Pregnancy Diabetes.

During my 29th week of pregnancy, doctor informed me that I have gestational diabetes which was very common among pregnant women. There is nothing much I can do about it except to take care of my food intake and practice regular light exercise. I have to go through pricking my finger for blood to check my glucose level 4 times a day for up to my 38th week of pregnancy. Doctor say nothing much to worry about until my check-up on the 37th week. My blood glucose level was quite high and the doctor insist me to get admitted to start on the Insulin programme. Upon hearing the word Insulin,  I was so shock and speechless at that moment. My tears starts rolling down my cheeks and luckily my hubby was me at that time. He hold my hands and calmed down saying it's all for our baby. I was so scared and worried about my baby. Thank god doctor say my baby is in good condition and healthy. I got admitted into Putrajaya hospital immediately on that day itself and started off with the Insulin programme.

After 3 days, doctor finally allowed me to go home and rest. I only need to inject insulin onto my belly once a day (night) but still need to prick my fingers 3-4 times a day for blood glucose reading. Due to this, doctor want me to get admitted again the following week (38th week - 30 Jul 09) to induce and deliver the baby. Can't wait until the due date (40th week - 14 Aug 09) arrive as baby will be very big and more prone to birth complications / defects later.  Baby was born on the 02 Aug 09 morning.

On the 2nd post-natal month, I have gone for my medical check-up and doctor confirmed that I don't have diabetes anymore. But still have to take care of my diet as chances of getting diabetes is very high later in the years.

Infomation extracted from http://www.thestar.com.my/ :

DIABETES mellitus is a condition in which the blood glucose is too high (hyperglycaemia). It is due to insufficient insulin being produced or the cells in the body being unable to use insulin the way they should. Without insulin, the blood glucose that cannot get into the body’s cells accumulates in the bloodstream.

There are many changes in the body during pregnancy. The placenta produces hormones essential to foetal development and they increase in the second and third trimester. They also prevent insulin from functioning the way it is supposed to (insulin resistance). Thus, the demand for increased insulin with feeding escalates progressively during pregnancy. The body has to produce about three times the normal amount of insulin to overcome the effects of the placental hormones.

In most women, the body produces extra insulin to maintain the blood glucose in the normal range. However, in about 5% of women, the extra insulin produced is insufficient, leading to hyperglycaemia by the 20th to 24th week of pregnancy. After delivery, the body uses insulin more effectively and the blood glucose returns to the normal range.

This condition only occurs during pregnancy and is called gestational diabetes (GDM). The risk factors for GDM include maternal age, obesity, obstetric history of diabetes or large babies and strong family of diabetes.

Poor control in the first trimester, when the foetal organs are being formed, increases the risk of birth deformities and miscarriage. Diabetic ketoacidosis, a complication due to poor control, can also lead to miscarriage. Gestational diabetics do not usually have these problems because the condition develops after the first trimester.

Poor control later in pregnancy increases the risk of foetal death and/or increased foetal growth with birth weights above 4kg (macrosomia), the incidence of which is thrice that of those with blood glucose within the normal range. Macrosomia increases complications during labour and delivery, the likelihood of instrumental vaginal delivery and caesarean section, and birth injury.

The timing of delivery is important as the objectives are to prevent stillbirth and asphyxia and to minimise morbidity to mother and baby. Delivery that is as near to the expected date of delivery increases the likelihood of spontaneous labour and vaginal delivery. However, the risks of increasing foetal macrosomia, birth injury and stillbirth increase as one approaches the expected date of delivery.The obstetrician considers several factors when deciding on the timing and mode of delivery. They include blood glucose control, maternal complications, foetal macrosomia and foetal biophysical profile.

Although there are potential complications, a healthy baby will result, provided there is good control of the blood glucose. This can be achieved by close partnership between the patient with her obstetrician and her physician or endocrinologist.