Watch your sugar, for baby's sake
When 33-year-old Anita conceived, she was overjoyed. But the joy was tempered when, in the seventh month of pregnancy, diagnostic tests revealed
that she had diabetes. Both her parents were diabetic but this had not prepared her for her own condition.
“When I was carrying, I felt weak and heavy. That is when doctors discovered I had gestational diabetes,” she says.
Anita is hardly unusual. The incidence of gestational diabetes, caused by the hormones produced during pregnancy, has shot up in India from a mere 2% in 1980 to 17% today. This diabetes usually occurs between the 24th and 27th weeks. The pregnancy hormones reduce a woman’s sensitivity to insulin, sending blood sugar levels soaring.
What’s particularly alarming is that babies of affected mothers are more likely to be obese, both as children and adults. They are also more prone to diabetes later in life. The mother is at risk too because 30% of women who get gestational diabetes also develop maturity-onset or Type 2 diabetes seven to 10 years after the pregnancy.
Experts say that the spike in gestational diabetes parallels the recent rise in diabetes cases. The World Health Organisation (WHO) estimates that India may see a rise in diabetes from 135 million cases in 1995 to 300 million in 2025 — a whopping 120% increase.
Asians are already regarded a high-risk group and have 11% more prevalence of gestational diabetes than the rest of the world, say experts. The global average is between 4-8%; in the US, it is 6%.
The rise of gestational diabetes cases in India was confirmed during a diabetes and pregnancy awareness project by Apollo Hospital, Chennai, in 2004.
The four-year project, which screened some 13,000 people in Tamil Nadu, revealed startling statistics, says Dr V Balaji, senior diabetologist at Apollo Hospitals. The results led to mandatory screening for glucose intolerance in pregnant women at all state government centres.
So what happens to a woman with gestational diabetes? Doctors say it affects the mother in late pregnancy. It could strike earlier if a woman has a family history of diabetes, polycystic ovarian disease or obesity. The mother’s increased blood sugar levels are transferred to the baby.
This, in turn, causes the baby’s pancreas, which start working within 11 weeks of conception, to produce extra insulin to get rid of this sugar.
“Insulin, incidentally, is a growth hormone. As the baby starts getting more energy than it needs, this gets stored as fat, leading to an abnormal weight gain, usually over 3.5 kg,” says Dr Ambrish Mithal, president-elect, Endocrine Society of India. “This may require delivery by caesarean section and cause breathing and shoulder problems at birth for the baby.”
Although gestational diabetes is only a temporary phase and it disappears after pregnancy, there is a 65-70% chance of it recurring. Therefore, it is vital for the mother to control her sugar intake and monitor blood sugar levels.
Mithal says gestational diabetes is often treated with insulin and dietary control rather than drugs. If treated in time, no complications ensue. Mithal says that many people don’t know that pregnant women have lower blood sugar levels than those who aren’t.
The baby absorbs nutrition from the mother, causing blood sugar levels to fall. So the pre-diabetic phase in a normal person becomes gestational diabetes in a pregnant woman. Testing is done an hour after fasting in pregnant women as sugar levels are highest at the time. Normally, this would be done two hours after fasting.
One of the important tests to get mean glucose value for the last 90-120 days of pregnancy is the HbA1c test. A woman with an HbA1c level lower than 5.3 does not indicate gestational diabetes, while one above 6 would.
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