Diabetes in pregnancy – there’s help at the DREAM Centre

By Jane Hope

Gestational diabetes (GDM) is defined by the International Diabetes Federation as “any degree of glucose intolerance with onset or first recognition during pregnancy”. It affects up to 15 percent of pregnant women worldwide and here in Bermuda it is estimated that 5-7percent of all pregnancies develop GDM; this number however is expected to rise. The rise in GDM rates is directly related to the rising rates of obesity and Type 2 Diabetes. Bermuda is following this trend as the results from the recently released STEPS survey showed; almost three-quarters of Bermuda’s participants were either overweight or obese.

GDM is typically identified during the 24th and 28th week of pregnancy. If the glucose (sugar) levels are not brought under control it can result in serious complications for both mother and baby. Excess levels of maternal glucose can cause macrosomia (a large baby – more than 9lbs in weight). Complications can include pre-eclampsia, shoulder dystonia, resulting in a traumatic birth for mother and baby, stillbirth, neonatal respiratory syndrome and neonatal hypoglycemia (low blood glucose).

GDM can also have a long-term health impact, with more than 50 percent of women with GDM going on to develop Type 2 Diabetes within 5-10 years of delivery. Moreover, infants of women with GDM have a higher prevalence of being overweight and obese, and are at higher risk of developing Type 2 Diabetes later in life.

If GDM is well controlled the outcomes for mother and baby are similar to that of a mother without GDM. The goal therefore is to maintain normal glucose levels. Management of GDM consists of healthy meal planning, exercise, glucose testing and glucose goals, medication and fetal monitoring.

Bermuda Hospitals Board has specialists that work closely with mothers helping them to manage GDM. At the Diabetes Respiratory Endocrine and Metabolism (DREAM) Centre, Bermuda’s only accredited program sees diabetes nurse specialists and registered dietitians in close collaboration with the Centre’s endocrinologist Dr. Annabel Fountain and the mother’s obstetrician. Individuals are assessed during a 90-minute interview and are followed weekly from the time of referral until delivery, to ensure the best possible outcomes for both mother and baby.

After delivery of the baby a mother’s blood glucose levels return to normal as the body’s insulin requirements drop. However as previously mentioned 50 percent of women with GDM go on to develop diabetes. The goal of the Centre is to follow up these mothers to reduce this rate by preventing diabetes developing later. Six weeks after delivery all GDM women should have a repeat 75gram two-hour oral glucose tolerance test using non-pregnancy criteria and undergo screening for prediabetes or Type 2 Diabetes every year thereafter as recommended by the National Institute for Health and Clinical Excellence in the United Kingdom. Women should also be counselled on eating healthy, maintaining a regular exercise regime and achieving a healthy weight.

Jane Hope is the Clinical Diabetes Manager and has worked in the Diabetes, Respiratory, Endocrinology and Metabolism (DREAM) Centre since 2004. She has a passion for helping improving the lives of all people with diabetes and has a special interest in managing women with GDM.

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