If you have been diagnosed with Gestational Diabetes during pregnancy, it is natural to feel concerned. However, having a good understanding of the condition and knowing how a healthy diet and lifestyle can help, will benefit you.

Diabetes means having higher than normal levels of blood sugar. The digestive system breaks down the food we eat into glucose to be used by the cells for energy. Insulin helps convert glucose into energy. Insulin plays a key role here and if it is not being produced in sufficient quantities, your cells have a problem responding to it, this results in higher amounts of glucose in the blood.

During pregnancy, hormonal changes make the cells less responsive to insulin and if the pancreas is unable to keep up with the increased insulin demand, blood glucose levels are elevated resulting in gestational diabetes. The good news is that most women do not remain diabetic after the pregnancy. However, this puts them at higher risk of developing diabetes later on in life or at the next pregnancy.

Risk factors for Gestational Diabetes include:
• A BMI over 30
• Excessive weight gain in the first trimester
• A previous pregnancy of gestational diabetes or a large birth weight baby (above 4 kgs)
• Family History of Diabetes
• Presence of sugar in the urine
• High blood pressure
• A stillbirth
• Age of 35 years and above

Glucose Tolerance Test

A Glucose Tolerance Test (GTT) is usually done during the 24th-28th week of pregnancy since gestational diabetes usually has no symptoms. If you have a family history of diabetes or show signs of diabetes you will have to undergo a GTT at your first prenatal visit and again at the 24th week. Even if you show a negative result for GTT, you will be assessed again in the 24th week.

Gestational diabetes and pregnancy

Mismanagement of diabetes at this stage can have short and long term consequences. High blood sugar levels causes too much glucose in the baby's blood and the baby's pancreas needs to produce more insulin to deal with all the extra glucose.

During the last 2-3 months of pregnancy your prenatal visits may increase as the doctor would like to keep a closer check on the baby. You may be asked to monitor the baby's movements from week 28 onwards, this involves counting the movements. As, a decrease in the normal number of movements is a concern and should be reported immediately.

If the diabetes is hard to control you may be asked to undergo further tests like non-stress tests and ultrasounds. These help assess the child's growth as the child may be getting big due to macrosomia caused from excess insulin production. A large baby could take more effort for the mother to deliver and may require a Caesarean delivery. Breastfeeding soon after delivery can help stabilize the baby's blood glucose levels.

If a mother is careful with her diet and exercise it can result in a healthy birth outcome, your doctor can give you guidelines and will monitor your sugar levels through the course of pregnancy.

Management of Gestational Diabetes

If you have been diagnosed with gestational diabetes you will be asked to regularly check your blood sugar levels and keep a record of these.

Diet:
At this point a qualified Dietitian can help you by providing a suitable meal plan for you which suits your weight, energy needs and activity levels. This is not a diet that is restricted, more than that it is a change in food patterns which will help you eat healthy. It is essential to have a healthy balance of carbs, protein, healthy fats and fiber at your meals. You will be advised never to skip a meal and to completely avoid sweet and sugary foods and desserts.

Exercise:
In consultation with your doctor, you should be able to exercise. This involves low intensity exercises such as walking. This improves the body's ability to process glucose and also helps in weight management.

Medication:
You doctor may choose to put you on a safe medication that will help control sugar levels without harming the baby.

Diabetes after delivery
Most women with gestational diabetes do not continue to remain diabetic after giving birth. But gestational diabetes could lead to impaired glucose tolerance (IGT) meaning that their blood sugar levels are higher than normal but not high enough to classify them as diabetics.

Your sugar levels will be checked again at your post-delivery visit, 6 weeks after the birth. If your levels are normal you need to check your sugar every 3 years to make sure they are in a healthy range. You need to maintain a healthy weight, eat right and exercise; you will also be encouraged to breastfeed as this helps post-delivery weight loss. Breastfeeding benefits both you and the child in preventing childhood obesity and lowering the child's risk for diabetes.

If you have any questions during the duration of your pregnancy and after regarding diabetes, do not hesitate to discuss these with your healthcare provider. It is always to be informed so you can make necessary changes for good health.