pregnant... ?

*One condition you may develop during pregnancy is impaired glucose tolerance. You need to take steps to ensure that all is well before a problem arises.*

PREGNANCY is an exciting time of change. Your body has to adapt to the development of your baby and you will see changes in your skin, hair, mood, appetite, sleep. In fact, just about everything!

Pregnancy also affects your blood glucose levels because insulin levels are different during pregnancy. Some women don't produce enough insulin to keep their blood glucose levels within range during pregnancy. This is called Gestational Diabetes (GDM).

In most cases of gestational diabetes, the high level of blood glucose can be controlled, but, if it is left untreated, it is unhealthy for both you and your baby. You need to take care of yourself and keep both your blood glucose levels and your blood pressure as close to normal levels as possible.

*What can high blood glucose levels do to my baby?*
High blood glucose levels result in glucose crossing over to your baby through the placenta. Your baby's body will work hard to lower the high glucose levels by making its own insulin. This extra insulin can cause your baby to gain weight and grow more than usual.

In the first few days after you have given birth, as a result of high glucose levels in pregnancy, your baby may produce too much insulin, which can make blood glucose levels fall at birth. Babies usually adjust their own insulin production but care needs to be taken to ensure normal blood glucose levels. Your healthcare professional will take the appropriate measures and take care of the baby to ensure that the baby does not face any problems due to the falling blood glucose.

*Will I always have diabetes?*
In most cases, your blood glucose levels will return to normal once your baby is born. However, now you have had gestational diabetes you have a higher risk of developing type 2 diabetes later in life, especially if you have a family history of diabetes, are overweight or inactive. Your healthcare professional will advise you on what you are required to follow up on

*Will gestational diabetes mean regular testing?*

Yes, regular testing of your blood glucose levels will give you and your healthcare professional a good guide to how well your diabetes is being controlled. You should also test your own blood glucose levels. This will help you manage your problem. Keeping blood glucose levels within the target range can ensure your health and your baby's well-being.

*How do I test my blood glucose?*
You should use a blood glucose meter to monitor your blood glucose during your pregnancy. Blood glucose testing is very straightforward. Everyone's blood glucose levels are different. You will need to work with your doctor to determine your target range and make sure you understand what your test results mean.

You should record your blood glucose test results and take them to consultations with your healthcare professional. Also, keep a note of foods you have eaten and whether you have experienced any episodes of hypoglycaemia (low blood glucose levels).

*Is finger pricking painful?*

To get a small sample of your blood to test, you will need to use a lancing device. You only need a tiny amount of blood and this can be virtually pain-free.

To keep control of your blood glucose levels it is advisable to be testing at least four times a day (before breakfast and one hour after each meal).

*Are there any other tests?*

Among the most common regular tests during pregnancy are blood pressure and urine tests. If you have high blood glucose, you may also have a greater chance of getting infections, especially vaginal, bladder and kidney infections, so you may be tested for these too.

Women with gestational diabetes should monitor their blood glucose at least four times a day, which includes both fasting and post-meal blood glucose measurements.

*What can I eat?*

Whether you are pregnant or not, it is important to have a well balanced and healthy diet. If you have gestational diabetes, this becomes essential. Balancing your meals appropriately ensures that both you and your baby get the most from the food you eat and also helps to control your diabetes.

The goals for a balanced diet are to provide adequate nutrition for the mother and foetus, provide sufficient calories for weight gain, and to keep your blood glucose levels within the target range, avoiding peaks and troughs.

*How do carbohydrates affect my blood glucose?*

There are three major types of nutrients in food: carbohydrates, proteins and fats. Carbohydrates have the biggest impact on your blood glucose levels. Foods high in carbohydrates include: fruits, cereals, bread, lentils, rice, pasta, potatoes, crackers, biscuits, beans, sweetcorn and honey.

The body turns carbohydrates into glucose, which is transported around the body in the blood and converted into energy in the cells. Most of the carbohydrate foods you eat become glucose in your blood within the first one to two hours. That's why you should test your blood glucose levels one hour after eating.

If you regularly miss meals during pregnancy, your body could slip into a 'starvation state'. Fat gets broken down and causes acids (called ketones) to be released into your blood. These ketones can pass across the placenta into your baby's blood and can be harmful. Your healthcare team may ask you to check your ketones using ketone testing strips if you are hyperglycaemic (high blood glucose levels) or you feel unwell. You may also need to test for ketones if you miss a meal.

*Can I exercise?*
Being active is good for all of us, but is especially important for people with diabetes. Exercise changes your blood glucose levels, so you will need to discuss this with your healthcare professional. You will have to exercise at a level which is safe for both you and your baby.

A good exercise programme can not only help your body prepare for the physical changes of pregnancy and labour, but can also make it much easier for you to get back into shape after your baby is born. If you are used to taking exercise in the form of a sport, you should be able to continue with this as long as it feels comfortable for you, but more gentle exercise such as walking, swimming, aqua-aerobics, and yoga are also very beneficial.

*Can I travel?*
Travelling can be straightforward, but if you are travelling a long distance, you will need to be well-prepared and well-informed.

Flying while you are pregnant is almost always completely safe. There are some guidelines as to just who should and should not travel when they are pregnant, but, generally, women who are having a healthy, normal pregnancy are free to come and go as they please. Different airlines have their own flight guidelines for pregnant women, but most healthcare professionals recommend that women don?t fly late in their pregnancy.

Airline guidelines for carrying testing systems and medications are becoming increasingly strict. Ideally, you should carry an official letter from your healthcare professional explaining that you have gestational diabetes and that you need to test your blood glucose regularly and take the medications on board.

In most cases, you are allowed to take insulin on board a plane. You need to confirm this with the airline that you will be travelling on. The flight cabin crew should be made aware of your need to carry diabetes equipment, food or drink in your carry-on luggage.

It is worth getting a letter from your healthcare professional explaining that you are 'fit to travel' if you are planning to travel late in your pregnancy or you are concerned.

Take double the amount of medication and test strips you expect to use on your travels' you may need to increase your dose in case of illness.

*Delivery and beyond ...*

As your due date approaches, your health and your baby's health will be closely monitored. If you are taking insulin, during labour and after delivery, your insulin needs may change dramatically. Your healthcare professional will ensure you get the right amounts. It may be several weeks after the birth of your baby before your blood glucose levels return to normal. You should have a glucose tolerance test six to eight weeks after your baby is born. Ensure you have a follow-up appointment with your healthcare professional within this time frame.

*Am I able to breastfeed?*

Breastfeeding is recommended as the best food for newborn babies as it provides everything a baby needs to develop and thrive for the first six months of life. It also provides the baby with a boost to their immune system just when they need it, as their own is still developing.

However, breastfeeding uses a great deal of energy.

*Looking good*

Pregnancy can bring the unexpected benefit of helping you look your best!

*10 steps to a healthy pregnancy:*

1. Check your blood glucose level at least four times a day.

2. Eat a well-balanced, healthy diet.
3. Keep active.
4. Consider folic acid supplements.
5. Stop smoking - talk with your healthcare professional for assistance and support.
6. Stop drinking alcohol.
7. Cut back on caffeine.
8. Attend all your antenatal appointments and contact your healthcare professional whenever you have a question or concern.
9. Begin doing pelvic floor exercises.
10. Make sure you don't overdo it.

- This information is courtesy of Roche Diagnostics -