Pregnant women undergo several physiological changes and among them- the fluctuation in blood sugar levels- is the most critical one, but it is often misunderstood. It is not uncommon to observe that an increasing number of women today are being diagnosed with gestational diabetes mellitus (GDM), a condition that demands awareness, timely diagnosis, and a proactive approach to management. Dr Mitul Gupta, Senior Consultant – Obstetrics &Gynaecology, Cocoon Hospital, Jaipur shares her inputs on ‘understanding the blood sugar levels during pregnancy’.
Blame it on the Hormonal Shift
Hormonal change is the main reason for the fluctuations in blood sugar levels. During pregnancy the body produces hormones such as progesterone, estrogen, and human placental lactogen. These hormones help in the growth of fetus. But the main concern is that they also compromise the efficiency of the hormone insulin, which controls blood sugar. It is evident that pregnancy makes the body to become somewhat insulin-resistant as a result. This happens especially during the second and third trimesters. It is also a fact that in the most cases, the pancreas compensates by producing more insulin. But when this compensation doesn’t occur effectively, it leads to elevated blood sugar levels, which is termed gestational diabetes.
Defining What is Normal
A fasting blood sugar level should be less than 92 mg/dL, according to national and international norms. Blood sugar levels may increase after eating, but they should ideally remain below 180 mg/dL an hour after eating and below 153 mg/dL two hours after eating. Getting the risk evaluated is advised. Therefore, between weeks 24 and 28 of pregnancy, we advise pregnant women to have an oral glucose tolerance test (OGTT). For women with high-risk factors, we advise them for earlier screening.
When Things Are Not Right
In initial phases, there is no visible symptoms for GDM. Sometimes pregnant women may feel excess thirst. Other symptoms may include frequent urination, exhaustion, or recurrent infections, especially vaginal or urinary. Here, it becomes important to go for regular screening as uncontrolled blood sugar may cause several complications which include preeclampsia, excessive weight gain during pregnancy, and the necessity of a caesarean section because of a large baby. Along with expectant mothers, new born are also at risks. For baby, high blood sugar may cause respiratory distress, low blood sugar after birth. A higher lifetime risk of obesity or Type 2 diabetes and macrosomia, a condition in which the baby is noticeably larger are other risk factors.
How to Manage Blood Sugar Effectively
Diet is the key for maintaining proper blood sugar levels. High-fiber food, less intake of carbohydrates, lean proteins, and healthy fats, can help stabilise blood sugar levels. It is advisable to eating smaller, more frequent meals instead of three large ones which also aids better glucose regulation. Light physical activities help in managing blood sugar levels effectively. Hence, we do emphasize on walking, yoga, and swimming, only after consultation. Exercise enhances insulin sensitivity.Would-be-mothers should not forget regular monitoring of blood sugar levels, both at home and at scheduled visits to ensure that fluctuations are kept in check. If it still remains at higher level, we do prescribe intervention in the form of insulin or oral medication as deemed necessary.
Postpartum Monitoring
Even after delivery, we do advise mothers to be careful and do not drop the guard. We have clinical evidences published in several journals, indicating nearly 50% of women diagnosed with GDM are at risk of developing Type 2 diabetes later in life. Therefore, a glucose tolerance test 6 to 12 weeks after delivery is crucial. Hence, it is recommended that women should adopt a healthy lifestyle post-pregnancy also and sustain this to reduce any future risk.
