Your Pregnancy - - Q & A Month 1 -

Q: Why should I start my preg­nancy at a healthy weight if I’m just go­ing to gain weight any­way? A: Vanessa an­swers: Ges­ta­tional di­a­betes par­tic­u­larly af­fects women who are over­weight or obese. Women should con­sider los­ing ex­cess weight be­fore fall­ing preg­nant, but if this isn’t the case, eat­ing sen­si­bly dur­ing preg­nancy can go a long way to re­duc­ing the risk of ges­ta­tional di­a­betes. Most ges­ta­tional di­a­betes oc­curs in women with risk fac­tors for type 2 di­a­betes. They’re un­able to se­crete suf­fi­cient in­sulin to over­come the in­creased in­sulin re­sis­tance that nor­mally re­sults as preg­nancy pro­ceeds. Ges­ta­tional di­a­betes af­fects about one in seven births, and may per­sist as type 2 di­a­betes or “pre-di­a­betes”, or re­solve com­pletely when the preg­nancy is over. Women who have had ges­ta­tional di­a­betes are at an in­creased risk for de­vel­op­ing type 2 di­a­betes later in life. A fur­ther of­ten un­ap­pre­ci­ated fact is that chil­dren whose moth­ers had di­a­betes dur­ing their preg­nan­cies have a greater like­li­hood of be­com­ing obese dur­ing child­hood and ado­les­cence and of de­vel­op­ing type 2 di­a­betes later in life. The num­ber of women be­ing di­ag­nosed with ges­ta­tional di­a­betes is in­creas­ing around the world, so find­ing sim­ple and cost-ef­fec­tive ways to pre­vent women de­vel­op­ing it is im­por­tant. The rule of thumb is to choose healthy liv­ing dur­ing preg­nancy. A healthy body means a stronger body, which will not only ben­e­fit the baby while in utero, but will also as­sist dur­ing the birth and re­cov­ery there­after. Healthy liv­ing means eat­ing prop­erly, ex­er­cis­ing reg­u­larly and do­ing away with bad habits such as smok­ing. Limit your in­take of sugar and pro­cessed food, and opt for a va­ri­ety of real, whole foods. Ges­ta­tional di­a­betes may end af­ter the baby is born, but women with ges­ta­tional di­a­betes have a 20 to 50 per­cent chance of de­vel­op­ing type 2 di­a­betes in the five to 10 years af­ter child­birth. Treat­ment of ges­ta­tional di­a­betes in­cludes healthy eat­ing, ex­er­cise and pos­si­bly in­sulin ther­apy. It’s im­por­tant to mon­i­tor blood glu­cose lev­els reg­u­larly to as­sess whether the ideal tar­gets are be­ing met. You should con­tinue self-mon­i­tor­ing of blood glu­cose af­ter de­liv­ery of your baby. Some women with ges­ta­tional di­a­betes will re­vert to nor­mal glu­cose tol­er­ance in the weeks fol­low­ing de­liv­ery, but with a high risk of de­vel­op­ing type 2 di­a­betes in the fu­ture. In oth­ers, di­a­betes re­mains and treat­ment should con­tinue. If blood glu­cose lev­els re­turn to nor­mal on home mon­i­tor­ing with­out any di­a­betes treat­ment, an oral glu­cose tol­er­ance test (OGTT) should be done in a lab­o­ra­tory six weeks af­ter de­liv­ery. This nec­es­sary stress test for your in­sulin-pro­duc­ing beta cells as­sesses for any ab­nor­mal­ity in glu­cose tol­er­ance. It is done by check­ing the fast­ing blood glu­cose level, and if in­di­cated by that re­sult, drink­ing a so­lu­tion con­tain­ing 75g of glu­cose. The blood glu­cose re­sponse to the oral glu­cose chal­lenge is then mea­sured two hours later. If this test is nor­mal, screen­ing for di­a­betes should be re­peated annually. To re­duce the risk of de­vel­op­ing type 2 di­a­betes in the fu­ture and to keep those an­nual tests neg­a­tive, it is vi­tal to con­tinue with healthy eat­ing, ex­er­cise and main­te­nance of a healthy weight range. Re­mem­ber, your child needs you to be healthy! YP

Vanessa Brown Di­a­betes spe­cial­ist nurse, Cen­tre for Di­a­betes and En­docrinol­ogy (CDE)

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