High risk pregnancy- gestational diabetes mellitus |Dr. Monica Agarwal| Paras Bliss Hospital
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High risk pregnancy- Gestational Diabetes Mellitus

High risk pregnancy- Gestational Diabetes Mellitus

by: Dr. Monica Agarwal
Sr. Consultant Obstetrics & Gynecology - Paras Bliss, Panchkula

A normal low risk pregnancy is a very normal and natural process. A woman becomes pregnant, all investigations and parameters are within normal range. She goes in labour at term and gives birth to a healthy baby. But things are not that smooth always. There are complications which can effect the mother, baby or both. Today I will specifically discuss an ever increasing complication of pregnancy i.e. gestational diabetes.

This is a special type of disease which happens only in pregnancy. Blood sugar levels are normal before pregnancy but become high during pregnancy. They usually return back to normal once baby is born.

Cause of Gestational Diabetes Mellitus:

Placental hormones are usually diabetogenic, means they cause built up of glucose in your blood. Pancreas is not able to produce enough insulin according to the increased need causing increase in sugar levels.

Risk factors associated with Diabetes Mellitus:

  • Family history of diabetes
  • Overweight
  • Asian, Hispanic or African American origin
  • Prediabetes
  • Previous large baby(>= 4 kgs)
  • Previous still born or baby with birth defects

Symptoms associated with Diabetes Mellitus:

 Usually none. Detected on blood tests but you can have

  • Increased thirst
  • Increased hunger
  • Increased frequency of urine
  • Dry mouth
  • Tiredness

Diagnosis is made by GTT done between 24-28 weeks of pregnancy of earlier if it is high risk.

Problems associated with Diabetes Mellitus:

  • Macrosomia- Weight of baby is increased so there are increased chances of induction, difficult labour and caesarean
  • Polyhydramnios- Increase in amniotic fluid leading to preterm labour and difficult deliveryPreterm birth
  • Pre eclampsia
  • Still birth
  • After birth- Baby can have low blood sugar and jaundice

Treatment for Diabetes Mellitus:

If it is mild, then some lifestyle changes can keep it under good control. Customised diet chart is formed according to your BMI and eating habits.

Diet– Diet changes can control the sugar levels

  • Eat regularly and avoid skipping meals
  • Eat food with low glycemic index like wholewheat pasta, brown rice, all bran cereal, beans, lentils, muesli
  • Eat plenty of fruits and vegetables at least five portions per day
  • Avoid sugary food and drink
  • Include protein in your diet

Exercise– Active lifestyle consisting of regular walk and exercise is a must to control the disease.

Sugar levels are checked regularly and urine also checked for presence of sugar and ketones. If sugars are not in control after 2 weeks of diet and exercise, you maybe given medication in form of metformin tablets or insulin injections. Metformin is usually taken with or after meals.

Insulin– It is given if you cannot take tablets or have side effects with it, if sugars are not controlled by tablets alone or in case patient has macrosomia and polyhydramnios. With insulin always be careful of the symptoms of hypoglycaemia.

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