Based on experts' opinions, pregnant women are, indeed, in dicey situation given their susceptability to developing diabetes, writes WINIFRED OGBEBO
Sharing her experience, a 28 year- old banker, Mrs Ifeoma Nnoli, in her 6th month of pregnancy had been experiencing some slight changes which she couldn’t lay a finger on. It was her first pregnancy.
However, not wanting to raise undue alarm at the initial stage, she finally convinced her husband to take her to see the doctor in hospital where she had registered for ante natal.
After conducting some tests, her doctor diagnosed that she had diabetes and promptly placed her on bed rest for subsequent treatment. She had no history of diabetes in her family.
A Consultant Physician (Family Health/ General Medicine) at Cedar Crest Hospital, Abuja, Dr Sunny Ekwunife narrated his experiences over the years attending to pregnant women with diabetes.
He says, “Over the years of practice in the United States, I have seen lots of pregnant women with diabetes known as gestational diabetes. One paticular case stood out.
This was a 25 year old Hispanic female who was in her 5th month of pregnacy. She was brought to the emergency room confused, vomiting, and dehydrated. On further examination and with blood and urine tests, she was found to be diabetic, with lots of glucose in her urine and blood. Incidentally, this is the first time she was found to be diabetic. However, she revealed that her mother had type 2 diabetes.
She was then given lots of fluid (drip) and insulin and she got better.
So pregnant women should be tested for diabetes in their 5th or 6th month of pregnancy, and if positive, treated with insulin injection or oral drugs such as glucophage or glyburide. Such women should continue to be tested yearly after they have had their babies since some will develop type -2 diabetes within 10 years of delivery. This is more so with women with a family history of diabetes.
Recent research has shown that diabetes is on the rise in Nigeria among pregnant women and our hospitals receive high number of patients suffering from the disease today.
The medical director of Phalycon Clinic, Bauchi State, Dr Hassan Moh’d Garba noted that this type of diabetes called gestational diabetes is induced by pregnancy.
In the view of Dr Ekwunife, “A lot of women who get pregnant usually become diabetic. But the good thing is, as in most cases after delivery, they go back to normal. About 60 per cent of them would eventually develop diabetes 10 years after pregnancy. So you have to monitor a woman once she gets pregnant. If a pregnant woman had Type -2 before, the chances of having gestational diabetes is much higher. Seven out of 100 pregnancies in most cases develop this and the reason is obvious.”
Explaining the cause, he said, “When a woman is pregnant, she is eating for double, so what happens is that the body requires more Insulin to break down the food for energy and, definitely, if her body cannot make that Insulin, that’s one way of developing diabetes or the Insulin her body makes cannot be utilized by her body. Those are the two major causes of diabetes.What happens is that when a woman is pregnant, the need to make more energy for both is high and if your body cannot make insulin to help develop that energy, then you become diabetic.”
Having diabetes cured depends on the causative factor. According to the medical director of Phalycon Clinic,Bauchi State, If the pancreas is not well and that is why there is deficiency in production, it means by the time the pancreas is cured and the functional cells go back to their functions as normal, you can say the diabetes has been cured. For instance, in pregnancy, you could have what we call pregnancy induced diabetes because in that situation, there is sugar accumulation going on. So once delivery has taken place, sugar level goes back to normal, you are okay. So if there is no permanent damage to one of the four situations we have earlier mentioned, then diabetes can be cured.
Ekwunife explained that It is important to monitor pregnant women for diabetes because diabetes during pregnancy can lead to miscarriages, large babies (which can lead to caesarian section), premature babies, etc.
Other medical experts agree that the risks of maternal diabetes to the developing fetus include miscarriage, growth restriction, growth acceleration, fetal obesity (macrosomia), mild neurological deficits , polyhydramnios and birth defects.
Dr Ekwunife some tips for controlling diabetes in pregnancy which include:
• Meals – cut down sweets, eats three small meals and one to three snacks a day, maintain proper mealtimes, and include balanced fibre intake in the form of fruits, vegetables and wholemeal.
• Increased physical activity - walking, swimming/aquaerobics, etc.
• Monitor blood sugar level frequently, doctors may ask to check the blood glucose more often than usual.
• The blood sugar level should be below 95 mg/dl (5.3 mmol/l) on awakening, below 140 mg/dl (7.8 mmol/l) one hour after a meal and below 120 mg/dl (6.7 mmol/l) two hours after a meal.
• Each time when checking the blood sugar level, keep a proper record of the results and present to the health care team for evaluation and modification of the treatment. If blood sugar levels are above targets, diabetes management team may suggest ways to achieve targets.
• Many may need extra insulin during pregnancy to reach their blood sugar target. Insulin is not harmful for the baby.
He noted, “Gestational diabetes (GD) occurs because pregnant women require more insulin to regulate their blood sugar. So if they are unable to produce more insulin during pregnancy, it now results in GD. Pregnant women are usually tested for GD between the 5th and 6th month of pregnancy. If the result is positive, they can be treated with insulin injection or oral drugs such as glucophage and glyburide.
In most cases, the gestational diabetic woman’s blood sugar return to normal after delivery, but 60 out of 100 females with GD will develop adult type diabetes by 10 years after pregnancy. So, it is important that such women undergo periodic (yearly) tests for diabetes especially if diabetes runs in their families.”