Gestational Diabetes in South Asian Women

Pregnant South Asian women carry a higher risk for developing gestational diabetes, a condition that’s dangerous for both mother and child. Between 2 and 10 percent of all pregnancies each year are complicated by gestational diabetes, according to the Centers for Disease Control and Prevention.

Gestational diabetes can develop during the second half of pregnancy (between 24 and 28 weeks) and usually goes away after the baby is born. Gestational diabetes describes any degree of glucose (sugar) intolerance that begins during pregnancy and requires insulin or diet modification as treatment, whether or not the condition persists after pregnancy.

High blood glucose during pregnancy may be due to hormones, your body’s insufficient use of insulin and/or poor diet habits. It doesn’t mean your baby will be born with diabetes or birth defects, but if you have gestational diabetes you’re at a higher risk of developing Type 2 diabetes later in life. Other potential complications include:

• A large baby, which increases the chance of cesarean delivery (C-section).
• Low blood sugar in the baby at birth.
• Pre-eclampsia in the pregnant woman.
• Pre-term delivery.

Risk Factors for Gestational Diabetes

Your doctor will assess your risk of developing gestational diabetes during your first prenatal visit. Risk factors include:

• Being older than 25, or younger than 25 but overweight.
• A family history of diabetes.
• Previously delivering a baby weighing more than 9 pounds or with a birth defect.
• A previous unexplained stillbirth.
• Being of Hispanic, Native American, African-American, Asian-American or Pacific Islander descent.
• Polycystic ovary syndrome (PCOS).

Unless you are categorized as high risk early in your pregnancy, between weeks 24 to 28 your doctor will give you an oral glucose test to measure how well your body metabolizes sugar. If the results indicate high blood sugar, your doctor will order further tests to find out if you have gestational diabetes.

Working with Your Healthcare Team

If you do develop gestational diabetes, it’s very important to maintain contact with your healthcare team, including your OB/Gyn, diabetes educator, registered dietitian and endocrinologist, throughout your pregnancy. Your doctor or a diabetes educator will show you how to monitor your blood glucose at home. In addition, your team will work together to monitor your nutrition and diet, weight gain, daily exercise, kick counts (baby’s activity), blood pressure, urine tests, baby’s growth and size, and your need for insulin.

During visits, your healthcare provider may also discuss stress management, barriers to achieving good blood glucose control and plans for the baby after birth.

Nutritional Guidelines During Pregnancy

If you have gestational diabetes, you’ll receive nutritional counseling from a registered dietitian to meet your nutritional needs during pregnancy while maintaining healthy blood glucose levels. Plan to follow these guidelines:

• Keep daily food and blood glucose records.
• Eat three small meals and three small snacks every day, two to three hours apart.
• Don’t skip meals or snacks.
• Eat breakfast no more than 10 hours after going to bed.
• Drink plenty of fluids.
• Limit coffee to two cups daily.
• Do not drink alcoholic beverages.
• Use artificial sweeteners in moderation.
• Avoid fruit, fruit juice, milk and instant hot or cold cereal at breakfast.
• Avoid eating sweets (mithai) like candies, burfi, gulab, jamoon and ladoo.
• Gain weight slowly.
• Exercise 15 to 20 minutes after every meal.
• Eat high-fiber foods.
• Manage stress (stress increases blood glucose levels).

Postpartum Care

Women who have had gestational diabetes have a 20 to 50 percent chance of developing diabetes in the 5 to 10 years following pregnancy. All women with gestational diabetes must be tested for Type 2 diabetes six to eight weeks after delivery. If your blood glucose levels are still high, talk to your doctor and avoid becoming pregnant before additional tests are done.

Take care of yourself after pregnancy with these guidelines:

• Maintain a healthy weight, which reduces the chance of having gestational diabetes again.
• If you’re overweight, lose 5 to 10 percent of body weight to reduce your risk of developing Type 2 diabetes.
• Eat a healthy diet. Choose foods low in fat and high in fiber, such as vegetables, fruits, whole-grain cereals, beans and legumes.
• Use less sugar and drink fewer sweetened beverages.
• Breastfeed your baby. Breastfeeding can help lower blood glucose levels.
• Have blood glucose levels checked annually.

Gestational Diabetes Resources for South Asians

• Indian and Pakistani Food Practices, Customs and Holidays, 2nd Edition, The American Dietetic Association and American Diabetes Association
• The American Dietetic Association
• The Indian Task Force on Diabetes Care in India
• American Association of Physicians of Indian Origin