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High-risk pregnancies require specialized expert care: Gestational Diabetes and Obesity

Most pregnancies proceed normally without significant issues. Yet, there are several common health problems to which pregnant women may be exposed to. Besides hypertension, preeclampsia and risks associated with advanced age of the expecting mother, diabetes and obesity are further risk factors that mothers-to-be might face. None of these conditions should be taken lightly. They can severely affect the pregnancy, endangering both mother and child if not properly diagnosed, monitored, and treated.
 
Diabetes can be a condition before the woman becomes pregnant or  - as gestational diabetes - develop during pregnancy, while obesity is usually already present before pregnancy. According to medical experts, gestational diabetes and obesity may be correlated; meaning a lower body weight before getting pregnant might lower the risk of gestational diabetes.
 



What is gestational diabetes?

Just because you eat a certain diet doesn't mean you'll automatically develop gestational diabetes and there is no sure way to prevent it.  Even mothers who suffered from gestational diabetes during a previous pregnancy may not develop it during a later pregnancy.
 
As a general rule, excess weight before pregnancy may play an important role in the development of gestational diabetes. Add the many changes occurring in the body during pregnancy. While various hormones usually keep blood sugar levels in check, hormone levels change during pregnancy and can make it harder for the expecting mother to process glucose efficiently. Blood sugar may rise. The condition is usually diagnosed at the first antenatal care visit or at 24 to 28 weeks into the pregnancy.
 
As a rule of thumb, if diabetes occurs before the gestational age of 20 weeks, the diabetes is then considered to have occurred before pregnancy. Approximately 1 in 20 mothers develops gestational diabetes after the 20th week of pregnancy. The number of mothers affected by gestational diabetes doubles among women with factors such as obesity.
 


Is gestational diabetes preventable?

Some women face a greater risk of having gestational diabetes than others. Some might have diabetes in an immediate family member while others may have previously delivered a baby weighing more than 4.1 kilograms, which might be an indication of diabetes. According to studies, non-Caucasian women seem to suffer more often from gestational diabetes than Caucasian women.
 
Drugs, which treat diabetes that occurred before the pregnancy, may also affect the fetus. It is within the doctor’s discretion to carefully evaluate all prescribed medication, especially since preexisting diabetes becomes more dangerous during a pregnancy.

 

What are the pregnancy risks associated with gestational diabetes?

Affected mothers face an increased risk of preeclampsia and spontaneous abortion, risks which can be reduced with the proper diagnose, monitoring and treatment.
 
Not only the mother is put at heightened risks, the fetus is endangered too with an increased risk of congenital anomalies, poor fetal growth, preterm birth or macrosomia, which is a newborn who's much larger than average. Further risks include perinatal mortality and dead fetus in utero.
 
Gestational diabetes risks increase further if the mother is overweight, if she has an immune system disorder such as lupus, if her age is older than 40 or if she carries multiple fetuses, such as twins or triplets.

 

Being pregnant with gestational diabetes

Whether you know you have diabetes or not: it is strongly advised to consult with your trusted medical expert before becoming pregnant to determine how well prepared your body is to handle the pregnancy and if there might be any underlying conditions putting yourself and the baby at risk. Preconception checkup programs are standard procedure to help find some of the treatable risks while controlling preexisting risks.
 
If you think you belong to a risk group it is even more so important to take all precautions. Being affected by diabetes while carrying the fetus in your womb is a high-risk pregnancy that needs an experienced specialist team to take care of both the mother and baby during pregnancy, delivery and postpartum.

According to studies, obesity during pregnancy increases the risk of developing gestational diabetes. Overweight as such is defined as having a body mass index (BMI) of 25 to 29.9. Obesity, on the other hand, is defined as having a BMI of 30 or greater. A woman with such a pronounced BMI may feel well and healthy overall, yet the excess in body mass can pose serious risks to both mother and child.
 
 

How does obesity affect pregnancy?

Overweight and obesity are considered general risks factors, as is a lack of physical exercise which increases associated risks. Among medical practitioners it is commonly thought that the higher a person’s BMI, the greater the health risks. Obesity can thereby increase several health risks for both mother and child during pregnancy.
 
An obese mother is more likely to suffer from gestational diabetes, sleep apnea, cardiac dysfunction and preeclampsia, there are also additional signs of damage to other organ systems, most often the liver and kidneys. An obese expectant mother is furthermore more likely to suffer a recurrent miscarriage while caesarean sections are more often performed, which in turn increases the risk of wound infections.
 
The baby, on the other hand, faces an increased risk of spontaneous abortion, congenital anomalies, birth defects, impaired growth, macrosomia, preterm birth and stillbirth.
 


How to minimize obesity health risks during pregnancy

Weight gain during pregnancy is normal and necessary to nurture the growing baby while strengthening the expecting mother’s physical health. Obesity, on the other hand, sometimes is a preexisting condition which can be addressed by lifestyle changes. Losing weight before pregnancy is the most effective and efficient way to decrease associated risks caused by obesity.
 
Excessive weight gain during pregnancy, on the other hand, often is associated with endocrinological changes of mother and fetus. Bumrungrad specialist teams always pursue a policy of combined care, meaning obstetricians in this case will coordinate with specialized endocrinologists.
 
Bumrungrad preconception checkup programs will both diagnose this treatable risk while specialist experts can offer advice on weight control to prepare for a safe and stable pregnancy.
 
Even if you as a prospective mother feel healthy, if your BMI is elevated it is strongly advised to consult with your trusted doctor before getting pregnant. Obesity in a pregnancy is considered a high-risk condition that requires an experienced specialist team all the way through from planning, pregnancy and delivery to postpartum.
 

By Dr Amporn Thaisomboon, received her Diploma from the Thai Board of Obstetrics and Gynecology a Sub-board Diploma in Maternal Fetal Medicine. Dr Amporn is presently seeing patients at Bumrungrad International Hospital

 
Women’s Center:
+66 2011 2361
Location: Bumrungrad International Hospital (BIH) Building, 2nd floor
 
 

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