Diabetes and Pregnancy

What is diabetes?

Diabetes is a condition in which your blood glucose (blood sugar) levels are too high. Glucose comes from food. A hormone called insulin helps glucose enter your cells, where it is used for energy. In type 1 diabetes, the body doesn't make insulin. In type 2 diabetes — far more common — the body either doesn't make enough insulin or doesn't use it well. Without enough working insulin, glucose builds up in the blood.

What is gestational diabetes?

Some women already have diabetes before pregnancy. Others develop diabetes during pregnancy — this is called gestational diabetes (GDM). It usually shows up around the 24th week, when the body needs more insulin than usual to handle pregnancy hormones.

GDM is particularly common in India — South Asian women have one of the highest rates of GDM globally, estimated at 10–17% in various studies. Screening is therefore routine during antenatal care.

Who is more likely to develop gestational diabetes?

Anyone pregnant can develop GDM, but the risk is higher if you:

• Are overweight or have obesity
• Have a family history of diabetes
• Had GDM in a previous pregnancy
• Have previously given birth to a baby over 4 kg
• Have polycystic ovary syndrome (PCOS)
• Are of South Asian, East Asian, African, or Caribbean background — all of which have higher GDM rates than the white European population

How is gestational diabetes diagnosed?

GDM often has no symptoms. If symptoms do appear, they are mild — more thirst or more frequent urination.

Screening is done with a blood-glucose test at your antenatal visits, usually between 24-28 weeks (earlier if you're high-risk). Different tests are used at different clinics; your doctor will explain which one you're having.

How can diabetes affect my pregnancy?

Having diabetes during pregnancy affects both you and your baby:

• Higher risk of preeclampsia — a serious condition with sudden high blood pressure
• Higher likelihood of a bigger baby, which raises the chance of needing a caesarean delivery
• Pregnancy hormones change your blood-glucose needs — if you had diabetes before, you'll likely need to adjust your medicines and meal plan
• GDM usually resolves after delivery, but leaves you at higher risk of type 2 diabetes later — up to 50% of women with GDM develop type 2 diabetes within 5–10 years

Effects on the baby can include:

• Higher risk of birth defects if blood glucose is high in early pregnancy
• Increased risk of obesity and type 2 diabetes later in life
• Higher likelihood of preterm birth
• Breathing problems or hypoglycaemia (low blood sugar) just after birth
• Increased risk of miscarriage and stillbirth

How can I manage diabetes during pregnancy?

If you already have diabetes, the best time to control blood glucose is BEFORE conception. High blood glucose in the first weeks — often before you know you are pregnant — can harm the developing baby. See your doctor when planning pregnancy.

During pregnancy, management includes:

• Regular antenatal check-ups
• Daily blood-glucose monitoring as advised by your doctor
• A balanced diet — a dietitian or diabetologist can adapt a plan that works in Indian diets (whole grains, dal, vegetables, limiting refined sugars and fried foods)
• Regular physical activity as recommended (walking, yoga)
• Medicines if diet and exercise aren't enough — insulin is the safest option in pregnancy; some oral medicines can also be used under doctor supervision
• Prenatal vitamins including folic acid and iron
• Avoiding alcohol, tobacco, and recreational drugs

After delivery, if you had GDM, you will be re-tested 6–12 weeks later, and then every 1–3 years for life. Breastfeeding for at least 6 months lowers the long-term diabetes risk for both mother and baby.