Hyperglycaemia in Pregnant Mothers

Hyperglycaemia during pregnancy is one of the main causes for the birth of large babies and it can also cause complications to both the baby and the mother. Speaking to Dr. U.D.P. Rathnasiri, Consultant Obstetrician/Gynaecologist, Castle Street Hospital, Health Capsule learned that if no monitoring and regulation is done, pregnant mothers who have never suffered from diabetes may have an unfortunate surprise sprung on them.   

What is Hyperglycaemia?
“Hyperglycaemia occurs when the blood glucose levels are not in the normal range before or after meals. However most often, we take this into consideration after meals. If the blood sugar levels are above the normal range, we consider it hyperglycaemia. During pregnancy we test for hyperglycaemia through blood sugar,” said Dr. Rathnasiri.   

He further said there were two categories of patients when it came to hyperglycaemia during pregnancy. “The first category includes mothers who are already hyperglycaemic before the pregnancy. These mothers may have chronic diabetes even before pregnancy. The second category are mothers who are normoglycaemic, which means their blood sugar levels are normal before pregnancy. Later they develop hyperglycaemia during their pregnancy. This is called gestational diabetes or pregnancy-induced hyperglycaemia. Not all mothers will develop this condition. Usually around 10% of them will develop it.”   

Causes
Speaking of the causes he said, “If the patient already has diabetes, it’s usually because the blood sugar is not controlled adequately by the body’s hormonal mechanism, which is insulin. The reason why insulin cannot control blood sugar in the body can be due to the deficiency of the pancreas which produces it. Sometimes hormones produced during pregnancy can develop resistance to insulin.”   
“When we have meals, sugar is absorbed by our body. The sugar is controlled by insulin. If there is an inadequate amount of insulin in the body, blood sugar levels can go up.”   

“At the start, insulin levels are not affected but as the pregnancy advances, some hormones produced by the placenta may have a resistance to insulin, as they contain antagonists. These hormones may act against the insulin hormone. Thus, the problem may not be due to the reduction of insulin in the body but because hormones are ineffective in controlling blood sugar.”   

“Hyperglycaemic mothers and normoglycemic mothers may develop diabetes during pregnancy due to hormonal changes that occur at this time. Hormonal changes during pregnancy take place in every mother but if the pancreas can increase its insulin production, the patient won’t go into a hyperglycaemic condition since their blood sugar levels are controlled. In case the pancreas can’t produce the additional requirement, they will develop hyperglycemia,” he added.   

Symptoms
Dr. Rathnasiri further spoke about primary and secondary symptoms that could be identified. “Sometimes patients may be asymptomatic, meaning they don’t develop symptoms. Symptoms of hyperglycaemia may include sweating and giddiness. Some patients can even go into a comatose state if the blood sugar level is very high. In the worst case scenario they can even go into ketoacidosis.”   

“These are mostly direct symptoms but secondary symptoms such as hypertension, urinary tract infection and fungal infection can also take place. Sometimes they can cause blindness, retinal problems, renal problems, and nerve problems. This is not limited to pregnant mothers and anyone with chronic diabetes can go through this.”   

Effects on the baby 
He further explained that it was not just the mother who was affected, but the unborn baby as well. “If blood sugar is not controlled early in the pregnancy, this could cause foetal abnormalities early on in the pregnancy. Later on the baby can develop macrosomia, which is when the baby is larger than the average size. If it’s not managed properly, it could lead to the baby’s death.”   

If it is a large baby, problems during labour and at the time of delivery could occur. After the delivery, if it is not controlled, babies can develop hypoglycaemia, the increase in the hemoglobin levels in their body, electrolyte imbalance, poor breathing and hypothermia. If they are delivered prematurely, they may have problems with respiration (respiratory distress syndrome). This does not happen to all babies but only with those who are not monitored properly after delivery.”  

Medical Management
Dr. Rathnasiri further said pregnant mothers’ blood sugar levels should be monitored before, after and during the pregnancy. “Before the pregnancy, mothers should undergo tests to check if they are normoglycaemic. If they have hyperglycaemia they should control their blood sugar and get it regulated.Treatment is directed to control blood sugar. The majority of these cases can be controlled through diet and lifestyle modifications. Doing exercises and avoiding eating sugar-based foods, drinking alcohol and smoking can help control the situation. Mothers should also avoid stress during pregnancy. If blood sugar is not controlled through diet and exercise alone, the patient will require drugs. Some patients can be treated with oral hypoglycemic drugs which are tablets and some will need insulin. The majority of these cases can be controlled through diet alone.”  

“Treatment has to be done with regular blood sugar monitoring and monitoring of the baby’s growth. The blood sugar will have to be controlled meticulously and the planning of the timing of delivery is important.   

When it comes to diabetic mothers, their pregnancy should not go beyond 40 weeks. If they are on insulin, we usually deliver the baby at around 38 weeks. If they are on metformin or oral drugs, the delivery is usually done at around 39 weeks. So it is important to have meticulous control of blood sugar before as well as during pregnancy.”   

“After delivery, blood sugar monitoring should be done because some of these mothers who develop diabetes during pregnancy are more prone to getting chronic diabetes later,” Dr. Rathnasiri advised.