How 32-year-old Lavina realised that gestational diabetes had caused her miscarriage

‘Indian women have a 11-fold increased risk of developing glucose intolerance during pregnancy compared to their Caucasian counterparts. Screening earlier on in the pregnancy and graded therapy ensure a healthy birth,’ says Dr Ankita Chandna, Associate Director, Obstetrics and Gynaecology, Max Hospital, Shalimar Bagh.

March 17, 2023 02:01 PM IST

5 min read

Gestational Diabetes Mellitus (GDM) is characterised by carbohydrate intolerance of varying severity with onset or first recognition during pregnancy. (Source: Freepik)

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Written by Dr Ankita Chandna

Thirty-two-year-old Lavina Tandon (name changed) was anxious when she began consulting us at six weeks of her pregnancy. She had had a miscarriage at 11 weeks during her first pregnancy and was understandably stressed. We monitored her and she developed gestational diabetes at 10 weeks. Perhaps this was undiagnosed during her first attempt at becoming a mother and may have triggered her miscarriage. Many women are not aware that if their diabetes is not well-controlled in the early stages of pregnancy, then they have a higher chance of miscarriage and stillbirth. Remember, Indian women have a 11-fold increased risk of developing glucose intolerance during pregnancy compared to their Caucasian counterparts.

Once we had diagnosed Lavina with a Glucose Tolerance Test (GTT), we put her on regular follow-ups with a diabetic diet and physiotherapy sessions. As per her blood sugar reports, she had to be administered insulin and with a graded protocol and constant monitoring, she carried the baby to term and birthed without major complications.

Usually, gestational diabetes mellitus screening is done between 24 and 28 weeks of pregnancy since insulin resistance increases during the second trimester. But as Lavina’s case shows, screening earlier on in the pregnancy, preferably during the first antenatal visit, and insulin therapy have a beneficial role in improving the outcomes of the pregnancy.

What is gestational diabetes?

Gestational Diabetes Mellitus (GDM) is characterised by carbohydrate intolerance of varying severity with onset or first recognition during pregnancy. If undiagnosed or sub-optimally managed, it could lead to harmful mother and foetal outcomes like preeclampsia (high blood pressure with fluid retention), caesarean delivery, future Type 2 diabetes, perinatal mortality, macrosomia (foetus above the desired weight) birth trauma, hyperbilirubinemia (high bilirubin in baby’s blood) and neonatal hypoglycemia (babies with a plasma glucose level of less than 30 mg/dL (1.65 mmol/L) in the first 24 hours of life and less than 45 mg/dL (2.5 mmol/L) thereafter). Major risk factors for gestational diabetes include maternal age, family history of Type 2 diabetes, increased BMI (body mass index) before pregnancy or glucose intolerance in previous pregnancies.

Improper weight gain during pregnancy also has serious implications for foetal outcomes. According to Indian as well as international recommendations, gestational diabetes is usually managed through nutrition, exercise and close blood sugar monitoring. Some women also need to take insulin, but this is the last resort.

Gestational diabetes has been found to be more common among women in urban areas than in those living in rural areas. Lifestyle modification has shown good results in India as well as other countries in better management and improving foetal outcomes.

What should women with gestational diabetes do?

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Going by Lavina’s case, I would recommend consulting a doctor before you decide to get pregnant and check your blood glucose markers to arrest the chances of developing severe gestational diabetes. If you are overweight, lose weight before getting pregnant to ensure better blood sugar control later.

1) Pregnant women with diabetes need to see the doctor more often than pregnant women without diabetes. The follow-ups need to be frequent and regular so that you can control your blood sugar and change medication if needed.

2) Eat healthy and follow a strict diabetes-friendly diet. Remember, once you know what to have, there are plenty of ways you can make even healthy food flavourful enough to satisfy your cravings.

3) Exercise is another way to keep blood sugar under control. You can exercise regularly before, during and after pregnancy. Work with your doctor and get at least 30 minutes of physical activity at least five days a week. This could be brisk walking, swimming or even playing with children.

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4) Keeping blood sugar well under control can lead to a chance of low blood sugar at times. Keep a candy or chocolate at hand to counter effects of low blood sugar. So, monitor blood sugar often.

Do dim lights during pregnancy slow down gestational diabetes?

A study published in the ‘American Journal of Obstetrics and Gynaecology Maternal Foetal Medicine’ has shown that women who spent the least time in dim light had five times greater odds of developing gestational diabetes compared to those who spent more time in dim light.

Exposure to artificial light at night disrupts the circadian timing system and might be a risk factor for diabetes as it disturbs glucose homeostasis. So cut down on use of laptops, cellphones and TV. A study in China has shown the more we stay in artificial light, greater the risk of developing diabetes as it has a positive association with blood glucose, insulin resistance and diabetes prevalence. This applies particularly to women who have shift work and are night workers. Any stressor should be addressed for the sake of a healthy birth.

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gestational diabetes miscarriage pregnancy