Diabetes mellitus, also known as diabetes, is a health problem that is often given attention in the media. It is one of the chronic diseases that can bring various complications or adverse effects that are detrimental to the health of a patient, and also incurs a high medical cost not only in Malaysia, but around the world.

Gestational diabetes or Gestational Diabetes Mellitus/GDM is a condition experienced by pregnant women who did not have pre-pregnancy diabetes but were detected to have blood glucose levels that are higher than normal.

According to our national statistics, more than eight per cent of pregnant women were diagnosed with diabetes during pregnancy in 2012.

During a woman's pregnancy, various hormones are produced by the placenta, which can affect the function and effectiveness of the insulin hormone in the body to control body sugar levels.

This is also known as insulin resistance. As the placenta grows, more inhibitory hormones such as cortisol, oestrogen and human placental lactogen are released, and this causes resistance to the action of insulin to increase even higher.

The pancreatic organ, which is one of the organs located in the back of the stomach, is forced to produce more insulin to overcome resistance to insulin function.

Insulin produced by the pancreas helps to control the amount of sugar in the blood and allows a person’s body to store glucose that is not needed immediately to produce energy.

If these efforts are insufficient or fail, glucose levels in the body will rise, and diabetes during pregnancy will occur. Usually, patients will recover after the child is born.

However, patients will face a higher risk of developing diabetes later in life. Because of this, periodic screening or check-ups are necessary to detect postpartum diabetes.

Contributing factors

Even healthy women before pregnancy are at risk for diabetes during pregnancy, but several factors increase the likelihood of diabetes during pregnancy.

Among these risk factors are:

1. Overweight (women who are ‘overweight’ or obese), have close relatives who have diabetes.
2. If the woman has had diabetes during pregnancy before and if she has ever given birth to a large baby (more than 4 kg) and the baby is deformed or dies at birth.
3. Advanced age, or if experiencing other related problems during pregnancy such as hypertension or excessive production of amniotic fluid.

Symptoms or warning signs

Usually, many women who develop diabetes during pregnancy do not show any warning signs but some will feel thirsty, tired and urinate frequently. Pregnant women at risk are advised to take an ‘oral glucose tolerance test’ (OGTT), also known as a ‘sugar water’ test, to check the body’s response and ability to control blood sugar levels and detect the presence of diabetes during pregnancy.

Guidelines in the country recommend that a pregnant woman who has a risk factor for developing diabetes during pregnancy should undergo this OGTT test on the first visit (booking visit) to the clinic for antenatal treatment. If the result is negative, this test can be repeated in the sixth to seventh month (or 24 to 28 weeks) of pregnancy. This is to allow for early detection and care for the disease.

For women 25 years of age and older who do not have risk factors for diabetes during pregnancy, this test can be done in the sixth to seventh month.

All mothers required to go through the OGTT procedure should fast for at least eight hours before the procedure. After the first blood draw, sugar water will be given. After two hours, a second blood draw will be performed. If the sugar level exceeds a certain level, the woman is diagnosed with diabetes during pregnancy.

Complications during pregnancy

It is known that women who develop diabetes during pregnancy have a higher risk of developing complications during pregnancy. Such complications include the risk for miscarriage, birth defects, premature birth, and even macrosomia (babies born weighing 4.0 kg or more).

This can make it difficult to give birth normally and increase the need for surgery to deliver the baby.

In addition, unborn babies have a higher risk for respiratory problems and tend to become obese or develop diabetes in the future.

Diabetes treatment during pregnancy

The treatments for diabetes during pregnancy include:

1. Taking steps to ensure that blood glucose levels are always at normal or optimal levels during pregnancy.
2. Patients should follow an appropriate diet plan according to the advice of a nutritionist and reasonable physical activity should be increased gradually so that blood glucose levels can be controlled within a safe range.
3. Regular monitoring of blood glucose levels is very important to ensure that blood sugar levels are always at normal levels.

Some pregnant mothers with GDM may need medication treatment or insulin injections, in addition to healthy eating habits and active physical activity, to achieve the recommended blood glucose levels.

Advice and treatment should be obtained from a qualified physician.

-- BERNAMA

Dr Chooi Kheng Chiew is a Physician & Endocrinologist with the KPJ Ampang Puteri Specialist Hospital.