Blood sugar control during pregnancy is a must

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A likelihood of gestational diabetes mellitus is considered when the fasting blood glucose level is 100 mg/dL or more and if it is 140mg/dL or more two hours after a meal. This can be confirmed by oral glucose challenge test.

Once a pregnant woman is confirmed of GDM or if she already had diabetes before pregnancy, tight control of blood sugar is a must to avoid future problems for baby. Apart from routine antenatal checkups, visits to endocrinologist are a must to start treatment for controlling blood glucose.

All complications occurring in babies born to diabetic mothers are always due to high sugar levels in mother's blood. Therefore, it is very important to control this high sugar level right from the start of pregnancy, even better when pregnancy is planned.

There is one test -- glycosylated hemoglobin -- which can indirectly inform us about the blood sugar control over past few months. If this test result is not normal, risk of defects is very high. However, ultrasound of developing baby may sometimes pick up such defects. There can be defects related to brain, spine, heart, limbs, and intestines to name a few.

On the other hand, if blood sugar is poorly controlled during the last six months of pregnancy, the baby born may be overweight, may have poor lung maturity, high hemoglobin, low sugar, low calcium and many more problems.

It may be difficult to deliver an overweight baby by vaginal route (normal) because such baby's shoulders may get stuck during delivery, thereby leading to injuries to bones and nerves of upper limbs and sometimes even death. Therefore, your obstetrician may decide to go for a delivery by cesarean section in case baby is oversized or overweight in proportion to mother's pelvis.

High levels of hemoglobin, a condition called as polycythemia, is also very common leading to further complications like thrombosis, jaundice, low calcium etc. All these problems lead to increased likelihood of illnesses in newborn baby.

In contrast to their mothers, babies of diabetic mothers often develop low sugar levels (hypoglycemia) which, if untreated, may cause convulsions (fits) and or poor mental development in later life.

It is of paramount importance to control blood sugar throughout the nine months of pregnancy because sometimes the developing baby may even die in uterus without much warning signals due to hypoxic effects of high sugars.

All pregnancies should be carried ideally up to 38-39 weeks. But, if any emergency arises, baby may be delivered early and managed in NICU as per need. In cases of women with established or longstanding  diabetes, complete evaluation by gynecologist  and  diabetician should be done because such women  may have other diabetes-associated problems. 

A concerted approach by a team of obstetrician, endocrinologist, dietician, and pediatricians is needed to manage all pregnant women with diabetes whether gestational diabetes or otherwise.

However, it is a matter of great pleasure to know that most of the cases of GDM can be managed by diet and exercise alone. Only a few may need insulin therapy or other medications to control blood glucose levels.

In nutshell, all the complications may be minimised with tight sugar control right from conception.

Dr Geetu Motwani,  Specialist Obstetrician and Gynaecologist, Zulekha hospital, Sharjah

By Staff Reporter

© Khaleej Times 2010