GESTATIONAL DIABETES

WHAT IS THIS? Gestational diabetes is a condition caused by a rise in blood sugar levels which can possibly develop in pregnant women around the 24^th week of gestation. “It is a common medical problem - Hypertension being the first while gestational diabetes comes second,” says Dr. Tarakeswari, our specialist in gestational diabetes. HOW IS IT CAUSED? Hormones from the placenta, which connect the baby and the mother, help in the baby’s development. These hormones also block the action of the mother’s insulin in her body. Insulin aids the process of converting glucose in the blood to energy. During pregnancy, the mother’s body uses at least three times the regular amount of insulin. When the body is not able to produce the optimum levels of insulin it requires during pregnancy, it leads to Gestational Diabetes. PREVENTION There is no guaranteed method to prevent the onset of gestational diabetes. However, adopting healthier choices earlier in life and during pregnancy are helpful in keeping it under control. If you have had gestational diabetes previously, then following a healthy lifestyle reduces the risk of having it in future pregnancies or developing Type 2 diabetes consequently. Here are some of the healthy choices women can make: Eat Healthy Foods:

• Choose to eat foods with high fibre content and low in fat and calories.
• Add ample fresh fruits and vegetables to your diet.
• Strive to balance your protein and carbohydrate content while making sure you gain enough nutrients from your daily food intake.
• Watch your portion sizes.

Exercise:

• Be sure to add a cardio workout for at least 30 minutes to your day. It could be brisk walking, light jogging, cycling or swimming.
• Stay moderately active every day.

Losing Excessive Pounds:

• It is not recommended to lose weight during pregnancy. Hence shedding excess weight before conceiving helps you have a healthier pregnancy.

MYTHS There are an umpteen number of myths about gestational diabetes which have been addressed time and again. These myths paint a false picture in people’s minds creating a stigma around this disease. Two of the most common and important myths are addressed below. However, diabetic pregnancies require extra care and excellent blood sugar control, before and during the pregnancy. If you have diabetes and are trying to conceive, it is vital to talk with your doctor. Myth 2: Gestational diabetes does not need to be taken seriously. Although gestational diabetes usually disappears after childbirth, it needs to be monitored. Ignoring it not only leads to complications in pregnancy, it is also a health hazard to the mother and baby. Our specialist Dr. Tarakeswari says, “There are two complications which may arise if the blood sugar levels are not controlled. Firstly, the baby is born overweight, leading to difficulty in delivering the shoulder, causing shoulder damage. The second one could be an increase in the need for a C-section to deliver the baby.” If precautionary measures are not taken in time, there are high chances that the mother and the baby will develop Type 2 diabetes later in life. This makes it vital for the mother to keep her blood sugar levels in check. HIGH AND LOW RISK FACTORS: These factors determine the likelihood of developing gestational diabetes. OUR SPECIALIST Dr. Tarakeswari is the Head of Obstetric Medicine Unit at Fernandez Hospital. Her professional interests include Medical Disorders Complicating Pregnancy, Recurrent Pregnancy Loss and High Risk Pregnancy. Dr. Tarakeswari, our specialist in the care of Gestational Diabetic mothers, has been associated with Fernandez Hospital for 20 years. Since joining in March 1995, she has supported, counseled and guided mothers with gestational diabetes through their pregnancies. Dr. Tarakeswari YOUR QUESTIONS ANSWERED Q: Tell us how Fernandez Hospital acts a referral center for Gestational Diabetes?  Dr. Tarakeswari: As we have a nutritionist, an endocrinologist and an expert fetal medicine team under the same roof, a lot of pregnant women diagnosed with Gestational Diabetes come in for a second opinion. We make sure we know complete details about the patient’s previous pregnancy history; it could be either diabetes or any other condition. Firstly, the nutritionist and the endocrinologist review the patient together. The nutritionist suggests the mother a diet plan and the endocrinologist checks her current diet and starts her on insulin. Once this process begins, the fetal medicine team keeps a constant check on the health of the baby. As everything is done under one roof, it becomes easy for the patient to keep herself and her baby healthy.

A picture of the team

Happy mother Ms. Sandhya gupta shares her experience with Fernandez hospital: “What really stuck us about FH from the very beginning - over and above their medical expertise - is their thoroughness and personal care. Despite packed schedule, Doctors would specifically ask us multiple times if we had any questions. And we had a lot of them! Doctor would listen to one and all and reply with full patience. Follow ups for tests/appointments were another hallmark. 3 months into pregnancy, and it was discovered I'm gestational diabetic and we went into panic mode, again! We had read/heard about stories of complications due to diabetes: high risk pregnancy, baby weight, C-section. FH staff also went into overdrive. We were given special appointments, all scenarios were explained, and assured that with proper advice and care it can be managed. Regular appointments with Dr. Santosh (Endocrinologist), dietician consultations, regular-and-frequent sugar level test records, and all these being discussed with Dr. Tara - led to keeping sugar level in control over the months. Towards the last weeks, doctor paid special attention to glucose levels and baby weights and advised induced labour a little before full-term. Sure enough, we have a healthy baby boy with 3 kg weight at birth from NORMAL DELIVERY! This requires another special mention - while we had a notion that doctors every-where jump to C-section at first chance, at FH, Hyderguda, it was just the opposite! Most beautiful reward we got for sure. Thanks FH (doctors/nursing staff/others) for the beautiful gift and amazing experience. We'll cherish the experience and be in your gratitude forever!”     Q: Does gestational diabetes go away after delivery? Dr. Tarakeswari: We do a follow up after 6 weeks of delivery. If the blood sugar levels are high, we advise the patient to continue the diet. There are cases where the blood sugar level returns to normal while in some cases, they might develop Type 2 diabetes after delivery. If one develops diabetes during pregnancy, there are high chances of it transforming into Type 2 diabetes in the future. Q: How much does gestational diabetes counseling help the pregnant women? Dr. Tarakeswari: Counseling helps a lot during pregnancy. There are women who come to us before planning their pregnancy. We tell them to check their blood sugar before they conceive because they might have a family history of diabetes. Counseling gives you information on the body health conditions. Information is provided to pregnant women before signing them for blood sugar levels check. They need to be kept calm as panicking can only cause distress. Before ordering the test, we tell them why it is important. Usually we do the test at 24 to 28 weeks as that is the time when gestational diabetes is detected. But for those with a family history of diabetes, it is done around the 16^th week. Q: Are there specific doubts that pregnant women have during pregnancy? Dr. Tarakeswari: They do have questions like -- What happens to my baby if I have gestational diabetes? Will the baby have diabetes? Will I have a normal delivery? We assure them that nothing will happen to their baby and if they are well in control of their diet, and exercise on a regular basis, they can have a normal delivery. But if the sugar level is high, we make sure to tell the patient to admit themselves a week before their due date.   Q: Is it compulsory to take the test at 26 weeks or does it depend on certain factors? Dr. Tarakeswari: We take a combination of both into consideration. If somebody is treated for infertility and her BMI is 30, we test them before 16 weeks itself. If she has a BMI of 24 and she conceives with no family history of diabetes, then we test her at 24 weeks. Happy Parents Ms. Richa and Mr. Anilesh share their experience with Fernandez hospital: ”When my wife conceived after two early miscarriages, it came as a beautiful surprise which was later shattered by the detection of Rubela/Herpes & MMR virus through torch test. To top up, the mother was also detected with Gestational Diabetes. Hope showed up with someone suggesting Fernandez Hospital as the best place for all such otherwise difficult cases. And the journey started with first visit at Hyderguda Branch. The consulting Doctor’s serious intervention along with much care and concern brought us to the last leg of our journey. Not even a single detail went unnoticed and at all steps taken by them stood by us and here we are, with a cute little girl delivered normally. Yes! Surprising but true, that even mothers with gestational diabetes can deliver normally and we are a true witness to this. We take pride and pleasure together to thank the whole team at Fernandez Hospital, Dr. Tarakeswari and other senior doctors who stood with us all through. We also thank the Nutrifit team led by Dr. P. Janaki for their dietary planning and assistance. Not to forget the ever smiling team at the OP helpdesk to always accommodate us even in the 11^th hour. But on top of all, we are humbled by patient intervention and concerning attitude of the labour room team who persisted despite all odds to help us deliver a health born baby. We fall short of words to describe our sincere gratitude towards all of them (as one team) for everything. It sure has been a life changing and heartwarming experience that God gave us through bringing us to Fernandez Hospital.”