Pregnancy and Diabetes

Have you been diagnosed with gestational diabetes? While that might sound overwhelming at first, it turns out the condition is more common than you may think. / Recent studies indicate that gestational diabetes is on the rise. How can you protect yourself and your baby during pregnancy from this condition? 

Gestational diabetes only happens during pregnancy and affects about three to five out of every 100 pregnant women. Even women who have not have diabetes before can experience gestational diabetes in pregnancy. So, what are the risks and how can they be overcome to ensure a healthy mom and baby throughout the nine months of pregnancy? Charlene Yared-West speaks to Dr Bandile Masuku and Dr Gaontebale Matlhaga, two obstetrician/gynaecologists from Life Suikerbosrand. 

What causes gestational diabetes?

Pregnancy can affect the normal way a woman’s body processes sugar. In normal circumstances, explains Dr Gaontebale Matlhaga, obstetrician/gynaecologist from Life Suikerbosrand, food is ingested and digested and glucose from the food enters the bloodstream. “In response to this increase of sugar in the blood, the pancreas releases the hormone insulin, which helps to move the sugars from your bloodstream and into your body’s cells, where it is used as energy,” he says. “In pregnancy however, the placenta produces pregnancy hormones, which impair the action of insulin, which automatically then raises the blood sugar levels.” As your pregnancy progresses and your baby grows, the placenta, he says, produces even more insulin-blocking hormones, which create a cycle of  increased blood sugar levels. He adds that the condition is most common from around 20 weeks of pregnancy, but generally not earlier than that. “It isn’t always easy to notice signs or symptoms – which are non-specific and so it is usually picked up in the urine test, which is then followed up with a fasting blood test to ascertain if the woman has this condition,” he says. 

<Sidebar> What are the different types of Diabetes Mellitus?
Diabetes mellitus, otherwise known as diabetes is a metabolic condition where there are uncontrolled high blood sugar levels over a long period of time. Symptoms can include increased hunger and thirst, as well as frequent urination. 

Type 1 Diabetes: An autoimmune disease, where the pancreas produces very little or no insulin at all. It is most common in people under the age of 20. 

Type 2 Diabetes: A disease found in people who are overweight as they get older, where the pancrease does not produce enough insulin, or the body does not use it properly. It can be considered a lifestyle disease which is usually triggered by little or no exercise and being overweight. 

Type 3 Diabetes: A condition otherwise known as gestational diabetes, which occurs in pregnancy.

<Sidebar>Who is at risk of gestational diabetes? 

  • Women older than 25 years of age are more prone to metabolic conditions.
  • Women with polycystic ovary syndrome. 
  • Family or personal history and pre-pregnancy diabetes. 
  • Women with a body mass index of 30 or higher. 
  • Women who are black, of indian origin or Asian are more likely to develop gestational diabetes. 

What are the complications of developing gestational diabetes? 

If left undiagnosed, the complications for mother and baby can be dire, explains Dr Bandile Masuku, obstetrician/gynaecologist from Life Suikerbosrand. “Babies are born with a high birth weight, because of the extra glucose in the bloodstream, which crosses the placenta and triggers the baby’s own pancreas to make extra insulin – and this causes the growth rate to speed up. As a result, many of these babies with this condition known as macrosomia, are born via Caesarean because of their size,” he says. “Preterm labour is also a risk, which also means that the baby’s lungs are not fully developed and the baby will not be able to breathe on its own. In addition, babies can also develop low blood sugar, because their insulin production is so high, which can also lead to seizures. As a result the blood sugar levels in the baby must be closely monitored after birth to help normalise the baby’s blood sugar level. Babies of mothers who have gestational diabetes also have  an increased risk of developing obesity and type 2 diabetes later in life,” Dr Masuku adds gestational diabetes can also increase the risk of high blood pressure and preeclampsia, which are also dangerous to mother and baby. Furthermore, women with gestational diabetes also often develop future diabetes; whether in a future pregnancy or type 2 diabetes later in life.

Why is it challenging to fall pregnant when you have diabetes?

Women suffering from Type 1 or Type 2 diabetes usually face challenges when trying to fall pregnant as the “conception environment” can be compromised, explains Dr Matlhago. Type 1 Diabetes sufferers also tend to have higher incidences of miscarriage or have a baby born with a birth defect. In a healthy person, food is digested with the help of the hormone insulin – and in diabetics, there are flaws in this metabolism system. Hormones and hormone production are an essential part of the reproductive process – especially for a person wanting to conceive – and diabetics have a compromised system of hormonal control. “In addition, diabetic men may also want to consult their doctor about problems that can arise such as erectile dysfunction and damaged nerves, which can cause the sperm to enter the bladder during ejaculation,” he adds. 

Getting ready for pregnancy: Consult your ob/gyn

“It would be beneficial for all women who want to fall pregnant to see their obstetrician/gynaecologists before conception, for counselling and to develop a plan – especially if they have diabetes as an existing condition. It is important for all women to gain control of their blood sugar levels before pregnancy, which can also help to avoid the onset of gestational diabetes,” says Dr Masuku. “It is also more challenging for women who have pre-existing diabetes to fall pregnant, so a consultation can help to see where the problem is and also to create a programme, which includes dietary advice and exercise guidelines. It even helps if a woman can lose extra weight before conception to also help achieve a healthier pregnancy and lower her chances of getting gestational diabetes.” 

Managing gestational diabetes

According to Dr Masuku, it can be psychologically challenging and inconvenient to be diagnosed with gestational diabetes, because of the lifestyle and dietary changes that come with the treatment strategy. “Daily checking of the sugar levels, before and after meals is necessary to make sure the levels are within a healthy range,” he says. “In addition, eating the right kinds of food in healthy portions is one of the best ways to control the sugar levels and help to avoid weight gain. Exercise also plays an important role and can help lower your blood sugar by encouraging your body to move glucose into your cells where it will be burned for energy – and less insulin will be necessary.” He adds that if diet and exercise are not impacting your sugar level, medication might be necessary, which is assessed on an individual basis. “Medication in the form of oral drugs and injectible insulin might be necessary to control the condition.” 

<Case Study>Millicent Ndlovu 

“I was 30 weeks pregnant, on the highway and driving to work one winter’s morning in June, when I suddenly felt extremely hot, so I opened the car window and then felt terribly nauseous. I started vomiting and moved over into the slow lane. Luckily I was close to the office, but the nausea wouldn’t go away and I started vomiting some more. My colleague took me to hospital, where I was kept for observation. They measured my sugar levels and they were exceedingly high and wouldn’t go to normal levels even that evening when the levels were taken again. It was decided to put me on insulin, which brought my levels back to normal. I also had to speak to a dietician who advised me on diet and exercise. Diabetes is hereditary in my family; both my parents and sister have it, but I did not – and I thought I was having a healthy pregnancy; no morning sickness or nausea, I only had fatigue.  It was very frustrating for me to have this condition and of course I was worried about the health of my baby too. Thankfully, through diet and injectible insulin I controlled my sugar levels well and my 4.5kg baby girl, Humelelani was born on July 22, last year, via caesarean section. The gestational diabetes cleared after I had given birth, but after a health screening at work about a year later, it was determined that I had diabetes type 1, which I now manage with medication and a strict diet.”