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Delivering hope

She overcame gestational diabetes Halle Berry

These days, when obstetrician/gynaecologist Dr. Gita Arjun and endocrinologist Dr. Usha Sriram meet, their conversation moves to a development that worries them both — the exponential increase in the rate of diabetes in pregnancy, aka gestational diabetes mellitus (GDM). “There has been an explosion of cases of GDM in the new millennium,” they say. “It's gone up from 4-6 per cent in the early 90s, to upwards of 15 per cent of all pregnancies now.” This, they point out, places a huge load on healthcare givers and increases complications for both mother and child.

Weight gain

The reasons are complex, but the root cause seems to be the overall weight increase in Indian population. “The average girl's weight at the first pregnancy visit has gone up by about 10 kilos, compared to even a decade ago,” says Dr. Gita. “Genetically, we're small-made and manage with small amounts of food. Our body, long used to starvation, is programmed to hold on to the consumed calories. It doesn't know how to process excess food. And we tend to overeat. We reach for fat/sodium-rich readymade food, while our physical activity is down dramatically — thank gadgets, elevators, vehicles and our desk(top) jobs.

“Previous generations were active throughout pregnancy,” says Dr. Usha. “Now we spend most of the time indoors. Having a maid is a marker for being obese.” Earlier, girls were underfed and anaemic, so pampering with better food was needed in pregnancy. Now, women have pregnancies later in life, start out heavier and tend to put on more weight than is safe. Unable to handle food overload, we develop diabetes.

The cards are stacked against us. Most now-gen young women have a strong family history of diabetes. If one parent has diabetes, we are at 40 per cent risk for it; if both parents are diabetic, the risk is 80 per cent. If you're pregnant and diabetic, the growing foetus is exposed to a huge glucose load. It will respond by producing insulin. Insulin makes the baby fat, necessitating a caesarean section. A fat baby has potential for childhood obesity, which in turn leads to diabetes.

Prevention first

If alarming rates of GDM are a healthcare burden and unchecked GDM puts the baby at risk, shouldn't prevention be our first thought? Dr. Gita and Dr. Usha want young women educated on GDM prevention. “Make weight control your life mission,” they say. Walk briskly for 45 minutes daily, do aerobics, eat healthy. “Most women are aware that it is essential to start taking folic acid well before pregnancy to prevent certain abnormalities in the baby. Similarly, Indian women should check for diabetes before starting a family,” says Dr. Usha.

“Share your family history of diabetes with your obstetrician,” says Dr. Gita. What happens if you are found to have diabetes in pregnancy? You will be put on a diabetic diet and an exercise regimen, based on your weight. Controlling diabetes boils down to controlling calories. Have three balanced meals with two snacks in between — that's enough calories to keep your sugar levels stable. “If you have GDM, you get medical nutrition therapy tailored to your lifestyle, weight, and eating habits. If this does not get sugar levels under control, the endocrinologist will administer insulin,” says Dr. Usha. “You know, a diabetic diet is the healthiest diet, even for non-diabetics,” adds Dr. Gita.

Sugar levels usually get back to normal after the delivery, but “once you've been diagnosed with GDM, never let the risk of diabetes go off your radar,” say the doctors. “Continue with a balanced diet and exercise. Incorporate these into your daily life.”

Genetically the gun is loaded for Indian women to develop GDM but we can try to prevent the trigger from being pulled.

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