Dear doctor;

I am suffering from type 2 diabetes and yet I would like to have my third child before I hit 40. I am now 39. However, my worry is that I could end up transmitting the disease to my unborn child. Could this really happen? If not, how does gestational diabetes occur?

Florian.

Dear Florian,

I can understand your problem. Diabetes type 2 occurs due to multiple causes like high carbohydrate diet,  obesity, particularly central obesity, physical and mental stress, ethnicity, alcohol, among others. Heredity also plays an important role in acquiring type 2 diabetes. One individual may develop type 2 diabetes due to other factors and it may be passed on to his progeny through genes. 

Gestattional diabetes is the situation where a woman who does not have diabetes, develops diabetes when pregnant. This usually occurs around 24th week of pregnancy. Gestational diabetes may resolve after delivery or one may continue to have diabetes even after that. The exact cause for gestational diabetes is not clear. But  most likely theory is that hormones from placenta may be responsible for it. The placental hormones are vital for baby;s development, but they also block the effect of insulin in the body. Thus glucose produced and present in the blood is not metabolized and there can be high blood glucose levels. 

Studies show that women with irregular menstrual cycles, polycystic ovarian syndrome are more prone to gestational diabetes. Those with a first degree relative suffering from diabetes are at higher risk of developing gestational diabetes. A woman who has had diabetes during a previous pregnancy has higher risk of developing diabetes in subsequent pregnancy.The symptoms of gestational diabetes are same as for other patients with diabetes like increased thirst ,polyurea, weight loss in spite of increased appetite. 

The individual with diabetes is prone to develop short and long term complications of diabetes, but the high blood glucose is detrimental to the fetus in mother’s womb. There is high risk of abortion and miscarriage and intrauterine death due to high blood glucose levels in the mother. 

The baby may be large in size causing difficult labor and may be born with birth abnormalities. Due to uncontrolled diabetes, a pregnant woman  becomes  more prone to develop infections like that of urinary tract and fungal infection of vagina. These infections can also harm the unborn baby.

Diagnosis of gestational diabetes is done by estimations of blood glucose in fasting and post prandial states. In case of doubt oral glucose tolerance test is done to confirm the diagnosis. 

Due to the risks involved it is recommended to screen all pregnant women for diabetes. Treatment is predominantly by insulin. 

Prevention lies in adopting a healthy diet and exercise programme. If planning to get pregnant and  is  obese, it is better to lose some calories before conceiving. Avoid high fat, animal proteins, alcohol and sugar. Focus on fresh vegetables, fruits and whole grains. Exercise at least 30 minutes per day or minimum three times per week.

Regarding risk of the baby being born with diabetes, as the baby grows up, they should be screened for diabetes regularly. Be vigilant to see any features of diabetes in the child like increased thirst, urination, delayed wound healing, among others. Adopting a healthy life style will also help the baby in prevention of diabetes later in life.