Gestational diabetes
This is a temporary form of
diabetes that affects about 5% of pregnant women. It develops when
hormones from the placenta interfere with insulin, the hormone that
regulates blood sugar levels. As a result, the level of glucose or
sugar in your blood can rise and dip steeply. You are more likely to
develop gestational diabetes mellitus (GDM) if you have a family
history of diabetes, have had a very large baby before, have a BMI over
30, or are of South Asian, black Caribbean or Middle Eastern origin.
Gestational diabetes is usually
detected at 24–28 weeks of pregnancy. The first sign is likely to be
glucose in your urine. A single positive test is not generally seen as
a cause for concern. But if glucose is found on several occasions, or
if you are at high risk of GDM, you may be given an oral glucose
tolerance test (OGTT or GTT). This involves having a blood test before
breakfast and another two hours later after having a glucose drink.
Women who develop the condition,
like those who have diabetes before pregnancy, are likely to have
bigger-than-average babies. This is because the baby receives more
glucose, and therefore more calories, than normal. This in turn
increases the likelihood of problems during delivery, including the
need for a caesarean. If blood sugar levels aren’t controlled, it can
also affect the development of a baby’s heart and lungs and increase
their chances of developing obesity and diabetes in later life.
However, if the condition is controlled carefully, it should not harm
you or your baby.
To combat the effects of
gestational diabetes, you need to keep your blood sugar levels as
stable as possible so that the baby doesn’t receive extra glucose. This
can be done by changing what you eat and exercising more, which isn’t always
easy. The most important thing is to avoid high-sugar foods and drinks,
including fruit juices, and to have low-GI carbohydrates whenever
possible .
Some people may need extra insulin. If you have gestational diabetes,
you will be given more frequent antenatal appointments to check that
you and your baby are both well. You should also receive advice about
what to eat and how to monitor your blood glucose levels.
After the birth, the
condition usually goes away completely. Both you and your baby will
have your blood glucose levels checked after delivery. Unfortunately,
having GDM during one pregnancy increases the chances of developing it
in future pregnancies, particularly if you are overweight. Also,
according to Diabetes UK, women with GDM have a 30% chance of
developing Type 2 diabetes at some time during their life, compared to
a 10% chance in the general population.
Pre-eclampsia
This is a potentially serious
pregnancy disorder characterised by high blood pressure, swelling due
to fluid retention and protein in the urine. Other symptoms may include
headaches and blurred vision. An estimated one in 20 pregnancies is
affected. You are more likely to develop pre-eclampsia if you are
severely overweight, aged over 40 or expecting more than one baby, or
if any of your close relatives has had it.
Mild cases of pre-eclampsia have no
significant effect on pregnancy, but if the condition isn’t treated, it
can progress to a more serious condition called eclampsia. Severe cases
can result in convulsions and, very occasionally, death. However, drugs
can usually be given to treat the symptoms of pre-eclampsia and, if
necessary, the baby will be delivered early.
A good diet
appears to reduce the risk of pre-eclampsia. When the medical records
of 775 mothers living in a vegan community in Tennessee were examined,
only one case of pre-eclampsia was found (0.1%). This is much lower
than expected and is probably related to the women’s healthy balanced
diet, multivitamin and mineral supplement intake, and generally healthy
lifestyle. Research has also shown that pre-eclampsia is less common in
women with higher intakes of antioxidants. Having a healthy diet, rich
in vitamins C and E, appears to be particularly important, although
vitamin C and E supplements do not have the same effect.
Multivitamin and mineral supplements might, however, help prevent
pre-eclampsia, according to another study. It has also been found that
calcium supplements may help protect against pre-eclampsia for women
who have low intakes of calcium. This is another good reason to make
sure you get enough calcium.
Research has also looked
at whether garlic and chocolate might reduce the incidence of
pre-eclampsia. It is thought that garlic may help by lowering blood
pressure, but findings have been inconclusive. In 2010, the media
reported that eating chocolate halved the risk of premature birth,
because it prevented pre-eclampsia. However, these claims weren’t
backed up by the evidence. It does seem plausible that chocolate might
reduce the risk of pre-eclampsia, as studies in the past have shown
dark chocolate may reduce the risk of heart disease, possibly by
lowering blood pressure. A study from the USA found that women who ate
chocolate at least once a week during pregnancy reduced their risk of
pre-eclampsia by 50%. This sounds pretty convincing but it may be a
case of ‘reverse causality’ – maybe women with pre-eclampsia eat less
chocolate because of their diagnosis, rather than women who eat less
chocolate getting pre-eclampsia more often. Cause and effect couldn’t
be differentiated in the study.
Foods to kick-start labour – or not
If your due date comes and goes and
nothing seems to be happening, it can be very frustrating, particularly
if family and friends start calling to see what’s happening. There are
many myths and old wives’ tales about what you can do to kick-start
labour – some of the ideas are more pleasant than others. When it comes
to diet, there are several suggestions:
- raspberry leaf;
- evening primrose;
- pineapple;
- curry.
Raspberry leaf is thought to be a
uterine stimulant which helps strengthen the muscles of the womb, so
that contractions are more effective and labour is easier. Several
trials have been carried out, including an Australian study in which
women were given either two raspberry leaf supplements (1.2g each) or
two placebo tablets a day from 32 weeks of pregnancy. It was found that
the second stage of labour (pushing the baby out) was 10 minutes
shorter in the group who took raspberry leaf. They also had a lower
rate of forceps delivery (19% versus 30%). However, they didn’t go into
labour any sooner.
Although raspberry leaf doesn’t
seem to bring on labour, the general advice is not to take it until you
are at least 32 weeks’ pregnant. You should also talk to your midwife
first as it isn’t suitable for everyone and probably isn’t a good idea
if you’ve previously had quite a quick labour, you’re expecting twins
or you’ve had problems such as high blood pressure or vaginal bleeding.
If you do decide to give it a try, you can either drink raspberry leaf
tea or, if you don’t like the taste, take raspberry leaf tablets or
capsules.
Some women take
evening primrose supplements, or use them vaginally, to kick-start
labour. Although some people swear by them, because they took them and
went into labour, there is no objective evidence that they are more
effective than just waiting. The National Institute of Health in the US
advises pregnant women not to take evening primrose oil because,
although evidence is inconclusive, it could possibly increase the risk
of complications.
Fresh pineapple could theoretically
help, as it contains an enzyme called bromelain, which breaks down
proteins. In a highly concentrated form, bromelain is used to treat
inflammation. Taking bromelain tablets or capsules during pregnancy is
not recommended, however, as it may cause abnormal bleeding. However,
some alternative therapists may recommend them at the end of pregnancy
to help soften and dilate the cervix, although there is no evidence
that this is effective. To get enough bromelain from fresh pineapple to
have any possible effect, you would need to eat between seven and ten
whole fresh pineapples at one sitting. Tinned pineapple and pineapple
juice contain little or no bromelain.
The final strategy, eating curry,
has the greatest potential for getting things moving, but only if it is
so hot that it causes discomfort and acts as a strong laxative. Then it
could have the same effect as castor oil, which has been used for
centuries to kick-start labour. It is thought that when the gut is
stimulated, it in turn stimulates the uterus to cramp and spasm,
thereby bringing on labour. Castor oil contains ricinoleic acid, or
ricinic acid, which irritates the small intestine and has a strong
laxative effect. One American study found that after a 60ml dose, 58%
of women started labour within 24 hours, compared with just 4% of
untreated women. However, this was just a small study, and
self-treatment is not recommended. Castor oil can result in severe
nausea and cramps, persistent diarrhoea, dehydration and other
complications. If you want to try castor oil or an
extremely hot curry, it is important to talk to a doctor or midwife
first. They will be able to advise you according to your medical
history, the position of your baby and the condition of your cervix.
There are other
non-dietary strategies that might help and are less likely to have
unpleasant side-effects, including sex, nipple stimulation or an
alternative therapy such as homeopathy or acupuncture.
