Diabetes diagnosed during pregnancy that is not clearly overt diabetes is called as Gestational Diabetes. It is associated with Pregnant women without previous known history of Diabetes Mellitus. Screening of Gestational Diabetes is done between 24-48 Week of pregnancy.
Generally Gestational Diabetes occurs in 2nd & 3rd trimester because of increase in insulin-antagonist hormone levels and insulin resistance that occurs during that time of the pregnancy.
Women with following characteristics are at high risk of acquiring Gestational Diabetes and should be extra careful during Pregnancy and should consult with their gynecologist . Regular screening should be done for high risk category.
- Obese i.e. (BMI – 30)
- Personal history of Gestational Diabetes
- Glycosuria and/or hypertension
- 1st degree relative with diabetes
- Prior poor obstetrical outcome
- Member of high risk ethnic group
Above factors are just an indicator – a physician must be consulted to understand ones risk of Gestational Diabetes.
Given that the female suffering from Gestational Diabetes has high blood sugar / glucose levels it becomes imperative that this extra glucose in the blood will get delivered to the baby. This results in excessive weight gain for the baby. As a result babies born to women with gestational diabetes are generally overweight.
Previous definition of Gestational Diabetes was to find any degree of glucose intolerance with onset or first recognition during pregnancy. This lead to a high number of undiagnosed diabetes cases. As a result nowadays physicians use any finding of diabetes at first prenatal visit.
Generally 75g – 2hr OGTT of 200mg/dl (11.1 mmol) is used to diagnose Gestational Diabetes. Please consult your Physician / Gynecologist before undergoing any test.
Most of the doctors wouldn’t recommend going on a strict diet during pregnancy. Diet should be based and adjusted on foods on postprandial Blood Sugar. Weight loss during pregnancy is not recommended but modest energy intake (70% of DRI for pregnant women ) may help slow weight gain. Again before planning a diet one must consult / seek opinion from a gynaecologist or a dietician. Following are some of the dietary tips for Pregnant females diagnosed with Gestational Diabetes
- All Recommendations for pregnant women apply
- Control of carbohydrate is the key. Foods rich in only carbohydrates should be avoided instead wholesome meal should be planned.
- Well balanced intake of micronutrients. Pregnant women should consult their gynecologist and dietician to get a proper meal planned.
- Spread food into 3 small meals and 2-4 snacks during the day instead of having just Breakfast, Lunch and Dinner
Minimum calorie intake of 1,700-1,800 kcal should be maintained to prevent ketosis and prevent excessive maternal weight gain. Extreme caution is advised during pregnancy and females should consult their dietician and doctor to know the right amount of calories to be consumed throughout the day.
Following are some of the tips on Carbohydrate management for pregnant women suffering from Gestational Diabetes:
- Minimum of 175gms of Carbohydrates should be consumed
- Higher circulating hormones during early morning hours, make (pre breakfast Blood Sugar most difficult to control
- Carbohydrates must be restricted to around 15-30 g at the time of breakfast
- Evening snack needed to prevent accelerated ketosis overnight
Following Chart shows management / distribution of carbohydrates during the day.
||Carbohydrate in grams
|Post dinner Snack
Following table shows minimum requirement of macro nutrients for Pregnant women when suffering from GDM.
||Minimum 175 grams per day
||1.1gm per kg of body weight per day about 25 extra grams
||20-35% of calorie requirement in the day should be met from Fat
30 minutes of physical activity per day for at least 3 days in a week is recommended. Again females with excessive weight gain mightn’t be able to do some of the normal exercises due to pain in joints and legs . It is always recommended to consult ones doctor / physical trainer to understand right exercises during pregnancy.
If unable to achieve Blood Sugar goals without ketones, adequate weight gain and normal nutrition then pregnant female needs to be put on Insulin therapy or medication for Diabetes. In such cases a Diabetologist and Gynecologist should be consulted.
Most females return to normal glucose tolerance shortly after delivery. To check Diabetes Management and control a 6-12 weeks postpartum, 75 g OGTT or A1C test should be done, use nonpregnant dx criteria. If test reports are normal then the same should be repeated after a year else a Diabetologist should be consulted immediately.