Obstetric & Gynaecology Malaysia

OBSTERIC & GYNAECOLOGY IN MALAYSIA

What is gestational diabetes (GD)?

Diabetes mellitus (also called “diabetes”) is a condition in which too much glucose (sugar) stays in the blood instead of being used for energy. Health problems can occur when blood sugar is too high. Some women develop diabetes for the first time during pregnancy. This condition is called gestational diabetes (GD). Women with GD need special care both during and after pregnancy.


What causes GD?

The body produces a hormone called insulin that keeps blood sugar levels in the normal range. During pregnancy, higher levels of pregnancy steroid hormones can interfere with insulin-insulin resistance. But in some women, the body cannot make enough insulin during pregnancy, and blood sugar levels go up. This leads to GD.


If I develop GD, will I always have diabetes?

GD goes away after childbirth, but women who have had GD are at higher risk of developing diabetes later in life. Some women who develop GD may have had mild diabetes before pregnancy and not known it. For these women, diabetes does not go away after pregnancy and may be a lifelong condition.


Who is at risk of GD?

Several risk factors are linked to GD. It also can occur in women who have no risk factors, but it is more likely in women who Asian descent and

  • are overweight, physically inactive, had a very large baby or GD in a previous pregnancy
  • have high blood pressure or have a history of heart disease, or PCOS.


How can GD affect a pregnant woman?

When a woman has GD, her body passes more sugar to her fetus than it needs. With too much sugar, her fetus can gain a lot of weight. A large fetus (weighing 4kg or more) can lead to complications for the woman, including

  • labor difficulties or heavy bleeding after delivery, emergency cesarean delivery
  • severe tears in the vagina or the area between the vagina and the anus with a vaginal birth, even tear to anus.


What other conditions can a woman with GD develop?

When a woman has GD, she also may developed high blood pressure (blood flow resistance d/t viscosity)-reduce placental perfusion to fetus-IUGR (intrauterine growth restriction). High blood pressure during pregnancy can place extra stress on the heart and kidneys. Preeclampsia also is more common in women with GD.


GDM can cause polyhydramnios (AFI =>22cm) d/t increase liquor production from fetus. Risk of polyhydramnios is placental abruption (premature placental separation) or cord prolapse.


How can GD affect a baby?

These babies may have low blood sugar at birth (<3mmol/L=poor maternal control). Babies born to women with GD may have problems with breathing. Most common is neonatal jaundice (day 3-5 of life d/t liver gluconeogenesis to support baby sugar level) Large babies are more likely to experience birth trauma, including damage to their shoulders, during vaginal delivery. Large babies may need special care in a neonatal intensive care unit (NICU). There is an increased risk of stillbirth with GD.


Will I be tested for GD?

All pregnant women should be screened for GD. If you have risk factors, oral glucose tolerance test (OGTT) will be tested early in pregnancy. Your blood sugar will be measured between 24 weeks and 28 weeks of pregnancy.


If I have GD during pregnancy, how will I manage it?

You will need more frequent prenatal care visits to monitor your health and your fetus’s health. You will need to track your blood sugar after meal and do things to keep it under control. Doing so will reduce the risks to both you and your fetus. For many women, a healthy diet and regular exercise will control blood sugar. Some women may need medications to help reach normal blood sugar levels even with diet changes and exercise.


How do I track blood sugar levels?

You will use a glucose meter to test your blood sugar levels, eg Glucometer Accu-Chek with 50 strips retail RM85- RM140 at most pharmacy. This device measures blood sugar from a small drop of blood. Keep a record of your blood sugar levels and bring it with you to each prenatal visit.


Should I change my diet if I have GD?

When women have GD, making healthy food choices is even more important to keep blood sugar levels from getting too high. Eating regular 2-3 times a day in proper portion helps avoid dips and spikes in your blood sugar level. Often, 2-3 meals (< 400kcal each ) and 2 snacks (<200kCal) per day are recommended for Asian women


Also, it is important to gain a healthy amount of weight during pregnancy. For a woman with GD, too much weight gained or weight gained too quickly can make it harder to keep blood sugar levels under control.


Will regular exercise help me control GD?

Exercise helps keep blood sugar levels in the normal range. Walking is a great exercise for all pregnant women. In addition to weekly aerobic exercise, it’s a good idea to add a walk for 10–15 minutes after each meal. This can lead to better blood sugar control.


Will I need to take medication to control my GD?

For some women, medications may be needed to manage GD. Insulin is the recommended medication during pregnancy to help women control their blood sugar. Insulin does not cross the placenta, so it doesn’t affect the fetus. In some cases, your ob-gyn may prescribe an oral medication, metformin. Peak plasma concentrations (Cmax) are reached within one to three hours of taking immediate-release metformin and four to eight hours with extended-release formulation

Changes to your medication may be needed throughout your pregnancy to help control blood sugar.


Will I need tests to check the health of my fetus?

Special tests may be needed to check the well-being of the fetus. These tests may help your ob-gyn detect possible problems and take steps to manage them


Will GD affect the delivery of my baby?

Most women with controlled GD can complete a full-term pregnancy. But if there are complications with your health or your fetus’s health, labor may be induced 1-2 weeks before the due date. Although most women with GD can have a vaginal birth, they are more likely to have emergency cesarean delivery than women without GD.


What are the future health concerns for women who had GD?

GD greatly increases the risk of developing diabetes in your next pregnancy and in the future when you are no longer pregnant. Having preeclampsia during pregnancy are at greater risk of heart disease and stroke later in life.


What are the future health concerns for children?

Children of women who had GD may be at risk of becoming overweight or obese during childhood. These children also have a higher risk of developing diabetes.


If I have GD, is there anything I should do after my pregnancy?

If you have GD, you are advised to repeat the blood test OGTT or HbA1c at 4-12 weeks after you give birth. If your blood sugar is normal, you will need to be tested for diabetes every 2-  years till you are 40 years old and yearly thereafter. A reliable way of testing blood sugar is HbA1c (a blood test of 3 month sugar control), which do not required fasting for the blood test. If your HbA1c is > 6.5%, you are likely have diabetes. If your HbA1c is > 5.9%, you are likely to have impaired sugar metabolism. If HbA1c >5.5%, yearly HbA1c.


Diagnosis of diabetes in non-pregnant=Fasting blood sugar > 7 mmol/L, 1 hour after first bite > 12 mmol/L,   2 hour after first bite > 11.1 mmol/L.


Diagnosis of gestational diabetet= Fasting blood sugar  >= 5.1 mmol/L, 1 hour after first bite >= 10 mmol/L,   2 hour after first bite >= 7.8 mmol/L


Control of gestational diabetes= Fasting blood sugar < 5.3 mmol/L, 1 hour after first bite < 7.8 mmol/L,   2 hour after first bite < 6.7 mmol/L