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Sunetra, on the other hand, has been a diabetic for the past three years. She is 29 years old and is pregnant for the first time. Both of them may expect some problems in pregnancy if the sugar levels are not kept under good control.

Diabetes caused by pregnancy is known as gestational diabetes. Gestational diabetes usually begins in the second half of pregnancy.

This condition is becoming more common in Indian women and may affect up to 10 per cent of pregnant women. Unless properly controlled, it can lead to problems for both the mother and her baby.

The blood sugar levels, as a rule, return to normal after the baby is born. Nevertheless, it is important to remember that developing gestational diabetes is a warning that a woman may develop full-blown diabetes later on in life.

What increases the chances of developing diabetes in pregnancy?

The risk of developing gestational diabetes increases with – age over 30, being overweight prior to pregnancy, a family history of diabetes, a history of diabetes in a previous pregnancy, a big baby in a previous pregnancy, a history of a stillbirth late in pregnancy, and polycystic ovarian syndrome.

How is gestational diabetes diagnosed?

Your obstetrician will test you with a glucose tolerance test between 24 and 28 weeks of pregnancy. If you have had gestational diabetes in an earlier pregnancy, your blood sugars will be checked at your first antenatal check up and if normal, will be repeated at 24-28 weeks of pregnancy.

If you have diabetes before pregnancy, you must be particularly careful about keeping your blood sugar levels well under control before you try for a pregnancy. Despite medical advances, babies born to women with diabetes, especially women with poor diabetes control are still at greater risk for birth defects.

It is a good idea to have good blood glucose control three to six months before you plan to get pregnant.

In a pregnancy with diabetes, the baby may be overweight (macrosomia) which increases the risk of complicated delivery. There may be also excessive fluid around the baby. The baby of a diabetic mother has the risk of developing difficulty in breathing after birth (respiratory distress), low blood sugars (hypoglycemia) and newborn jaundice (hyperbilirubinemia ). Stillbirth (delivery of a baby that has died before birth) occurs more often in babies of women whose diabetes is not well controlled before and during pregnancy.

Gestational diabetes is not an immediate threat to the mother’s health. Women who develop diabetes in pregnancy have a greater risk of developing high blood pressure. This is called pregnancy induced hypertension. You are more likely to develop gestational diabetes in future pregnancies. You are also at a higher risk of developing type II diabetes (non-insulin dependent diabetes) later in life.

In diabetes complicating pregnancy, the key to a good outcome is maintaining blood sugars in the normal range. The sugar levels must be maintained at less than 100 mg/dl before meals and less than 140 mg/dl 1 hour after a meal. Dietary modification and exercise will help to control blood sugars initially. If this alone is not enough, then insulin injections may be needed.

To make sure that the baby is doing fine, ultrasound examination of the baby at regular intervals to make sure that the baby is neither too big (macrosomia) or too small (intrauterine growth restriction). The fluid around the baby will also be monitored closely. The baby’s heart beat will be recorded (electronic foetal monitoring) closer to the due date

If the diabetes has been well controlled just with a diet and exercise regimen, and the baby does not have any complications, your obstetrician will wait for you to go into labour. If you are on insulin to control your sugar levels, then the baby may be delivered between 37- 38 weeks.

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