Earlier this month, Cloudnine launched a live Tweetinar on Gestational Diabetes on its Twitter handle @CloudnineCare. It was conducted by Dr Prakash Kini, Senior Obstetrician & Gynaecologist at Cloudnine Hospitals, Jayanagar, Old Airport Road and Malleswaram, Bangalore. The Tweetinar opened a wide-ranging conversation on gestational diabetes and swept through a plethora of pertinent topics. Its excerpts are included below.
Specialist Details:Dr Prakash Kini
Specialty: Gynaecology & Obstetrics
Clinical Focus and Expertise: Infertility evaluation, infertility treatment, in vitro fertilisation (IVF), intrauterine insemination (IUI), artificial insemination, high-risk pregnancy care, breast care, hysterectomy, laparoscopy, sexual health, embryo transfer, reproductive medicine
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1. Are there any precautions one can take to avoid gestational diabetes?
Yes! Reducing stress levels, adopting a proper diet plan, getting about 40 minutes of physical exercise daily, and practising yoga and meditation can all have a positive effect on your pregnancy and reduce the risk of gestational diabetes.
2. Can uncontrolled gestational diabetes affect my unborn child in any way?
Yes, gestational diabetes can lead to your baby becoming inordinately fat. In such a case, delivery becomes viable only via C-section. Also, gestational diabetes can increase the likelihood of your child requiring admission in the neonatal intensive care unit (NICU). Babies born to mothers with gestational diabetes run the risk of developing hypoglycemia and in the long run, diabetes too.
3. If one develops gestational diabetes, what precautions can be taken to prevent diabetes in the future?
There are various measures that can be taken. Developing a proper exercise routine and achieving a healthy weight prior to your next pregnancy is key. Also, seeking a laboratory investigation to check the status of your diabetes is vital before conceiving again. Additionally, folic acid should be started as a pre-pregnancy medication.
4. Is gestational diabetes curable, or is it a lifelong health condition?
Gestational diabetes is treatable, not curable. Lifestyle modifications are needed to keep it under check.
5. I am 33 weeks pregnant and have been diagnosed with gestational diabetes. My doctor has prescribed me Cetapin and insulin (4 units before dinner). My fasting, breakfast and lunch sugar levels are fine, but my dinner levels are in the range of 150-160. What should I do?
Treatment for gestational diabetes is always individualised, never generalised. Various parameters come into play while prescribing a treatment plan. It is best to continue with your doctor’s recommended treatment plan to keep your sugar levels in check.
6. Can gestational diabetes lead to polycystic ovarian syndrome (PCOS) after delivery?
PCOS can lead to gestational diabetes, never the other way around.
7. If one develops gestational diabetes, are the chances of becoming a diabetic in the future high?
Yes, the chances of becoming a diabetic in the future are high.
8. Are there any specific triggers for gestational diabetes?
Obesity, a stressful lifestyle, poor exercise efforts and insulin resistance are often precursors of gestational diabetes.
9. Are there any particular foods that cause gestational diabetes?
Rich sugary foods can trigger gestational diabetes in a potential diabetic. Fresh fruits like mango, jackfruit and pineapple have a high sugar content and are best avoided. Other fresh fruits can be had in moderation. Green vegetables and dry fruit are recommended, thanks to their high nutritive value.
1. 0Is it important to be active throughout pregnancy?
Yes, until and unless the pregnancy makes life uncomfortable.
11. Is there a correlation between gestational hypertension and gestational diabetes?
There is no correlation. However, gestational diabetics tend to be obese, which may be a contributor to hypertension in pregnancy. Hypertension can, in turn, lead to preeclampsia.
12. What are the symptoms of gestational diabetes?
Excessive weight gain, perpetual hunger, excessive thirst and a frequent urge to pass urine are some symptoms.
13. Can certain foods help to reduce or increase the chances of contracting gestational diabetes?
Rich foods consumed in high quantities can trigger gestational diabetes.
14. What is the probability that a thalassemia patient will develop gestational diabetes?
The probability is minimal. They are two very different disorders.
15. How long does a typical treatment plan for gestational diabetes last?
This is dependent on a variety of factors. Good eating habits, regular exercise, minimal mental stress and medication can help expedite the treatment process.
16. Are mothers pregnant with twins at an increased risk of gestational diabetes?
Not necessarily, but other factors like age, family history, obesity, poor exercise and overeating can give rise to gestational diabetes in mothers pregnant with twins.
17. Is there any correlation between gestational diabetes and neonatal jaundice?
Yes. Babies of mothers with gestational diabetes are more susceptible to hypoglycemia and hyper bilirubinaemia (neonatal jaundice).
18. Can gestational diabetes persist even after pregnancy?
Gestational diabetes is restricted to pregnancy. Its recurrence is limited to subsequent pregnancies.
19. I have been told my baby is growing faster than normal due to my sugar levels. What is the ideal sugar level range that needs to be maintained?
The ideal sugar level range is between 110-130 mg/dl. Occasionally, a reading up to 140 mg/dl is considered acceptable. If the sugar reading is consistently high, the baby is likely to be big, heavy and macrosomic.
20. What are the causes of gestational diabetes?
The exact causes are still unknown, but it is known to be associated with a family history of diabetes. Obesity and PCOS also play a role in spurring on the condition. Other factors include age and a previous case of gestational diabetes.
21. In the case of type 1 diabetes, which is better: insulin or NovoMix?
In the case of type 1 diabetes, insulin is better. It's a drug of choice. There are various types available: rapid-acting, long-acting and a combination of both.
22. How can gestational diabetes be managed?
You can adopt the following measures:-Regular medical check-ups with your obstetrician-Systematic meal plan guidance from a dietician-Structured exercise plan from a physiotherapist-Use of a home glucometer to periodically monitor blood sugar-Medication in the form of oral hypoglycemic agents (OHAs) or parental insulin-Proper birth plan as advised by your obstetrician-A trusted neonatologist to monitor your baby after delivery-Controlled diet and exercise-Planned pregnancy the next time around
23. Is gestational diabetes temporary? Does it harm the pregnancy?
Literally translated, gestational diabetes mellitus means ‘diabetes during pregnancy’. However, it can appear in subsequent pregnancies, especially if sugar intake is not controlled.
24. What is the normal sugar level required to be maintained during pregnancy?
The sugar level, on an average, should be less than 130 mg/dl.
25. How is gestational diabetes treated?
Once detected, strict check-ups, routine blood tests and scans, diet control and physical fitness all form an integral part of treatment.
26. How does gestational diabetes impact the health of the baby, both pre- and post-birth?
Gestational diabetes can cause a high sugar circulation in your baby’s bloodstream. This can put stress on your baby’s pancreas and lead to Macrosomia. Typically, babies with Macrosomia grow larger than normal. Labour can be complicated and there can be fetal risks associated with childbirth. Post-delivery, such babies tend to become hypoglycemic and their blood sugar warrants close monitoring. Sometimes, they require neonatal intensive care.
27. If blood sugar is within the recommended range, is there a need to induce labour on account of gestational diabetes?
Babies of mothers with gestational diabetes are very prone to complications at 38 weeks of gestation. They are more likely to succumb to intrauterine fetal demise or stillbirth. That’s why the ideal time to deliver such babies is between 37 and 38 weeks of gestation.
28. What type of diet should one follow in case of gestational diabetes?
A balanced diet is essential. It is recommended that you consult a dietitian through your pregnancy to help you manage your meals and nutritional intake. A high-protein, low-carbohydrate diet is ideal.
29. What are the tests one must undergo to be diagnosed with gestational diabetes?
The oral glucose challenge test and the haemoglobin A1c (HbA1c) test will ascertain the presence of gestational diabetes.
30. How is gestational diabetes different from type I and type II diabetes?
Type I & type II can affect non-pregnant individuals whereas gestational diabetes can develop only in women who are pregnant.
31. Is gestational diabetes hereditary?
It can be hereditary. However, its onset can be arrested through healthy mental and physical measures.
Authored By: Dr Prakash Kini
Senior Obstetrician & Gynaecologist, Cloudnine Hospitals