Attention, mothers-to-be
DURING pregnancy, there are a few reasons why diabetes may develop. Insulin is the hormone that normally helps to control blood sugars. If it cannot work properly, blood sugars may go up. The gain in weight that occurs normally during pregnancy can contribute to the body's insulin not working properly — a condition known as insulin resistance.
Another reason is a lack of physical activity. This is partly because women do tend to feel more tired during pregnancy, but also because Indian society actively discourages people from doing anything even a little strenuous.
During pregnancy, the body produces certain hormones that may also prevent insulin from working properly contributing to insulin resistance.
All these things happen in every pregnancy, but only some women develop diabetes. What is it then that tips the balance? One of the factors is our ethnicity. So there is something in our genetic makeup that makes us more prone to diabetes. Another factor is age — the older we are, the greater the risk of diabetes. Again, more women are opting to have babies when they are older as compared to a few years ago. Yet another factor is family history. Pre-pregnancy weight is also important. The higher this is, the greater the risk of developing diabetes during pregnancy.
How is diabetes that develops during pregnancy treated?
Treatment is similar in some ways to the person who is not pregnant, in that diet and exercise remain the cornerstone. Limiting weight gain and regular physical activity help to make insulin work better (by reducing the body's resistance to insulin). If the sugars do not remain under control with this alone, insulin treatment is required. Other tablets that are used in the non-pregnant state have not been studied well during pregnancy. Insulin, on the other hand had no ill-effects on the baby's development.
But why all this concern about diabetes in pregnancy? Once the baby is born, the sugars will come back to normal, won't they?
The concerns are to do with the development of the baby. The higher the mother's blood sugars, the more the baby grows. If the baby is very big, the mother cannot have a normal delivery, and may need surgery. There is a risk of the baby dying while within the womb. For this reason, a pregnancy complicated by diabetes is usually not allowed to progress beyond 37-38 weeks. After birth, the baby is at higher risk of low blood sugar (as it is removed from the high sugar environment of its mother), jaundice, and low calcium (which may lead to seizures). These problems get better, but more dangerous is the fact that the baby has been born with a very high risk of developing diabetes in the future.
So you can imagine the following scenario: A 33-year-old woman, whose parents have diabetes, becomes pregnant after eight years of marriage. There is rejoicing and she is encouraged to eat well. She is asked not to climb stairs as she needs all the rest she can to better nurture the growing baby. She rapidly puts on weight and routine tests show that she has developed diabetes.
She is asked to go on a strict diet, but the relatives feel that the doctor is overreacting, and this does not help her in her efforts to control her diet. She does not see her doctor regularly, and turns up again near the time the child is due, at which time her blood sugar is not under control. As her baby is big, she has a caeserean section. The baby's weight is 4.2 kg, and this is taken as good sign, with no one realising that the baby is at high risk of developing diabetes and heart disease.
Is there anything we can do to prevent the development of diabetes during pregnancy?
Knowing what causes the problem in the first place makes it easier to understand what needs to be done. Some things we cannot change, like our age, ethnicity and genetic make-up. The following can be achieved by everyone.
Being as close to ideal body weight as possible prior to pregnancy.
Remaining on a sensible diet throughout pregnancy, limiting the total weight gain to around nine to 11 kilograms.
Being as physically active as possible (remember you can continue to do some form of exercise throughout pregnancy — you can discuss this with your doctor).
Going for regular check ups, and monitoring your weight, blood sugar and pressure regularly.
Finally, even if you do develop diabetes during pregnancy, it can be easily controlled in most situations with a good diet and regular exercise.
Diabetes in women — what is different?
It used to be the belief that women were naturally protected against diabetes and heart disease. The reason for this belief is that most of the information we had about diabetes and its complications had come from research done on men, till as recently as 15 to 20 years ago. At that time, the shortage of information available on women and health problems was finally noticed, and steps have been taken to correct this. Recent studies show that more women have diabetes compared to men. Diabetes in women is also more worrying for the following reasons:
Women are more at risk of developing certain complications of diabetes, like reduced blood flow to the feet and heart attacks.
Women who develop diabetes before menopause are not protected against heart disease.
Oral contraceptives have a tendency to increase blood sugars. If these agents are used in women with diabetes, blood sugars have to be monitored closely. Other forms of contraception may be more appropriate in these women.
Even more alarming is the development of so called "gestational diabetes" that is diabetes that develops during pregnancy, for this is a big risk factor for the child developing diabetes in the future. We could all be producing a generation that has diabetes, unless we take steps to prevent it from happening.
Last, but not the least, it is the woman of the house who is responsible for the food on the table. And what determines what food is on the table — nine times out of 10, it is what the man in the house, or the children, like. If the woman of the house happens to develop diabetes, she is unlikely to change the eating patterns of the household to accommodate her health. However, if the man of the house develops diabetes, everybody goes on the special diet. This self-effacting nature of women can make it difficult to make them understand the importance of putting one's health in the forefront.
Dr. JAYASHREE GOPAL
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