Special Conditions

Home/Diabetes/Special Conditions

Gestational Diabetes

Gestational diabetes is a condition of high blood glucose that occurs during pregnancy and usually improves after childbirth.

Risk Factors

  • Obesity
  • Family history of diabetes
  • Having previously given birth to a baby weighing more than 4.1 kg (9 pounds)or one with birth defect
  • History of stillbirthor miscarriage
  • Having too much amniotic fluid (polyhydramnios)
  • Pregnancy over the age of 25 yrs

Symptoms and Signs

  • Frequent urination
  • Burning micturition (voiding of urine)
  • Excessive weight gain
  • Itching in genital region
  • Increased amniotic fluid
  • Large fetus
  • Pregnancy induced hypertension (high blood pressure)

Diagnosis

Oral Glucose Tolerance Test (OGTT) is the preferred test for diagnosis of Gestational Diabetes. The test is done after taking 100 gms of glucose in 300ml of water and blood samples are taken at 0 hour, 1 hour, 2 hour, and 3 hour intervals.

Normal values are :

  • 0 hr. : 105 mg/dl
  • 1 hr. : 190 mg/dl
  • 2 hr. : 165 mg/dl
  • 3 hr. : 145 mg/dl

The test is usually done :

  • At the end of the second or the beginning of the third trimester (between the 24th and 28th weeks of pregnancy) when insulin resistance usually begins.
  • In case one has had gestational diabetes in a previous pregnancy or if the doctor feels the need. One may be recommended OGTT as early as the first trimester (before the 13th week).

Management

Optimal nutrition is important during pregnancy to meet the demand of the growing fetus. Proper selection of foods and simple dietary restrictions can maintain normal blood glucose levels and could even preclude the use of Insulin.

Total weight gain for a healthy woman during pregnancy is about 12 –13 kg. The pattern of weight gain is as important as total weight gain.

Weight gain during pregnancy  
Period of gestation (in weeks)  Upto 10  Upto 20  Upto 30  Upto 40
Weight (kg)   0.65   4   8.5   12.6

Dietary management

  • Dieting or fasting during pregnancy is harmful.
  • Increased weight during pregnancy may also be due to water retention. In such cases, reducing food intake is not advisable. Consult your doctor. A salt restricted normal diet is to be taken.
  • During pregnancy, the energy requirement increases by 300Kcal and protein requirement by 15gm. Therefore, an increase in the carbohydrate and protein intake is advisable.
  • No single food can provide all nutrients; therefore, to achieve a balance, a combination of foods is desirable. Foods have been divided into food groups like cereals, pulses, meat, fish and poultry, vegetables, fruits, fats and sugar. It is advisable to select food from all groups in order to meet the nutrient needs.

food

  • Reduce your sugar intake, but do not resort to artificial sweeteners.
  • Restrict your fat intake. Increased fat intake may only add to the calories. Therefore, use white meat instead of red meat, grilled or baked dishes instead of fried. Use low fat salad dressings and low fat cheese.
  • Use of complex carbohydrates and foods rich in fiber including fruits, vegetables, cereals, pulses, legumes help in maintaining the normal glucose levels. Besides, it prevents constipation.
  • Foods rich in iron such as beans, green leafy vegetables, chirwa need to be taken. Taking lemon or citrus fruits with iron rich meals proves to be beneficial, because these are rich sources of vitamin C which enhances the absorption of iron.
  • Adequate intake of milk and milk products, green leafy vegetables provides enough calcium for the development of fetal skeleton and therefore is advisable.

calciumrichfood

  • Small frequent meals are preferred rather than large meals. This would reduce uneasiness and also help in maintaining a steady blood glucose level.
  • As constipation is a common problem during pregnancy, increase the intake of fluids.
  • A bedtime snack, which includes protein and carbohydrate, needs to be emphasized, as it would avoid hypoglycemia at night.
  • To prevent early morning sickness, a carbohydrate snack in the morning like biscuits or a toast could be taken.

Precautions

  • Alcohol and smoking should be avoided.

noalcohol

  • In case of water retention, salt should be restricted.
  • Tea and coffee should be taken in moderation.
  • In case the blood glucose level becomes too low, consult your doctor immediately.
  • Exercise- Daily walk proves to be beneficial during pregnancy, as it would reduce stress. In case of other exercises, consult your doctor.

Complications

I. Effect on mother

  • abortion
  • recurrent infections of urinary tract and genital region
  • pregnancy induced hypertension (pre-eclampsia and eclampsia)
  • hydroamnios (increased amniotic fluid)
  • ketoacidosis

II. Effect on baby

  • Macrosomia (large baby)
  • Birth defects
  • Birth injuries
  • After birth (neo-natal period)
  • hypoglycemia (low blood glucose)
  • hyperbilirubinemia (jaundice)
  • hypocalcemia (low blood calcium)
  • respiratory distress syndrome (difficulty in breathing)