HIGH RISK OBSTETRICS

Tell Dr. Alex Polyakov

• If you have had gestational diabetes during a previous pregnancy
• If you have a family history of gestational diabetes or diabetes
• If you have given birth to a baby weighing four kilos or over.

Course of Illness

Although gestational diabetes usually goes away after birth (when hormone levels return to normal), it still needs to be taken seriously.

• The main concern is that it can increase the baby’s weight, and have other health effects on the unborn baby.
• If the baby becomes very large (four kilos or more) it may be necessary for the woman to have a caesarean delivery, or for the doctor to induce the birth a little earlier, before the baby grows too big. But this can usually be avoided.
• Women who develop gestational diabetes have about a 50% risk of developing type II diabetes later on.
• Type II diabetes, which is increasingly common in people over the age of 40, is a chronic disease, which has to be carefully managed with healthy eating and regular physical activity. Sometimes long-term medication is also needed. If type II diabetes isn’t controlled it can cause serious health problems including heart and kidney disease, and eye problems.
• In severe cases, the baby may die in the uterus.

When gestational diabetes is well controlled, these risks are greatly reduced.

Routine Tests

Pregnant women are routinely checked for gestational diabetes between the 24th and 28th weeks of their pregnancy. Women at increased risk are usually tested earlier. The glucose challenge test involves taking a glucose drink, waiting for one hour and then having a blood test. If your glucose levels seem high, you will have a glucose tolerance test to confirm the diagnosis. This involves fasting from the night before the test, drinking a stronger glucose solution, and taking a blood tested two hours later.

Managing Gestational Diabetes

A woman with gestational diabetes needs careful monitoring for the remainder of her pregnancy.

Management is mainly aimed at changing to a healthy eating plan, physical activity and monitoring blood glucose levels. Specific management strategies include:

• Eating Regular Meals – Hospital dietitians can advise on which foods to eat and which foods to avoid, and how often to eat
• Regular exercise to help reduce insulin resistance
• Dietary modifications, such as switching to a low fat, high fibre diet with plenty of fresh foods
• No alcohol or cigarettes
• Regular blood tests performed at home to check glucose levels
• Some women may need to take medications, these may include tablets or insulin injections