If you have been diagnosed with gestational diabetes mellitus (GDM) during pregnancy, your treatment and management will include regular follow-up with your obstetrician, your endocrinologist for your hyperglycemia, your dietician and your trained physiotherapist, all of who will advise you in their respective field of expertise.
Once you have gestational diabetes, it is not going to go away and will stay with you throughout pregnancy. Treatment, therefore, aims at controlling it. And, you remain the most important person responsible for the success of the treatment.
Recommendations for overall treatment and management of gestational diabetes follow a protocol and involve the following:
Close monitoring of your growing baby and your blood sugars
Safe pregnancy exercises about five times a week will help the more effective action of insulin to lower your raised blood sugar.
Medication
The aim of all the measures mentioned above is to always keep your blood sugar levels within the normal range throughout pregnancy and ensure the proper growth and well-being of the fetus.
Choosing a healthy lifestyle, following the proper diet and safe pregnancy exercises will make you feel better, symptoms of gestational diabetes will disappear and you will feel more energetic.
Most pregnant women can manage their gestational diabetes with diet and exercise alone and without medicines.
Close monitoring of mother and baby
Checking blood sugar levels a few times every single day can be quite overwhelming but it is necessary and forms an important part of gestational diabetes treatment. You can do this using a glucometer at home.
The digital meter displays your blood sugar level within two minutes and it is fairly accurate.
The procedure. You have to prick your finger with a needle or lancet. A drop of the oozing-out blood is placed on a special strip, which is then inserted into the glucometer.
This method helps to test your blood sugar in the comfort of your own home or even at your place of work. This is called home blood sugar testing or self-testing.
It is convenient and also keeps your apprehension away when you know that your blood sugar has been normal throughout the day and your diet, exercise, and medication (if any) are effective.
Any abnormal readings should be reported to your diabetic specialist. Do maintain a chart of your test results for your doctor to examine when you visit him or her.
Regular medical checkup
When you have gestational diabetes, visits to your doctor will have to be more frequent than otherwise. Regular checkups will involve checking your blood pressure and urine and examining your blood sugar level chart, which you have been maintaining.
Your weight gain will also be compared to see that you have been gaining weight as desired. This will also tell the doctor whether your pregnancy exercises are proving effective.
The doctor may then be able to ask you to continue or may make certain changes for more effective control of blood sugar and proper weight gain.
Monitoring of fetal growth
Women with GDM require close monitoring of fetal movements, which is done with regular ultrasound testing. Ultrasound tells your doctor about fetal growth.
If your doctor feels that your baby is growing larger than normal, he may advise you insulin shots to control your blood sugar. Insulin is safe and does not harm the baby.
Your doctor may also ask you to keep a count of the baby’s kicks. Kick counts are fetal movements, which you feel when the baby moves its legs or flutters or rolls. You start feeling them after 18 to 20 weeks of pregnancy.
It indicates how active the baby is. In the last trimester, normally, ten kick counts are felt in one hour.
If you do not feel this much, it may just mean that your baby is sleeping. Do take the count in the next hour. If you again feel that your baby is not adequately active, and you do not feel 10 kick counts in a 2-hour period, you should talk to your doctor.
Eating a balanced diet for gestational pregnancy
The gestational diabetes diet incorporates the restrictions of diabetes and the additional requirement of nutrients and calories in pregnancy. Your diabetic specialist and dietician will help you in this regard. Carbohydrates are limited to controlling your blood sugar. Keep a record of what you eat and also your periodic weight results.
Diet is most important in cases of gestational diabetes and full importance should be given to sticking to what you have been advised. It varies from woman to woman and follow what you have been advised and not what your friend ate when she was pregnant.
Whole grains, fruits, and vegetables will be the main contents of your diet. Low fats and low carbohydrate-containing foods will be advised. Stay away from sweets and fried foods.
Regular exercise regime
Regular exercise for women is a must if there are no other contraindications. Moderate exercise during pregnancy should be a regular affair with a 30-minute session every day as recommended by The College of Obstetrics and Gynecology.
The Centers for Disease Control and Prevention (CDC) advocates two and a half hours a week of moderate aerobic activity like brisk walking in a healthy woman during pregnancy and the postpartum period.
Do not start with 30 minutes if you have not exercised in a while. Build up those minutes gradually over time. You could start with a 5 to 10 minutes session alternate days a week and increase gradually to 20 to 30 minutes 5 days a week and if possible to seven days a week.
Exercise will help better utilization of insulin to keep your blood sugar within normal limits.
You need the energy to exercise. This energy is provided by the glucose in the blood. The utilization of glucose for energy helps to bring down blood sugar levels.
Walking or swimming is ideal and you could even join classes that are conducted under the supervision of experts.
However, it is strongly recommended that you consult your doctor before starting your pregnancy exercises. You could read safe exercises for pregnancy for details.
Medication
Most cases of gestational diabetes, however, do well with diet control and exercise while about 10% to 20% require medication to control diabetes. Most doctors advise insulin shots in pregnancy when diet and exercise have failed to keep the blood glucose levels within normal range. Insulin does not harm the baby.
Some doctors may advise oral anti-diabetic drugs such as metformin, as part of gestational diabetes treatment but the general feeling is that their safety in pregnancy is yet to be established.
The American College of Obstetricians and Gynecologists and the American Diabetes Association do not currently recommend oral anti-diabetic drugs as a treatment for GDM.
Insulin is fast acting and helps to rapidly lower raised blood sugar levels after meals. You should adhere to the prescribed insulin doses in order to prevent low sugar levels (hypoglycemia).
When on insulin, make sure not to skip meals and not to over-exercise. It can cause hypoglycemia (low blood sugar levels).
Management during labor and delivery
Usually, nothing special needs to be done during the delivery of your child. The good news is that most women with GDM have a normal vaginal delivery and do not need any surgical interference.
But, the fact remains that women with GDM are prone to a higher risk of vaginal operative deliveries such as forceps-assisted delivery, vacuum-assisted delivery, and episiotomy. Even, the risk of cesarean section is higher than in normal non-GDM pregnancies.
This becomes necessary because at times, in uncontrolled GDM women, babies tend to be larger in size. To avoid damage to the baby and the birth canal of the mother, surgical intervention becomes necessary. Too large babies may require a cesarean section to be delivered.
It is the doctor’s decision. She closely monitors the vital parameters of the mother. Fetal heart monitoring helps to monitor the heart rate of the fetus.
If she feels that for the sake of the health of the mother and the fetus, any intervention is necessary, she will take the decision and proceed accordingly.
This is because delivering the baby after the due date may increase the risk of complications for the mother and the baby.
Post-delivery management of gestational diabetes
Management of mother post delivery
Blood glucose testing is advised every hour for a few initial hours.
Put another immediate pregnancy on hold. Choose a method of contraception that does not increase the risk of glucose intolerance in the mother.
Exclusive breastfeeding is encouraged due to its profound benefits for the baby. Breastfeeding reduces the risk of obesity and glucose intolerance in the baby. It even helps build a strong immune system.
In most women, the blood sugar levels return to normal in a few hours or days after delivery. In some women, hyperglycemia may persist in the mother. Diabetic medical management may be necessary for it and including for other conditions that may as arise such as hypertension, microalbuminuria, and dyslipidemia.
Management of baby post delivery
The baby’s blood sugar is closely watched. There may be hypoglycemia due to high insulin levels in the blood of the baby, which come on to fight the high blood sugar coming from the mother to the baby before birth. In such cases, the baby may require sugary water to drink or even intravenous glucose.
Baby’s blood may also be checked for low calcium and high bilirubin.
