Morning sickness, nausea, a sudden change in food preferences, and the hope of a healthy baby – pregnancy is a fulfilling experience that combines both pain and joy together. However, the worst part of pregnancy is having apprehensions and concerns. Gestational diabetes is one such risk factor that can have long term complications both to the fetus and mother.
What is gestational diabetes?It is diabetes during pregnancy. Gestational diabetes is characterized by high blood sugar levels in pregnant women caused due to carbohydrate intolerance.Hormonal changes that occur during pregnancy responsible for mood disorders, and anxiety also create insulin resistance and can lead to gestational diabetes.Though gestational diabetes symptoms are not always clearly visible due to pregnancy, they manifest, in some cases, in the form of regular symptoms of diabetes. They include:
- Excessive thirst
- Frequent urination
- Blurry vision
- Tingling sensation in hands or feet
- Slow healing wounds
How is gestational diabetes diagnosed?Since gestational diabetes occurs from 3. 8 % to 21% across India, all pregnant women are advised to take a screening test for gestational diabetes twice during their antenatal stages.The first screening should be done after being tested positive for pregnancy. The second test is done between 24-28 weeks of pregnancy. Ideally, there should be a gap of at least four weeks in between the two screening tests.Upon testing positive for gestational diabetes in the screening tests, diabetes doctors, and obstetricians should follow the guidelines for gestational diabetes treatment.
Glucose challenge test or Oral Glucose Tolerance TestSince most women do not experience gestational diabetes symptoms, pregnant women are advised to undergo a Glucose challenge test (GCT) or an Oral glucose tolerance test (OGTT). Also known as the 75 gm. two-hour glucose tolerance test, it is done after eight hours of fasting.Initially, a blood sample is taken for fasting blood glucose level. After that, the pregnant woman is given eight ounces of a sugary drink with 75 gm. of glucose in it. This has to be consumed orally.After two hours of consumption of this sugary drink, another blood sample is drawn in order to measure the postprandial blood glucose levels. This test is done to ascertain the level of glucose intolerance.Gestational diabetes diagnosis is confirmed if:
- Fasting blood glucose level is more than 95 mg/dL
- 2-hour postprandial is more than or equal to 140 mg/dL
Gestational Diabetes TreatmentIf it takes two to tango, it takes a team to treat gestational diabetes. A woman diagnosed with gestational diabetes needs comprehensive management in order to avoid serious complications to the fetus and mother. This is done with active participation of a diabetes doctor, obstetrician, dietician, and diabetes educators.It is important for the care team to educate the mother-to-be on the risks and complications of gestational diabetes. Apart from this, she should be informed about:
- Importance of self-monitoring of blood sugar levels with a glucometer
- Dietary modifications needed to reduce blood sugar levels
- Exercise requirements at various levels of pregnancy with safe physical activities
- Identification of low sugar levels or hypoglycemia
- What to do when sugar levels are low
Gestational Diabetes Treatment – Medical Nutrition TherapyThough some women are initiated on insulin therapy if they are not able to control their blood sugar levels, the mainstay treatment for gestational diabetes is medical nutrition therapy.
What is medical nutrition therapy?It is an evidence-based therapy that is provided by a registered dietician in conjunction with a diabetes doctor or an endocrinologist. It is a therapy that is based on regulating diet intake in order to control blood sugar levels and weight.Medical nutrition therapy is a key aspect of gestational diabetes treatment. When done in conjunction with self-monitoring of blood sugar levels at home with the help of a glucometer, medical nutrition therapy is highly effective in managing and treating gestational diabetes.
How does medical nutrition therapy work?Women with gestational diabetes need proper nutrition in order to ensure appropriate growth of the fetus. However, they need to take their carbohydrates, proteins, and fats as per the advice of a nutritionist in order to avoid high blood sugar levels.In medical nutrition therapy, a registered nutritionist or dietician provides a diabetes diet chart as per the recommendations of the diabetes doctor and the target range prescribed.By adhering to this diet plan and by promoting self-care with self-monitoring, a pregnant woman with gestational diabetes can gain control over high blood sugar levels and avoid serious complications.
Steps in medical nutrition therapy
- Initial assessment by a nutritionist on dietary patterns of the patient
- Considering medications prescribed by the diabetes doctor or the obstetrician
- Assessing the sugar level trend
- Prescribing a diabetes diet plan as per the nutritional requirements including macro and micronutrients
- Monitoring nutritional intake periodically using technological interventions
- Periodical assessments and modifications to reach target blood sugar levels