The Philippine Online Chronicles

As if pregnancy itself isn’t challenging enough with morning sickness and bodily changes to contend with, five percent of Filipinas who get pregnant also end up developing gestational diabetes.

Gestational Diabetes Mellitus (GDM) is a type of diabetes that afflicts women who did not have diabetes, or were yet undiagnosed, prior to the pregnancy. Because hormones sometimes make it harder for a woman’s pancreas to keep up with the increased insulin requirements of a pregnant woman, blood sugar levels may rise and result in gestational diabetes. Women are among those considered at higher risk, which could probably be attributed to diet (fatty, salty and sweet) and the growing incidence of diabetes in the country.

Who are more likely to develop GDM?

Women with increased risk of developing gestational diabetes include those with:

• Gestational diabetes with a prior pregnancy, with increased risk for each following pregnancy;
• A family history of a first-degree relative, especially on the mother’s side, with type 2 diabetes;
• Pregnancies over the age of 35;
• Obesity;
• A previous pregnancy resulting in a high birth weight baby (starting at 9 lbs.);
• An ethnic background from the following groups: African-American, Afro-Caribbean, Native American, Hispanic,  Pacific Islander and people from South Asia;
• A history or presence of having too much amniotic fluid (polyhydramnios);
• A history of smoking before, and during, the pregnancy;
• A history of Polycystic Ovarian Syndrome (PCOS); and
• A previous pregnancy that ended in a stillborn baby.

About 40 to 60 percent of those who develop GDM, however, report no risk factors, which is why universal screening has become the regular practice by obstetricians for pregnant women in their third trimester.

What are the symptoms of GDM?

Gestational diabetes is generally asymptomatic but some women may suffer from increased thirst, urination, fatigue, nausea and vomiting as well as constant hunger. Women might confuse these as just the typical hormonal imbalance associated with pregnancy but GDM sufferers say that these things are more pronounced than the usual pregnancy symptoms, especially when the GDM is still not yet being managed.

Other symptoms include bladder and yeast infection, especially if it’s recurring, and blurred vision. Excess weight gain, especially if you were overweight to start with, can also be a symptom.

How is it diagnosed?

An obstetrician usually orders an oral glucose challenge test (OGCT) when a woman is 24 to 28 weeks pregnant. She will be asked to drink a sweet liquid containing 50 grams of glucose and blood will be extracted an hour later for sugar level measurement. Depending on the findings, an oral glucose tolerance test (OGTT) may then be ordered wherein a fasting of eight hours is required. She will then drink 100 grams of liquid glucose and blood will be drawn from her every hour for the next three hours.

Many women hate the liquid glucose more than the blood extraction. However, I found that it was just like a sweeter version of orange soda and actually liked having to drink it especially since I couldn’t eat till the last extraction was done. One tip I got though was to make sure the glucose you will be drinking is the already-bottled type instead of the powdered one that still has to be prepared in water. The ready-to-drink, they say, tastes better.

How is it managed?

For pregnant women who will exhibit sugar levels at a cut-off point of 140 mg/dl for OGCT, an obstetrician may only prescribe a restricted diet and exercise. However, those who will clearly show elevated sugar levels will be asked to consult with an endocrinologist who will determine if the patient would need constant monitoring of blood glucose levels with the use of a glucometer (which costs an average of P2,500 from drug stores) and antidiabetic drugs (usually insulin shots). The endocrinologist may also prescribe a diet plan and request repeated OGTT. The obstetrician, on the other hand, will most likely order a congenital anomaly scan and repeated biophysical monitoring. Non-stress tests may also have to be performed regularly if the mother is unable to control her sugar levels.

What are the risks for the baby?

GDM may result in macrosomia, essentially giving birth to a large baby, which may make normal deliveries difficult and may even result in obstetrical emergencies. Babies born to mothers with GDM, especially if the condition was not managed and strictly monitored, are also more likely to suffer from neonatal hypoglycaemia which may make the baby jittery or fussy, or cause seizure or breathing problems. The baby is also more likely to suffer from jaundice and imbalances in magnesium and calcium, as well as develop diabetes in adulthood. Depending on when the GDM was diagnosed or how serious it was, there may also be an increased risk of birth defects and still birth.

What are the risks for the mother?

Mothers with GDM are more likely to develop Type 2 Diabetes in the next five years after delivery and suffer from eye (e.g. retinopathy) and kidney problems (e.g. frequent UTI) during the pregnancy. These infections can trigger premature labor and the GDM may also result in preeclampsia.

How restricted is the diet?

A lot will depend on the severity of the GDM, but pregnant women with the condition will basically be put on a low glycemic index diet (a.k.a. low g.i. diet). People may be surprised that there are a lot of low g.i. food that is readily available but pregnant women will have to exercise portion control and they may be craving for other stuff which will make the diet hard to follow.  For example, women with GDM would have to go easy on, or without, sugar and salt for a while. They may have to shun white rice and potatoes too. Still, popcorn can be sweetened by cinnamon and they can refresh with pineapple juice or young coconut water. For crunchy cravings, cucumber, jicama (singkamas) and carrot sticks, as well as peanuts, can be handy snacks.  Plus, we have vegetables like ampalaya, taro, and purple yam which can be eaten or made into tea to help lower blood sugar.

GDM will require vigilant monitoring, medication and management for both mother and baby to avoid complications during the pregnancy. The constant tests and diet restriction, aside from insulin injections for those who need it, may exhaust a pregnant woman both physically and emotionally. The support of their partners and the expert care of their doctors are critical and necessary. However, GDM is manageable and often resolves itself after delivery, and the lifestyle changes during the pregnancy could be an opportunity to institute healthier habits for the entire family even after the baby is born.

Photos: Pregnant Woman and Glucose meters from Wikimedia Commons. Under public domain.

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Mec Arevalo is a serial blogger, stay-at-home Mom, breastfeeding peer counselor for L.A.T.C.H. Inc. and volunteer counselor/facilitator for FAD Inc. Aside from being an intentional parent and preparing their family for homeschooling, she does what she can for her advocacies: breastfeeding, children-in-conflict with the law (CICL), HIV/AIDS Awareness and sign language. She relaxes by Plurking and digiscrapping.