Stress, sugar and carbs: Alarming prevalence of diabetes in pregnant women of Chennai

The prevalence of gestational diabetes in Tamil Nadu is significantly higher compared to the rest of India.
Stress, sugar and carbs: Alarming prevalence of diabetes in pregnant women of Chennai
Stress, sugar and carbs: Alarming prevalence of diabetes in pregnant women of Chennai
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Back in 2014, about 20 weeks into her pregnancy, Keerthana (name changed) experienced intense itching and irritation in her vaginal area. Already stressed about her pregnancy, she immediately visited the doctor to get it checked. Her doctor prescribed medicines for the infection, but also ordered blood and urine tests. “She didn’t really need the test results, she was pretty sure that it was diabetes,” Keerthana recounts. The yeast infection in her vaginal area was only a manifestation of gestational diabetes mellitus (GDM) - the diabetes women get during pregnancy.

Tests for diabetes are routine in the first trimester of all pregnancies now, but few years ago even doctors believed that a sugar test was not required until the second trimester, when women usually develop GDM.The prevalence of diabetes in Tamil Nadu is significantly higher compared to the rest of India. In Chennai, a random survey found 16.2% of pregnant women to have GDM, while another sample survey found 17.8% of pregnant women to have GDM in the city. “From our experience we can say that we see GDM in at least 12% of the pregnant women in Chennai,” says Dr K Baraneedharan, Senior Consultant Diabetologist at Kauvery Hospital in Chennai, “If it is not treated, it could lead to serious medical complications for the mother and the baby.”

Why it happens

What we eat is broken down by our body and made into glucose, which is then pushed from the bloodstream to the cells, and then broken down for energy. Insulin plays a vital role in moving the sugar in our bloodstream into our cells. When the insulin in our body is too low or if the function of insulin is not good and it leads to insulin resistance, we develop diabetes. During pregnancy, the hormonal changes which happen in our body make it harder for it to make and use insulin and that leads to GDM.

“This usually happens between 18-20 weeks of the pregnancy, but nowadays we are seeing gestational diabetes in the first trimester of the pregnancy itself,” the Dr Baraneedharan says, “which is why we have now started doing universal screening for all pregnant mother.”

While pregnancy itself can cause diabetes, diet plays a major role in its high prevalence. “In Tamil Nadu, women have a lot more carbohydrate in their diet, in the form of rice. Women also tend to have more sweets during pregnancy. The insulin in the body is not adequate to bring the sugar under control,” Dr Baraneedharan explains, and adds, “Obesity can also cause insulin resistance.”

Stress also plays a major role. “Pregnancy is a stressful period, and stress changes the way hormones work in our body. This also contributes to GDM,” he points out. With women opting to get pregnant much later in their lives, and the increasing number of women in the workforce, the mental stress during pregnancy is very high. “We believe that just by having a late pregnancy, a woman is more prone to GDM, due to the hormonal imbalance of the body and mental stress,” Dr Baraneedharan adds.

Genetic disposition is yet another risk factor. If parents of the pregnant woman have diabetes, the possibility of GDM is higher.

Say No to ‘White’

The most important aspect of preventing or controlling GDM is diet, so lifestyle modifications are key.

The first modification in diet is to follow a “split meal” plan. “Instead of 2 or 3 big meals, pregnant women should have several small meals, so the use of insulin is rationalised. If the body has less insulin, only so much would be needed, if we eat less,” Dr.K.Baraneedharan explains.

“Avoid ‘white’ in your diet, have a colourful plate,” he says. Pregnant women should reduce or stop intake of sugar, rice and salt. Instead, more vegetables, greens and fruits (in limited amounts) should be a part of the diet. Meat is a rich source of protein, so it can be included in the diet. “Women are not aware of what a balanced diet is during pregnancy, so we have started pre-pregnancy counselling,” he says.

Women should be relaxed and stress-free during pregnancy. “In our clinical practice, we are seeing more working women coming in with GDM. Stress coupled with a bad diet can be a vicious cycle,” says Dr Baraneedharan.

If the blood sugar levels are too high, then doses of insulin will be prescribed. Oral hypoglycaemic agents can also be taken in extreme cases, and they are safe for the foetus.

“Women should rest assured that diabetes during pregnancy is a manageable problem, they don’t have to worry about their pregnancy. Just follow the treatment plan, and both the mother and baby will be just fine,” the doctor assures.

This series was produced by TNM Marquee in association with Kauvery Hospital.

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