With the spread of diabetes reaching near-epidemic proportions, especially in this region, it is no longer a condition that is restricted to the ageing or the overweight. One form of diabetes that is increasing at a particularly alarming rate is gestational diabetes, the incidence of which in the UAE is as high as 22 per cent, compared to an estimated global average of less than 15 per cent.
According to Dr A P Manjunath, specialist gynaecologist at RAK Hospital, Ras al Khaimah, "Obesity is a leading risk factor for gestational diabetes, and it is on the rise here; over 20 per cent of women in the UAE are classified as obese. Other causes for the growing prevalence of the condition in this region are the sedentary lifestyles and poor eating habits."
Gestational diabetes mellitus (GDM) develops during pregnancy, usually in the second/third trimester, and is caused by a change in the way a pregnant woman's body responds to insulin. "Insulin is the hormone that helps the body utilise glucose from the food we eat," explains Dr Jennifer Kasirsky, specialist obstetrician and gynaecologist at Welcare Hospital, Dubai. "During pregnancy, a woman's body becomes slightly more resistant to the effects of insulin in order to help increase the amount of glucose available for the foetus."
Essentially, the placenta produces hormones that help the baby develop and these hormones also block the effects of insulin in the woman's body. As the baby grows, the placenta produces more insulin-blocking hormones and the mother's body responds by making more insulin but some women don't make enough to keep their blood sugar in the normal range. As a result, the condition causes high levels of glucose (sugar) in the blood. Luckily, in most cases, the blood sugar usually returns to normal levels soon after delivery.
Risk factors
Any pregnant woman can develop the condition, but some are at greater risk, says Dr Youssef Shawki Hassan, consultant endocrinologist at Al Noor Hospital, Abu Dhabi.
There are several factors that increase a woman's risk of developing gestational diabetes including age, ethnicity, weight and genetic factors. Being overweight is the most common cause, and obese women are more likely to develop diabetes due to a constant high sugar environment. Women with a body mass index (BMI) of 30 or higher are classified as being overweight.
Aside from weight, some other risk factors include age - the older you are while pregnant, the higher the health risk, and experts peg women over 25 as being in the risk zone; previous pregnancies - women who've already given birth to a big baby, weighing more than 4kg (a big baby points to high levels of glucose in the mother), or a stillborn baby (high blood sugar can be a cause of stillbirth); family history - close family members who are diabetic; and descent - women who are Asian, Latina, Pacific Islander or African-American. Racial descent is an important factor in the rise of the condition in the UAE, as gestational diabetes is widely prevalent among South East Asians, especially Indians and Filipinos, and there is a large South East Asian expat population here.
The majority of women with gestational diabetes have no warning signs or symptoms, says Dr Hassan, as it doesn't have any unique symptoms. Some things like tiredness, excessive thirst or increased urination, which can point to gestational diabetes, are also experienced by pregnant women in general, so it is easy to stay undetected. Therefore, it is advisable for women to be tested for diabetes before planning a pregnancy.
"Sugar levels must be tested and controlled a month or two before pregnancy since diabetes affects the foetus from the first few weeks," advises Dr Manjunath. "If possible, seek health care early so your doctor can evaluate your risk of gestational diabetes as part of your overall childbearing wellness plan." Testing at the first pre-natal visit is recommended for women who are at high risk. Otherwise, a routine screening test between 24 and 28 weeks of pregnancy is recommended for all women, with an oral glucose tolerance test.
The effects of the condition are serious for both mother and baby. Gestational diabetes that is not controlled causes a high-sugar environment for the foetus, resulting in rapid growth, which leads to a large baby that the mother may have difficulties delivering naturally. In addition to increasing the chances of needing a Caesarean section, big babies "may get wedged in the birth canal and suffer birth injuries," says Dr Hassan.
High blood sugar in the mother can also increase the risk of premature delivery or stillbirth. In addition, the baby can have difficulties coping as their blood sugar can drop significantly, resulting in hypoglycaemia. "In the womb the baby's pancreas produces a lot of insulin in response to the mother's high blood sugar," explains Dr Hassan. "After birth the baby continues to produce large amounts of insulin, but without the sugar from the mother, the excess insulin can cause the baby's glucose level to drop, which in turn can lead to seizures." Feeding or administering an intravenous glucose solution helps return the baby's blood sugar level to normal.
Uncontrolled GDM can also increase the risk of jaundice in newborns and generally, babies born to gestational diabetic mothers are at risk for obesity and diabetes later on in life.
Managing the condition
The first step in managing gestational diabetes is an evaluation of diet and exercise habits, says Dr Kasirsky.
"It's common for pregnant women to have cravings and to eat more, as they think that they're eating for two," says Dr Manjunath. "Unhealthy food choices, such as eating too much junk food, can contribute to causing GDM."
It is important for the mother-to-be to consult an endocrinologist or diabetes educator who'll assess her diet and discuss ways to improve it. A healthy diet should include foods that are high in nutrition and fibre but low in fat and calories, such as fruit, vegetables and wholegrains. It is important for the diet to be tailored to the body's needs based on weight, pregnancy weight gain goals, blood sugar level, exercise habits, food preferences and budget, says Dr Nath. Plus, intake of carbohydrates and of course, sweets, should be reduced.
It is critical to monitor blood sugar levels regularly at home to help keep it under control, says Dr Hassan. Exercising is also important as it lowers blood sugar by stimulating the body to move glucose into the cells, where it is used for energy. Physical activity also increases the effect of insulin on your cells. In severe cases, when controlling blood sugar with diet and exercise isn't enough, the next step is oral medication or insulin injections.
Usually after delivering the baby, in most women the sugar levels return to normal. However, within ten years, six out of ten women who had gestational diabetes develop diabetes, says Dr Kasirsky. Since women who have suffered from gestational diabetes run a risk of developing type 2 diabetes in the future, they should continue to monitor and manage their blood sugar even after delivery.
In fact, some women who actually have diabetes before pregnancy are only detected as a result of their antenatal care. As a result, it is essential for women who are diagnosed with GDM to test for diabetes post-pregnancy, to make sure they're not diabetic. "If you had gestational diabetes you should have your sugar tested again six to 12 weeks after delivery and then every three years for the rest of your life," says Dr Kasirsky. Maintaining a healthy weight, eating a balanced diet and staying active helps reduce the risk of getting diabetes later in life.
Try the alternative
According to wellbeing expert Dr Lixiaoling from Chaslu Dubai Wellbeing Centre, green tea can help with gestational diabetes. Yilouhe Green Herbal Tea is made from fenugreek, bitter melon and other herbs which help reduce blood sugar levels. It also contains bee glue, which aids pancreas cell recovery and boosts the immune system. Dr Lixiaoling recommends women who are at high risk for GDM to drink three cups of this tea before conception, and continue throughout pregnancy.
