GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 54 : JUNE/JULY 2017GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 54 : JUNE/JULY 2017

27HEALTH26 HEALTH

GESTATIONAL DIABETES IS A FORM OF DIABETES THAT OCCURS IN WOMEN DURING PREGNANCY, USUALLY AROUND THE 24TH TO 28TH WEEK OF GESTATION. IN AUSTRALIA, 12–14% OF WOMEN WILL DEVELOP GESTATIONAL DIABETES. WHILE MOST WOMEN WILL NO LONGER HAVE DIABETES AFTER THE BABY IS BORN, SOME WILL CONTINUE TO HAVE HIGH BLOOD GLUCOSE LEVELS, WITH APPROXIMATELY 50% OF WOMEN DEVELOPING TYPE 2 DIABETES. THE BABY IS ALSO AT INCREASED RISK OF DEVELOPING TYPE 2 DIABETES LATER IN LIFE.

Diabetes is a condition where there is too much glucose (sugar) in the bloodstream. Glucose is an important source of energy, originating from carbohydrate-containing foods such as breads, cereals, potato, pasta, rice, fruit and certain dairy products. Blood glucose levels are regulated by insulin, a hormone produced by the pancreas. Insulin moves glucose from the blood into the body’s cells where it can be used as energy. Diabetes develops when the body does not make enough insulin or the insulin is not working properly.

During pregnancy, the placenta produces hormones that support the baby’s growth and development. Some of these hormones reduce the action of insulin, known as insulin resistance. As a result, the need for insulin in pregnancy can be 2 or 3 times higher than normal. If the pancreas cannot produce enough insulin, blood glucose levels rise and gestational diabetes develops. After the baby is born, the mothers’ insulin requirements return to normal and the diabetes usually resolves.

WHO IS AT RISK? Risk factors for developing gestational diabetes are:

• Increasing maternal age (≥40 years);

• Family history of type 2 diabetes or a first degree relative (mother or sister) who had gestational diabetes;

• BMI > 30 kg/m2 (pre-pregnancy or on entry to care);

• Ethnicity (Aboriginal or Torres Strait Islander, Asian, Indian subcontinent, Maori, Middle Eastern, non-white African);

• Previous gestational diabetes;

• Previous elevated blood glucose level;

• Polycystic ovary syndrome;

• Multiple pregnancy;

• Previous large for gestational age (LGA) (birth weight > 4500g or 90th percentile);

• Previous perinatal loss;

• Medications (corticosteroids, antipsychotics).

Some women who develop gestational diabetes have no known risk factors.

WHAT ARE THE SYMPTOMS?Gestational diabetes usually has no symptoms. If symptoms do occur, they can include:

• Frequent thirst;

• Excessive urination;

• Tiredness;

• Thrush (yeast infections);

• Bladder infections;

• Nausea and vomiting;

• Sugar in urine;

• Blurred vision;

• Mood changes.

INDICATIONS FOR BEING TESTEDWomen who have one or more risk factors should be tested initially when their pregnancy is confirmed and then again at 24 weeks if diabetes was not detected earlier. All women should be tested around 24–28 weeks gestation (except those already diagnosed with diabetes or known to have gestational diabetes).

Gestational diabetes is diagnosed using an oral glucose tolerance test (OGTT). Diagnosis occurs when the woman’s blood glucose level is above normal range at either the fasting (≥ 5.1 mmol/L), one (≥ 10 mmol/L) and/or two (≥8.5 mmol/L) hour blood tests.

MANAGEMENT OF GESTATIONAL DIABETESManagement of gestational diabetes is a multi-disciplinary team effort, involving the woman with gestational diabetes, doctor, specialist doctors (if necessary), Accredited Practising Dietitian (APD), Credentialed Diabetes Educator, pharmacist and midwife. Gestational diabetes is often initially managed with healthy eating, regular physical activity and monitoring blood glucose levels.

Dietary adviceManaging gestational diabetes can help keep blood glucose levels in the target range for a healthy pregnancy. Women with gestational diabetes are encouraged to:

• Eat regular meals and small amounts often;

• Include controlled amounts of carbohydrate foods at every meal and snack, choosing high fibre and lower glycaemic index (GI) options such as rolled oats, grainy breads, milk, yoghurt, brown rice and natural museli;

• Avoid food and drinks that are high in added sugars and have little nutritional value;

• Limit foods high in saturated fat by choosing lean meats, skinless chicken and low-fat dairy;

• Include small amounts of healthy fats such as olive oil, avocado, seeds and unsalted nuts;

• Eat a wide variety of nutritious foods including vegetables, fruits, lean meats, low-fat dairy and wholegrain breads and cereals;

• See an APD who can provide expert advice on the proper nutrients for a healthy pregnancy.

Physical activityPhysical activity helps reduce insulin resistance and is an effective way to lower blood glucose levels. Engaging in 30 minutes of moderate physical activity daily is advisable. Women should talk to their doctor before starting or continuing any physical activity.

Monitoring blood glucose levelsBlood glucose monitoring is an essential part of managing gestational diabetes, and is helpful for understanding the effects of food and physical activity on blood glucose levels. Suggested blood glucose levels are: fasting/before meals ≤5.0 mmol/L, 1 hour after commencing meal ≤7.4 mmol/L and 2 hours after commencing meal ≤6.7 mmol/L. If blood glucose levels are elevated, medication may be needed.

Common medications usedBlood glucose lowering medications are generally not used during pregnancy, with the exception of metformin. Therefore, insulin injections may be necessary. Approximately 27% of women require insulin to help keep their blood glucose levels in the target range. Women requiring insulin injections work closely with their doctor and diabetes educator to monitor and review medications and blood glucose levels.

Patients seeking individualised dietary advice should be referred to an APD. APDs are University-trained to provide evidence-based dietary advice tailored to the specific needs of each client. Pharmacists are a key referral agent to APDs and are well positioned to ensure that both, medications and dietary advice are followed. To locate your local APD, search ‘Find an Accredited Practising Dietitian’ at www.daa.asn.au or freecall 1800 812 942.

ELLIE GRESHAM

Accredited Practising DietitianB. Nutrition and DieteticsPhD

Gestational Diabetes