Kerryn's story

Kerryn Feigenbaum, 31, has been pregnant four times. She was 25 when she first fell pregnant but miscarried shortly after conception.

Kerryn recalls, “My doctor gave me a urine test just before the miscarriage and detected sugar in my blood. I miscarried and my sugar levels stabilised.”

High blood-sugar levels are often indicative of gestational diabetes, a form of diabetes that only affects women during pregnancy. Although diabetes was not the reason given for the miscarriage, when she fell pregnant a second time, Kerryn immediately went to the Centre of Diabetes in Johannesburg. She was concerned that she might again develop gestational diabetes, especially because diabetes runs in her family.

After assessments by a doctor, dietician and biokineticist, Kerryn was given a special diet and exercise regime to control her blood-sugar levels. “I had to follow a very strict diet where I was not allowed to eat any sugar, fats or oils. I also had to eat six small meals a day and plenty of fruit and vegetables.”

On top of that Kerryn had to exercise five days a week until the last month when she could only manage two to three times a week. “Mostly, I’d go to the gym at the Diabetes Centre and walk moderately on the treadmill for about 30 minutes and do about 15 minutes of weights.”

By sticking strictly to this regime, Kerryn remained healthy until the 28th week of pregnancy. “At week 28, my sugar levels just kept getting too high and I was put onto insulin. I had to inject myself with an injection pen before every meal. I also had to give myself a pin-prick test twice a day to check my sugar levels, as well as have regular blood tests every two to three weeks.”

Due to careful monitoring, Kerryn’s pregnancy continued uneventfully and she carried up until 39-and-a-half weeks when her baby was delivered via Caesarean section. Because her sugar levels had been so strictly controlled, her baby boy was a healthy weight and was not too big, as many babies of diabetics are.

“What was incredible,” recalls Kerryn, “was how, just after delivery, my sugar levels immediately normalised and I was no longer diabetic. My baby was also completely healthy. It was well worth having been so strict during my pregnancy. What got me through the pregnancy was that I was determined to manage my diabetes properly to ensure the health of my baby. I also knew it was only a short-term thing and that once I’d given birth I would no longer have to do all the monitoring and insulin injections. It was tough but, in hindsight, there was nothing to be afraid of.

I’m just grateful that modern medicine has made advances to the point that I was able to get through my pregnancy as healthily as possible and finally give birth to a healthy baby.” Kerryn’s subsequent two pregnancies were diabetes free.

Causes & symptoms

What is gestational diabetes?
Gestational diabetes is when a pregnant woman develops diabetes during her pregnancy, with the symptoms disappearing once she’s given birth. As in regular diabetes, in gestational diabetes there is an excess of sugar in the blood, which, if untreated, can result in complications for the mother and baby. It affects about four per cent of pregnant women and usually begins between the 24th and 28th week. Dr Mogi Lingham, gynaecologist in Johannesburg, says, “We don’t see a lot of gestational diabetes but screening tests to pick it up are vital. If it does occur, it can cause harm to the unborn baby.”

What are the causes?
During digestion, your body breaks down carbohydrates from foods such as bread, vegetables, fruits and dairy products into various sugar molecules. One of these sugar molecules is glucose, which is one of the main sources of energy. Glucose is absorbed directly into the bloodstream after eating but it needs insulin to carry it out of the blood and into the cells. The pancreas produces insulin continuously but when you eat, and your blood sugar increases, insulin production also increases to help rid the blood of this sugar.

During pregnancy, hormones make it more difficult for insulin to do this job. As your placenta grows larger in the second and third trimester, it secretes more “pregnancy” hormones, making it even harder for insulin to work. In most pregnant women, your pancreas responds by producing enough extra insulin to overcome this resistance. But in some women the pancreas can’t keep up and too little glucose gets to the cells and too much of it stays in the blood. This is gestational diabetes.

Am I at risk?
There are a number of factors that could put you at risk of developing this condition. Dr Sarah Shanahan, a gynaecologist specialising in high-risk obstetrics, says, “If you’re obese, more than 85 kilos, are older than 35, have had a previous baby of more than four kilos and if there’s been any unexplained death of a mature foetus, you could be at risk of developing gestational diabetes. A family history of diabetes is also very important. This, together with two of the other criteria, puts you at high risk.”

What are the symptoms?
For most women there are no obvious symptoms of diabetes, which is why it’s important to have regular medical check-ups. Dr Lingham says, “Excessive thirst or increased urination is usually a symptom, although these may also be present in a ‘regular’ pregnancy. Many women think that a craving for sugar is a symptom, whereas this is not a typical sign.”

Tests & treatment

How is it picked up?
The routine urine test that is conducted during your monthly visits to your doctor or gynaecologist will pick up if there’s an excess amount of sugar in your system. Normally, sugar is not detected but, if it is, you will then be required to have a blood test, which will measure your exact glucose levels to see whether or not you’re diabetic and which treatment plan to follow.

If diabetes is suspected either because of symptoms of if you’re in a high-risk category, you might be given a glucose blood test that occurs after 16 weeks of pregnancy, says Dr Shanahan. This test involves drinking a syrup glucose solution and having a blood test one hour later to see how your body has processed the sugar.

What effect does gestational diabetes have on my baby and me?
Most women who develop gestational diabetes deliver healthy babies. But it is vital that your blood-sugar levels are treated and controlled. Dr Shanahan says, “If left unmanaged, gestational diabetes can cause excess growth of your baby to a size of more than four kilos at birth, increasing the chances of a difficult delivery for both baby and mother.”

Untreated diabetes can also cause your baby to have low blood-sugar level or jaundice at birth. Dr Lingham says, “Congenital abnormalities like heart problems might also occur and gestational diabetes has also been associated with unexplained foetal death, although only when the diabetes has gone undetected and unmanaged.”

Babies of mothers who have gestational diabetes are also more at risk of developing obesity and type II diabetes later in life. The risks associated with gestational diabetes are greatest for the mom. As with regular diabetes, in extreme cases, if left untreated it can result in kidney, heart and nerve damage. The biggest concern for moms is that it can increase the risk of pre-eclampsia. If left untreated, pre-eclampsia can lead to life-threatening complications for both mother and baby.

How is it treated?
Gestational diabetes needs to be managed throughout your pregnancy. Your diet is a crucial aspect of controlling your sugar levels. Often your doctor will urge you to consult a dietician who’ll devise a specific diet, which must be followed closely. The diet will usually involve a balanced diet including fruit, vegetables and wholegrains with fewer animal products and sweets.

However, no single diet is right for everyone. An eating plan would take into account age, weight, exercise habits and food preferences. If diet is adequately managed, there may be no need for insulin injections.

Exercise is another important aspect of controlling diabetes. Exercise can greatly lower your blood-sugar levels by ensuring that the sugar in your blood is transported successfully to your cells. Mild aerobic exercise, such as walking and swimming for about 30 minutes a day, are good choices. However, you do need to talk to your doctor before embarking on any exercise programme. Exercise is best avoided by pregnant women with complicated diabetes, such as high blood pressure, or kidney, heart or eye problems.

If your diabetes can’t be controlled through diet and exercise, you may be prescribed insulin injections. In some cases, oral medication will be given. Your doctor may also ask you to check your blood-sugar levels a few times per day. This is usually done by drawing a drop of blood from your finger using a needle and then placing it onto a test strip inserted into a blood-glucose meter, which in turn measures your blood-sugar level.

Dr Shanahan says, “Women with gestational diabetes on insulin also frequently have increased foetal surveillance from 32 weeks. We regularly do scans to check baby’s growth and also foetal heart rates to check wellbeing.”

Can I prevent it?
Although there are no guarantees, diabetes is one of those conditions that can best be prevented by healthy habits. Eating a healthy diet, getting physically active and maintaining a healthy weight all decrease the chances of developing the condition.

Will I have to deliver early?
Not necessarily. Most gestational diabetics deliver between 38 to 40 weeks, unless an earlier delivery is needed. However, it is not recommended to allow these women to go past their due date, says Dr Shanahan.

If I had gestational diabetes in my first pregnancy will I develop it again?
It is not a given but you are more likely to develop it in subsequent pregnancies. You are also more likely to develop type II diabetes as you get older.