly if needed.
5. Be sure to drink plenty of fluids to stay hydrated.
6. Check your blood sugar levels each time before and after nursing.
Q: Your advice to women trying to become pregnant and those already pregnant on how to prevent developing gestational diabetes and avoid complications of gestational diabetes.
A: Know your risk of developing gestational diabetes, and always seek to eat healthier and move more, while avoiding excess weight gain even before you get pregnant. Speak to your doctor early to understand your risks.
Q: Since this year’s theme for the upcoming Breastfeeding week is “Enabling working mothers to breastfeed makes a difference” how is your organisation helping working mothers with gestational diabetes to do so ?
A: At Suwa diviya we offer support groups for anyone who feels overwhelmed by their diabetes management and needs some motivation to control their sugars more effectively. Our support groups are run by medical professionals and can provide you the much needed clarity on monitoring your blood sugars, targets to meet, dietary changes and also just to answer any of your questions.
Q: How can they reach you?
A: You can get in touch with Suwa diviya on 0773533791 to reserve your place.