High blood sugar is a common problem in a vulnerable group of women during pregnancy.
About 10% of pregnant women in Sri Lanka develop high blood sugar during their pregnancy. This is mainly due to the increased production of hormones in the body. These hormones cause blood sugar (glucose) levels to rise, and with the increase in circulation of blood volume and metabolites, the organ which controls sugar in the body (pancreas) fails to cope with the increasing demand for insulin (hormone which controls sugar levels).
Therefore, during pregnancy some women are at risk of developing glucose intolerance. Meaning that their bodies cannot tolerate increase in glucose levels.
If you are unable to keep your blood sugar levels within a safe range (fasting less than 112mg/dl, post prandial that is two hours after any main meal should be less than 140mg/dl) you and your baby will face many problems due to uncontrolled blood sugar levels.
Different types of Diabetes or Abnormal blood sugar during or before pregnancy
If you are a child born with defective pancreatic cells called islets of Langerhans, then you will be having childhood diabetes, which will respond to insulin only (Insulin dependent).
This type of woman can get pregnant, so her problems pre pregnancy and during pregnancy maybe different.
During pregnancy, a woman can develop abnormal blood sugar levels and this is called gestational diabetes. You are still able to have a healthy baby despite these conditions, so you are advised to control your diabetes and take pre pregnancy folic acid about 3 months before. If your blood sugar is not controlled at the time of conception you will have a risk of developing abnormal babies.
Complications that can affect you if you have high blood sugar during or before pregnancy;
- Recurrent pregnancy loss known as abortions or miscarriages can occur in diabetic woman
- The baby’s growth may get enhanced and you will have a big baby
- Babies growth can get retarded and you call this intra-uterine growth restriction or small baby due to severe uncontrolled diabetes mellitus
- If your diabetes is not well controlled you will have sudden death of your baby inside the womb; this is called intra uterine death
- During labour also you can have various complications due to big baby
- You will have too much fluid around your baby in the womb (too much amniotic fluid)
- You will have risk of giving birth before 37th week of pregnancy– known as premature labour
- You will have recurrent infections specially in the urinary and genital tracts
- You will have a greater chance of developing high blood pressure
- You are more likely to develop diabetes in future pregnancies and type 2 diabetes in later life
Complication that can affect your baby;
- Your baby will grow larger inside the womb than the average Sri Lankan baby, thereby increasing problems that can encounter during labour (Macrosomic)
- Birth can be difficult specially due to shoulder dystocia (which refers to when the baby is delivered, the head comes out but the shoulders and arms get stuck behind the bones of the pelvis outfit)
- Babies body structure will not be normal
- Baby will have heart lesions and spinal cord abnormalities
- Sometimes baby will be born, smaller than an average baby
- If your baby is born before the 37th week he is likely to have problems in respiration due to immature lungs
- Soon after birth, your baby can have low blood sugar and care should be taken to monitor the blood sugar levels and treat if the sugar levels are low
- It is proven that later in life, there is a high chance that your child will be obese
- Your baby can die suddenly in the womb
How do you know that you have high blood sugar?
It is important to keep in mind that blood sugar levels start to rise around 13-28th week of your pregnancy and become normal once your baby is born.
Some of the symptoms you might experience if your blood sugar rises will be;
- Feeling thirsty more than usual
- Need to urinate more often
- Passing large amount of urine than usual
Usually diagnosis is done using tests namely, Oral Glucose Tolerance test (OGTT). It involves fasting 10-12 hours without taking anything to drink or eat. Then you will be given 75 gms of glucose in a drink, before that your blood will be taken to assess the sugar levels. Then two samples of blood will be taken at hourly intervals.
If you have the following factors the above tests will be done early by your obstetrician, and if you don’t have any of the risk factors you will anyway be treated between 24th to 28th week of pregnancy.
- If you are a mother aged above 35 years
- If you have previously given birth to a large baby weighing more than 4.5kgs
- If you have high blood sugar in your previous pregnancies
- If you have a family history of diabetes (parents/brother/sister)
- If you have polycystic ovary syndrome
- If you have recurrent abortions
When you are diagnosed as having diabetes during your pregnancy, it is mandatory to initiate treatment from the earliest stage as possible, frequent clinic visits will make sure that the blood sugar levels are under control.
Eating a healthy balanced and doing regular exercises (moderate exertion) for 20 minutes is crucial.
It is advisable to avoid sugar and foods high in sugar, also eating mostly complex carbohydrates such as vegetables, whole grain cereals, breads, brown rice, legumes such as soybeans, black beans are encouraged.
Having foods in high in fibre is mandatory. In addition, it is advised that you eat 3 small meals and 3 snacks spread evenly throughout the day. If you are unable to control your sugar level, with diet control and exercise your obstetrician will decide on your medical management, which includes insulin injection.
Once your baby is born, your blood sugar levels become normal. Hence, it is mandatory to monitor you and your baby’s sugar levels frequently.