Juanita Williams was only two months pregnant when she realised something was wrong – seriously wrong. ‘I usually start the day with a bowl of oats,’ the 36-year-old online editor says, ‘but I would get these drowsy spells about half an hour after eating breakfast. At one stage I put my head on my desk and thought I was going to pass out.’
After doing routine tests, her gynaecologist realised gestational diabetes – a kind of diabetes which develops during pregnancy – was to blame. Juanita was sent to a specialist who recommended she changed her diet and monitor her blood sugar levels before and after meals.
Although there are no precise figures, it’s estimated that 3–10% of women who are pregnant develop gestational diabetes. The older you are and the stronger the family history of diabetes is, the greater your chances are of developing it. The biggest risk factor, says Professor Derick Raal, head of endocrinology at Johannesburg Hospital, is obesity.
‘Women who develop gestational diabetes usually have a genetic predisposition towards diabetes. Obviously when they fall pregnant, it places stress on your body’s system, particularly the pancreas which produces insulin. Think of it like this: if your pancreas is like a car engine, a woman predisposed to diabetes has an engine firing on six cylinders instead of four. Then when she falls pregnant, she’s maybe only firing on three cylinders. The car comes to a hill and can’t get up. In the same way, your pancreas can’t cope any more when you’re pregnant.’
He says the risk to the unborn child is that he will become too large, meaning caesarean section is often inevitable. ‘There are health implications if the mother’s blood sugar levels are too high. The baby can grow very big because it’s as if he’s sipping a milkshake the whole time.’ The baby may also have jaundice as a newborn and is at greater risk of developing type 2 diabetes.
Gestational diabetes is usually diagnosed in the second trimester, at around the same time when the hormones produced during pregnancy increase a woman’s resistance to insulin, resulting in impaired glucose tolerance. In a healthy woman’s body this would result in increased insulin production, but for women who develop gestational diabetes, this is not the case. Fortunately it is treatable, which means that controlling your blood sugar levels should be sufficient in managing the condition.
‘A lot of people think that diabetes means you should cut sugar out your diet,’ comments Juanita. ‘There is truth in that, but there are many foods which aren’t sugary which you need to stop eating – foods like potatoes, butternut and mielies, which many people consider to be healthy.’
However, diet alone was not enough to lower Juanita’s blood sugar levels. ‘When I was about five months pregnant, I realised I was starving myself. It was ridiculous – I would have a salad and my blood sugar levels would spike. I was so worried about my baby and the effect this was having on him that I wasn’t eating sensibly any more.’
In fact, she lost 5kg during her pregnancy, way below the guideline weight gain of 10–12kg. ‘That’s when I switched to insulin,’ she says. ‘I had to get over my needle issues, injecting myself three times a day. My legs were blue!’
Now 14 months old, her son Noah is the picture of health and Juanita’s blood sugar levels have returned to normal. She still goes for regular check-ups, though, and is mindful to watch what she eats: ‘I try to eat healthy and have six small meals a day rather than three.’
She is wise to do so. Prof Raal reckons one in two women who suffer from gestational diabetes will develop type 2 diabetes a few years after giving birth. He believes the condition is a warning sign to women that they need to shape up, lose weight and control their eating habits.
‘Most people think that HIV-Aids is the biggest pandemic in the world, but they fail to realise that ten years from now, the prevalence of type 2 diabetes could be ten times the prevalence of HIV,’ he says.
Juanita’s advice for women who suspect they may have gestational diabetes is to get it checked out by a doctor. ‘The sooner it’s treated,’ she says, ‘the better.’
The following factors play a role in whether you will develop gestational diabetes:
- Family history of diabetes
- Age – women over 35 are more at risk
- Carrying twins or multiples
- Ethnic background – Indian people, for example, are most at risk of developing type 2 diabetes in SA.