DIABETES AND INFERTILITY (PART 2)

Last week, we started a topic titled Diabetes and Infertility. The Types of Diabetes, effects and Managements were also discussed. This week, our focus will be on Gestational Diabetes Mellitus (GDM). Diabetes can be present before or after the start of pregnancy. If after the start of pregnancy, it is termed, gestational diabetes and there are high accumulations of sugar in the blood (over 150 mg/dl).

Gestational Diabetes tends to resolve (disappear) after delivery of the baby. It occurs in 2-3% of all pregnant women. The exact cause of Gestational Diabetes is not known.

Science believes that the hormones that interfere with the normal processing of sugar, insulin, are increased during pregnancy. The levels of these hormones tend to increase in the later part of pregnancy allowing the sugar to accumulate in the blood with Diabetes as the end result. With Gestational Diabetes, the blood sugar is elevated and the developing baby is at high risk for certain problems, such as increase in growth hormone and a large overweight baby (macrosomia), weighting over nine pounds in result. With the large size, surgical removal or Caesarean section would be necessary, with special care concerning the lung maturity of the baby. The close monitoring with your Reproductive Endocrinologist and Obstetrician will permit the birth of a healthy baby with the mother alive
Management Of Gestational Diabetes.

• In order to lower blood sugar properly, your medical team will recommend a diet tailored to meet your diet needs; this will include lots of vegetables for fibre and fruits for vitamins. A certain amount of exercise, walking, swimming is essential to keep your blood sugar under control.

• Assessment with laboratory technology, HbA1C testing of the amount of blood sugar that is measured in percentages should stay under 6.5%. The results are stable for a few months.
• A foetal echocardiogram (special ultrasound of the baby’s developing heart) will ensure that his/her growth patterns are normal.
• Close monitoring of the eyes and kidneys to avoid complications, such as proliferative retinopathy or kidney infections.
• Periodic ultrasounds of the developing baby will safeguard against undetected overly large new bones.

RISK FACTORS FOR GESTATIONAL DIABETES:
• Mom’s age over 25.
• Family health history. Close family members such as a parent or sibling or having slightly raised blood sugar.
• Personal history of Diabetes. Having a slightly raised blood sugar (prediabetes).
• Racial background. Studies show that Blacks, Hispanics and Asians have higher rates than whites.
• Previous BIG baby over nine pounds.
• Previous unexplained Foetal death.
• Obesity: Body Mass Index( BMI) over 30kg/m
• Recurrent pregnancy Loss, 15-20% of pregnancies lead to miscarriage even before the pregnancy test.

COMPLICATIONS OF GESTATIONAL DIABETES:

For the Mother, you can be faced with high blood pressure and preeclampsia (a feared complication of pregnancy) with alterations in blood proteins and high blood pressure.

The best management for this condition is the immediate delivery of the baby. Seizures (convulsion) can occur, if left untreated. It would then be called eclampsia, a true medical emergency with need for urgent intensive care support and care. Gestational Diabetes increases the changes that the blood pressure will increase, leading to decisions of saving either the mother or the baby’s life. Once you have Gestational Diabetes, you can become at risk of getting Type 2 Diabetes. Management, with life long, lifestyle choices of healthy eating and exercise can reduce your risk.

For your precious baby fed by the umbilical cord and the placenta (blood vessels that supply the nutrition from the mother through the blood) with this extra rich amount of sugar will cause your baby to produce more insulin. Your baby can grow too big with the resulting difficulty in exiting normally from the vagina at birth. A surgical delivery or caesarean section will need to be performed. Another serious complication is early labour (preterm delivery) with difficult breathing (Respiratory Distress Syndrome).

As you can see, it is vital to understand how your baby is affected by your own health. If your blood sugar is high (over 150mb/ dl), the baby can develop Diabetes too. He /she may have Type 1 Diabetes, where the cells of the pancreas do not produce any insulin. The result will be a baby that needs insulin injections to survive and process any food.

Prevention and General Management of Diabetes:

While there is no known prevention for type 1 DM, below are the measures that can be taken to reduce the risk of type 2 DM which accounts for 85-90% of all cases of Diabetes.

Prevention! The Best Policy

• Eat a healthy diet, full of fruits, vegetables and learn protein, high fibre, and high vitamins.
• Exercise regularly and maintain high level of activity
• Close monitoring of your blood sugar using the glucometer if you have a positive family history and had been tested to have high blood sugar level.
• Take prescribed medications
• Avoid tobacco smoking
• Once you decide to become pregnant, visit your doctor for antenatal screening, it will give a good picture of your health.
• Lose weight before pregnancy.
• During pregnancy, you need to nourish the developing baby, best not to try to lose weight, take prescribed medications/ insulin injections.