Dr Girija Wagh, Obstetrician, Gynecologist, IVF expertMD, FICOG, DIP ENDO, FICS
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Diabetes in pregnancy (DIP) a terrifying menace, definitely preventable, easily detectable and a mandatory to be screened disorder before conception, during pregnancy and post delivery. Yes friends, diabetes is on rise and especially takes an untoward and sometimes serious turn during pregnancy. The disorder has immediate and futuristic consequences of concern and especially in Indian women and therefore a focussed approach to diligently screen for it, prevent it and treat it have to be undertaken. Indian ethnicity is special and therefore needs special approach and this blog is an attempt to make women and their families understand this special situation. As always this is for the purpose of making women understand the details as an educated, knowledgeable woman can take responsibility of her own health for the betterment of her family and the entire society.
Today on an average 20 % of pregnant moms are diagnosed with diabetes, this incidence is somewhat equal to the occurrence of PCOS(polycystic ovarian syndrome ) in Indian women and this rings a bell for sure !!! Lifestyle challenges seems to be an underlying cause compounded by the Asian ethnicity. Many studies have now proved without doubt that pregnant women in India are at higher risk of developing diabetes and its consequences. So, Let us go through this write up and try to understand what this is ?
Diabetes Mellitus is a disorder characterised by abnormal sugar levels in the blood associated with many other symptoms such as water thirst, excessive urination, susceptibility to infections and may be diagnosed when the person is suffering from some other illness. The pancreas is a special gland situated behind the stomach in the middle part of our body which secretes a special hormone insulin. Insulin helps in driving the sugar from the blood into the cells for energy and metabolism and stores the excess glucose in the liver. Glucose, as we know is necessary for our energy requirements. But excess or very less amount of glucose in the blood is harmful as it can further cause the release of insulin and increased level of the latter in the body. Increased insulin can cause creation and accumulation of free fatty acids giving rise to increased triglycerides in the blood and cause fat mobilisation accumulation. Diabetes can occur when the insulin production is deficient ( since birth ) (Type 1 diabetes ) or the insulin produced is ineffective (insulin resistance which is acquired) ( Type 2 diabetes).
Pregnancy is a condition identified as ‘diabetogenic’. This is because the hormones released from the placenta, meant for the specific growth of the baby and the adaptations of the mother’s body are all anti-insulin in their actions and cause increased insulin resistance. This is a normal physiology intended to nurture the baby but can get toppled into a pathological condition such as diabetes due to external factors.
These external factors also are the risk factors for diabetes. Obesity with BMI (Body Mass Index) more than 30, lack of exercise, improper diet and genetic factors, prior disorders such as PCOS, thyroid dysfunction and family history of diabetes are these situations. Asian ethnicity is a major risk factor making it mandatory that all mothers be screened during pregnancy and all moms-to-be screen themselves before conception.
There is a special DIPSI test which is best validated test for diagnosis of diabetes and is glucose challenge test. It screens, as well as diagnoses the mother for presence of pregnancy related or overt diabetes. This test also helps in identifying mothers with insulin resistance and the pre-diabetic condition evaluating the mothers at risk of developing diabetes. It’s a simple test and recommended by the government of India. Some other blood and urinary tests too can help identify diabetes or evaluate it further.
Diabetes, if present at the time of early pregnancy around the time of conception, can cause some serious anomalies in the foetus. High levels of glucose in the mother’s blood is embryo toxic and can cause, mis-carriages, missed abortions, and serious defects in the foetus. After 16 weeks of gestation, it can program the foetus to have a sudden surge of growth leading to macrosomic ( pathologically large) baby.
Mother, who is a diabetic before conception can have all these issues if her sugars are not well controlled and in addition, can have growth restriction in the baby if the disorder is long prevalent. The mother can have complications such as seriously low or high sugar levels leading to complications. They can also develop raised blood pressure which can be life threatening. These mothers are also susceptible to infections especially of the urinary and the respiratory system.
Preterm deliveries, premature rupture of bag of water due to infections, need of a operative delivery due to large baby or a compromised baby health are other issues with diabetes.
Specially structured diet, daily walks at least for 30 minutes and medicines such as oral medications or insulin injections along with proper supplements help in controlling the blood sugar levels, reducing insulin resistance and reducing other consequences
The delivered mother has to maintain weight and not put on excessive weight. She has to continue taking medications and has to get herself regularly screened for diabetes and its consequences. Regular yearly screening after this is mandatory as it is been observed that 50% of mothers may develop diabetes after 5 years if appropriate lifestyle changes are not made.
These women are at risk of developing diseases such as raised blood pressure, diabetes and risk of ischemic heart diseases in earlier ages. Therefore, regular screening and modifications of health are necessary. Babies born to dinacteic mothers can become programmed to become diabetics in future.
She must regularise her sugar levels to ideal measurements and try to achieve right BMI and take folic acid supplements. Also, revision of the diabetic medications is necessary.
To conclude, we must understand that diabetes is an acquired disorder as a result of lifestyle challenges and as Asians we are more at risk of contracting and transferring this illness to future generations. With proper planning and determination, we as a society can definitely curb this illness and make our society free of diabetes. We must all pledge to such an achievement. Let’s avoid the avoidable and help build a healthy society for tomorrow and longtime to come !!
Dr. Girija Wagh, MD (Obstetrics & Gynaecology), FICOG, FICP, Diploma (Endoscopy, Infertility), Fellowship of Indian College of Ob-Gynec, Women health care specialist, Academician, Acclaimed Orator & Researcher, B. J. Medical 1990-1992, Topper University Of Pune 1992
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