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Sugar Mommies + Sugar Babies

Posted on February 27, 2018 | No Comments on Sugar Mommies + Sugar Babies

Mothers who develop high blood sugar levels first detected during pregnancy are diagnosed as having Gestational Diabetes Mellitus or GDM. Unfortunately, we Filipinos are among the people at high risk for developing this disease. With timely detection, proper nutrition, close monitoring, and the use of insulin when necessary, the outcome of pregnancies complicated with GDM is just about the same as normal pregnancies. But after one gives birth, what happens next? Are there still existing health issues a mother should worry about – both for her and her new beloved bundle? Should she be afraid to breastfeed? Would future babies be at risk? Pray tell, would there ever be normalcy in life after GDM?

Future Diabetes Risk
After pregnancy, the care for a woman with diabetes is similar to that for women without diabetes. However, it is important to pay close attention to blood glucose levels. These are usually measured within the immediate stay in the hospital after delivery of the baby, and then re-checked at least six to 12 weeks after delivery with a laboratory test called the 75-gram glucose tolerance test (OGTT) to be interpreted based on recommended values. Nearly all women (>=90 percent) with GDM have normal blood sugar levels after delivery. However, they are at risk for recurrent GDM, prediabetes or impaired glucose tolerance (IGT) – more commonly termed as “borderline” diabetes, and overt diabetes. Around 35 to 70 percent of women with GDM will have recurrent GDM in a subsequent pregnancy. Women who have a recurrence tend to be older, have higher number of previous pregnancies, and have a greater increase in weight between their pregnancies. Higher infant birth weight in the first pregnancy and heavier maternal pre-pregnancy weight have also been associated with recurrent GDM.

The long-term risk of future diabetes ranged from 2.6 to 70 percent (depending on the ethnic race), with the greatest increase in risk in the first five years after pregnancy, and the trend plateaus after 10 years. Risk factors for pre-diabetes/IGT and overt diabetes at a later date include requirement for insulin to control GDM, maternal obesity, high fasting blood sugar concentrations during pregnancy and immediately after delivery, and early onset of GDM within the gestation. The risk of type 2 diabetes is also importantly affected by body weight: it is 50 to 75 percent in obese women versus less than 25 percent in women who achieve ideal body weight after delivery. GDM can also trigger type 1 diabetes at a later period if there is the presence of abnormal antibodies in the immmune system that may attack the pancreas – the organ that produces and secretes insulin.

Diabetes Prevention
How can this evolution to diabetes be prevented? A woman with GDM should be able to resume a regular diet postpartum. However, maintaining a diet low in carbohydrate content with healthy food choices and smaller portions will facilitate postpartum weight loss. Weight loss (as little as five to 3 percent from baseline) can reduce blood sugar levels. It is recommended that mothers try to reach their pre-pregnant weight within six to 2 months after giving birth. Exercise should also be done for 30 minutes at least five times a week to prevent diabetes. Reassessment of blood glucose levels should be undertaken at one to two year intervals, or even more often if symptoms suggestive high blood sugar occur such as weight loss, thirst, frequent urination, blurring of vision, etc.

Is breastfeeding allowed? Breastfeeding is strongly encouraged, and benefits both the infant and the mother. Breastfeeding for longer than three months can aid in maternal weight loss and provides significant short and long-term benefits to the infant. Just like in normal pregnancies without GDM, adequate amounts of human milk meet all the nutritional requirements of an infant during the first six months of life. Exclusive breastfeeding (without formula supplementation) is recommended for the first six months after birth, and partial breastfeeding is recommended for at least 12 months, and thereafter for as long as mutually desired. The World Health Organization recommends that partial breastfeeding continue for up to two years, and beyond.

How about the little baby? Infants who were born with birthweights below and above the normal expected range have a higher risk of developing type 2 diabetes in their lifetime. It is never too early to start the proper nutrition and good choice of food for young children so that they can maintain their body weight within the acceptable range. In fact, the whole family should be involved in making the right food choices and doing enough physical activities in order to sustain the normal weight and body size to keep the blood sugar from going up. Sedentary activities like watching television, videos, or playing computer games should only be limited to a maximum of two hours a day.

Subsequent Pregnancy
Can the woman get pregnant again? GDM does not alter the chances of bearing children again. But to safeguard metabolic health, pregnancies should be planned especially if the mother developed persistent diabetes. Both the patient and the doctor should agree on the planning and timing of subsequent pregnancies.
How about contraception? Does it affect development of GDM? Low dose estrogen-progestin oral contraceptives may be used in women with a history of GDM as long as the usual medical contraindications to their use are absent upon proper evaluation by the gynecologist. Formulations with progestin-only (but not combined estrogen -progestin) oral contraceptives (OCs) have been associated with an increased risk of developing type 2 diabetes in women with recent GDM in a few cases.

Indeed, there is normalcy in life after Gestational Diabetes – both for the mother and the child. All it needs is the simple and healthy living our wise elders have always advised -“DON’T eat too much, sleep too long, or watch too much television.” Hopefully, by keeping diabetes at bay …the real sweetness of life will go on …and on …and on.

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