11-12_BT_Nov-Dec 2021

Bump to Birth
9 Months
Q: What are the possible symptoms of
diabetes during pregnancy?
Dr. Prakash: Usually, gestational diabetes has no symptoms.
If a woman does have symptoms, they may be mild, such as
being thirstier than normal or having to urinate more often.
Q: What age group or category of
women can be affected with this type
of diabetes?
Dr. Prakash: A woman is more likely to develop gestational
diabetes if she is overweight with a BMI of 27kg/m2 or
higher, previously have had Gestational diabetes, has a history
of giving birth to a large baby, have a first-degree family
member with diabetes or with the presence of sugars in the
urine test done during routine follow up.
Q: How can pre -existing diabetes be
managed in a pregnant woman?
Dr. Prakash: Assessment of sugar levels in a pregnant
woman with pre-existing diabetes is vital. Women already
on medication, would either be advised to continue current
medication or she may need to start on insulin injections. Low
dose aspirin will also be given in addition to folic acid, calcium
carbonate and vit D3 tablets. Additional blood tests to look at
kidney functions would need to be done. An appointment for
eye assessment by an ophthalmologist will be organized to
look for eye related complications secondary to pre-existing
diabetes. The woman will also be given a consultation with
the dietician for relevant advice in maintaining a healthy diet.
Her pregnancy follow ups would further be under combined
care with the endocrinologist.
Q: Is it necessary for pregnant
women to be screened for GDM?
Dr. Prakash: All pregnant women with risk factors will need
to be screened for GDM. Women at risk of developing GDM
will be advised to screen early in pregnancy. Women aged
25 and above with no risk factors will be advised screening
between 24 to 28 weeks of gestation.
Q: What is the treatment for GDM in
pregnancy, and how is it managed?
Dr. Prakash: In some women, GDM will respond to healthy
diet and exercise. Majority will need oral medication or
insulin. Follow ups with the obstetrician will be on a regular
basis. The woman will be advised to monitor her blood
sugar levels frequently and any abnormal results will require
immediate attention by the obstetrician.
Q: What are the likely complications
of diabetes during pregnancy?
Dr. Prakash: Most women who develop gestational
diabetes have healthy pregnancies and healthy babies
but occasionally gestational diabetes can cause serious
problems, especially if it is not recognized or treated. With
gestational diabetes, a woman is more likely to develop a
condition called preeclampsia, which is when you develop
high blood pressure and too much protein in your urine
during the second half of pregnancy. Uncontrolled sugar
levels can also result in a woman having a stillbirth. In terms
of delivery, gestational diabetes may also increase your
chance of having a cesarean section as your baby may be
large. In the long term, the chance of developing type 2
diabetes later in life is also increased.
Q: How will gestational diabetes
impact the baby’s development, and
are there any birth defects?
Dr. Prakash: Most of the developmental anomalies or birth
defects are seen in women with pregestational diabetes
in pregnancy. The anomalies include problems with the
development of the heart, central nervous and skeletal system.
These anomalies are usually a result of poorly controlled
diabetes during preconception up to the first trimester.
Q: How prevalent is diabetes in
pregnancy in Malaysia?
Dr. Prakash: The prevalence of diabetes in pregnancy in
Malaysia is quite common ranging from 18% to 24%.
The global rapid increase of gestational diabetes mellitus is
alarming. Diabetes can be a common endocrine disorder in
pregnancy, which is detected in weeks 24 to 28. In certain
occasions, the condition can develop earlier as well. Being
diagnosed with gestational diabetes can be disturbing
emotionally in pregnancy, but with early screening and
detection the condition can be well managed to avoid any
complications during pregnancy and delivery. The prevalence
of diabetes has been associated with lifestyle changes,
environment and increasing urbanization. Lifestyle and eating
routines play an important role in keeping your blood sugar
levels within a healthy range.
14 BabyTalk | November/December 2021