A di­ag­no­sis of gestational di­a­betes shocked MICHELLE D SOUZA to the core. She ex­plains the im­pli­ca­tions of the silent, of­ten mis­un­der­stood, dis­ease she has over­come – lift­ing the lid on some myths along the way

Little Treasures - - NEWS -

We look at the di­ag­no­sis and con­se­quences of this of­ten­si­lent con­di­tion

Your test results are out,” my mid­wife said. “You have gestational di­a­betes.” I clutched the sides of my seat and tried not to fid­get ner­vously. My hus­band started ask­ing ques­tions which my mid­wife gra­ciously an­swered. I sud­denly seemed to have a lot of in­for­ma­tion thrown my way. Or at least that’s what I as­sumed since I had al­ready started to zone out. ‘Is this some­thing I did?’ my mind wan­dered. ‘I thought preg­nancy was the time I could eat what­ever I wanted. Sat­isfy those crav­ings, they said.’ I tried hard to pay at­ten­tion to what my mid­wife was say­ing. I clearly failed. ‘I don’t need this right now,’ I thought. ‘Maybe the test results are wrong? But I wouldn’t want to re­peat that glu­cose test again!’ In my fam­ily, I am gen­er­ally known to be a ‘strong’ per­son, yet some­how at this mo­ment, I was far from be­ing one. Blame it on those preg­nancy hor­mones. Tears fol­lowed. Un­con­trolled sobs, ac­tu­ally. It took me quite a while to get my­self back to­gether. A cou­ple of weeks passed by be­fore I was able to ac­cept what was hap­pen­ing. And the jour­ney? It was one I couldn’t wait to get over with; one I would wres­tle with al­most all the way up to my de­liv­ery. But more im­por­tantly – it was one I would over­come.

So what ex­actly is gestational di­a­betes?

Gestational di­a­betes mel­li­tus (GDM) is a tem­po­rary con­di­tion where your body is not able to pro­duce enough in­sulin to reg­u­late blood sugar ef­fi­ciently. This, in turn, can have ad­verse ef­fects on your baby de­pend­ing on the sever­ity of the is­sue. Ac­cord­ing to re­search done by the Auck­land District Health Board, GDM af­fects roughly 6.6 per cent of preg­nant women in New Zealand. Women with a fam­ily his­tory of di­a­betes or those who are over­weight are more prone to de­vel­op­ing gestational di­a­betes dur­ing their preg­nancy. Re­searcher Dr Chris Mckin­lay of the Lig­gins Institute, who also works as a neona­tol­o­gist at Mid­dle­more Hospi­tal, said, “I think it’s im­por­tant to em­pha­sise that GDM can af­fect all women, not just those who are over­weight, though there is cer­tainly eth­nic pre­dis­po­si­tion to­wards Asian and Pa­cific peo­ple.” Ir­re­spec­tive of your eth­nic­ity, find­ing out that you have gestational di­a­betes dur­ing your preg­nancy can be quite un­set­tling. Judy Gra­ham, clin­i­cal mid­wife spe­cial­ist for di­a­betes in preg­nancy at the Coun­ties Manukau District Health Board, said that for some women it is the first time they have ever heard of di­a­betes so have no prior knowl­edge about the con­di­tion. “Be­ing told you have di­a­betes in preg­nancy is the last thing many women want to hear. It can be quite fright­en­ing for them,” she said. “They of­ten do not un­der­stand the con­di­tion or the ef­fects that it can have on their health or that of their un­born baby. This along with dif­fer­ent cul­tural at­ti­tudes to­wards food makes it dif­fi­cult for us to en­sure that we are get­ting the cor­rect mes­sage across to women.” De­vel­op­ing a med­i­cal con­di­tion dur­ing preg­nancy can also of­ten mean ad­di­tional fi­nan­cial com­mit­ments for some fam­i­lies, which can be a strug­gle for women to meet. “In spite of the ad­vice and in­for­ma­tion that we pro­vide to our women, they are not al­ways able to buy the health­i­est foods,” Judy ex­plains. “Also, be­cause di­a­betes is a some­what silent dis­ease – you can’t see or feel any­thing – it can be hard to com­pre­hend it as a real threat,” Judy said. “It’s not un­til the im­por­tance of mon­i­tor­ing their sugar lev­els in their preg­nancy are ex­plained to them or that they see con­cerns in their baby’s growth scans, that GDM mums be­come more com­mit­ted. So the chal­lenge is not just for the mid­wife. The woman faces the great­est chal­lenge. We try to hold her hand and help her along the jour­ney if she’ll let us.”

How do you find out if you have gestational di­a­betes?

To start with, you will be asked to do a glu­cose chal­lenge test in your 24th to 28th weeks of preg­nancy. If you have a fam­ily his­tory of di­a­betes, a higher gestational weight, pre­vi­ous signs of Poly­cys­tic Ovary Syn­drome, or a rou­tine Hba1c blood test re­sult with 41 mmol or higher, you will have to do a two-hour glu­cose test as op­posed to the one-hour glu­cose test. Both these tests re­quire you to have a sweet glu­cose drink on an empty stom­ach and then have your blood tested an hour or two later, re­spec­tively. If your results show that you have di­a­betes, your LMC will then re­fer you to a di­a­betes mid­wife spe­cial­ist and a nutri­tion­ist, who will fol­low up with you through­out your preg­nancy. Ad­di­tion­ally, you will also be asked to see an ob­ste­tri­cian in the weeks closer to your de­liv­ery. Many women, ini­tially, can feel a sense of shock or even guilt when they first find out they have gestational di­a­betes. Kate Adams, who dis­cov­ered she had it much later on in her preg­nancy had such a re­ac­tion. “At first I was shocked,” Kate says. “I was also up­set. I felt like it was some­thing I had caused, and that I had put my baby at risk.” “Later on, after talk­ing to a few peo­ple, I re­alised that this was some­thing I could not con­trol, and it was just some­thing I had to deal with for a short time. So I kind of got on with it – I had to re­ally.” Vicky Fletcher, a mum with GDM in her sec­ond preg­nancy, had a dif­fer­ent ex­pe­ri­ence. “Well, the first thing I asked my ob­ste­tri­cian was, ‘Is it man­age­able?’ and she said, ‘Yes, it’s to­tally man­age­able.’ So then I just thought, that’s fine. I can just deal with it.” “What was re­ally nice is that my di­a­betes mid­wife said, you can’t give it to your­self, it just sort of hap­pens,” Vicky re­calls. As a preg­nant mum with gestational di­a­betes, you then get ac­cess to all kinds of sup­port or ad­vice you need.

What next?

Upon di­ag­no­sis, if not con­trolled ef­fec­tively, gestational di­a­betes can af­fect both mum and baby. Preg­nant women are then at a higher risk of pre-eclamp­sia, go­ing into pre-term labour and need­ing to de­liver a large baby. The ma­jor con­cerns, how­ever, are the ef­fects that GDM can have on the baby. Is­sues start to arise when baby grows too large for their gestational age. This can lead to com­pli­ca­tions dur­ing and post-de­liv­ery, in­clud­ing shoul­der dys­to­cia

or birth trauma, res­pi­ra­tory dis­tress (par­tic­u­larly in cae­sarean births) and hy­po­gly­caemia (low blood sugar). “The risk of hy­po­gly­caemia is re­duced by good ma­ter­nal con­trol but all ba­bies of di­a­betic moth­ers are at risk and need ini­tial blood glu­cose mon­i­tor­ing,” Dr Mckin­lay said. If the baby is seen to have any risks, they will spend a few hours or a cou­ple of days in NICU un­til they’re ready to go home. Scary thoughts aside, it is im­por­tant to re­mem­ber that gestational di­a­betes can be kept in check by mon­i­tor­ing your diet, in­clud­ing some ex­er­cise in your day, and tak­ing some med­i­ca­tion (if re­quired). “An im­por­tant mes­sage is that gestational di­a­betes can be treated, which for most women just means chang­ing how they eat in preg­nancy,” Dr Mckin­lay said. A nutri­tion­ist can as­sist you in com­ing up with a proper meal plan to help con­trol your blood sug­ars. The meal plan will in­clude por­tion sizes, snack ideas and car­b­count­ing. Good eat­ing habits should be com­ple­mented with some form of ex­er­cise for at least 20-30 min­utes a day. You will also be asked to keep a food di­ary. To test your blood sugar lev­els you will be given a home glu­cose test­ing kit which will in­clude a dig­i­tal me­ter, test strips and a fin­ger pricker. As part of your daily rou­tine, you will be asked to test your blood at least four times a day; once in the morn­ing be­fore you eat any­thing, and then once two hours after break­fast, lunch and din­ner. This process can be frus­trat­ing, and can even make you anx­ious about how what you eat af­fects you. “Sugar mon­i­tor­ing was hard,” Kate said. “I found it frus­trat­ing that my lev­els were all over the show no mat­ter how well I ate or ex­er­cised. It was frus­trat­ing to have no con­trol.” Dur­ing my own jour­ney with gestational di­a­betes, after try­ing a few meal op­tions, I was suc­cess­fully able to keep my blood sug­ars down with a change in diet and half-hour walks daily. Nonethe­less, this may not suf­fice for all women, and sub­se­quently, a bit of med­i­ca­tion may be re­quired. Re­mem­ber that need­ing to take med­i­ca­tion is in no way an in­di­ca­tion that you have failed. Some­times what works for you one week may not work the next week. It of­ten hap­pens that most women are able to man­age their sugar lev­els in the first few weeks but find it harder later in their preg­nancy. While tak­ing med­i­ca­tion can make some preg­nant mums feel se­cure that their blood sug­ars are in con­trol, other mums tend to feel anx­ious and scep­ti­cal. Kate had sim­i­lar anx­i­eties. “At first I was scared about how it would af­fect my baby. The in­jec­tions didn’t faze me. It was more about what I am putting into my body and what ef­fects that’s go­ing to have on the baby. After see­ing the ef­fect tak­ing in­sulin had on the growth of my baby via the growth scans, I was more re­laxed about it all.” An­other preg­nant mum, Nita Yu, who had gestational di­a­betes in both her preg­nan­cies, strug­gled to come to terms with tak­ing med­i­ca­tion. After she got her glu­cose chal­lenge test results, she was pre­scribed to take Met­formin tablets and in­sulin. Look­ing for a cause, Nita found that it could’ve been due to a re­cent over­seas trip and a needed change of diet; and went to talk to her doc­tors again about re­con­sid­er­ing the med­i­ca­tion route. Nita felt that the change in her diet made a big dif­fer­ence, and per­haps she did not need med­i­ca­tion any­more. “I would of­ten think to my­self, can I avoid tak­ing in­sulin? But [the doc­tors] did ex­plain to me why they are giv­ing you medicine, be­cause they’re look­ing more at the baby’s liv­ing en­vi­ron­ment inside and try­ing to re­duce all the risk fac­tors when the baby comes out. I un­der­stand that. But I was still strug­gling.” After a few con­cerns in the baby’s growth scans, Nita re­alised that she may be bet­ter off hav­ing the med­i­ca­tion and has since taken her rec­om­mended dose.

How does this af­fect my de­liv­ery?

As a GDM mum, your birth plan is go­ing to look a lit­tle dif­fer­ent and will in­clude less con­trol from your side. Your ob­ste­tri­cian will de­cide when the baby needs to come out – roughly in the 38th-40th week of your preg­nancy de­pend­ing on how well you are pro­gress­ing. In most cases, you may have a date set to be in­duced. How­ever, it is pos­si­ble for you to go into labour nor­mally and have a nat­u­ral birth, which is what I had ex­pe­ri­enced. Baby will then need to be checked for hy­po­gly­caemia and en­sure that they don’t need any ex­tra glu­cose. Al­most all mums go back to their pre-preg­nancy glu­cose lev­els after de­liv­ery of the baby. You will, how­ever, need to do rou­tine checks once a year from then on to check for type 2 di­a­betes. When I de­liv­ered, I re­mem­ber be­ing ec­static about fi­nally get­ting to eat what­ever I wanted. Look­ing back on those months, the jour­ney was hard. But one line that my mid­wife told me on that very first day still sticks with me, and that is: “This too shall pass.” And she was right.

If not con­trolled ef­fec­tively, gestational di­a­betes can af­fect both mum and baby

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