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Pregnant. GCT test done. Suspected for gestational diabetes. Looking for medication, diet and exercise

Mar 2013
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My wife is 36 weeks pregnant till yesterday. Her weight before pregnancy was 58 Kgwt, her weight on completion of 32nd week was 72.8 Kgwt whereas on completion of 34th week her weight was still found to be 72.8 Kgwt (no change in two weeks) and her current weight is 73.5 Kgwt. She got her Glucose challenge test (GCT 50g 1 Hr post load) done on 27-DEC-2012 for first time which resulted into 145 mg/dL (range 70-140). She controlled on her sugar & fat intake, and started doing a mild walk for 1-1.5 Km daily for 15-20 days. Then, she got her GCT done after 15 days which resulted into 167 mg/dL. Afterwards, she got her Glucose Tolerance Test (GTT 100g 1 Hr post load) done, please see all reports attached. Her GCT test repeatedly indicates that she is succeptible to >80% chances of gestational diabetes but GTT test seemed to be normal. We are very worried due to this. Kindly advise if there are any adverse effect of abnormal GCT test results on expecting mother or child ? If yes, then please suggest appropriate medication, diet, change in lifestyle and exercise etc.

Note: She couldn't continue her walk due to decreased stamina and frequent breathlessness. Kindly suggest on what kind of exercises she should do ?

Thank you.
Posted Sat, 2 Mar 2013 in Women's Health
Answered by Dr. Aarti Abraham 23 hours later
Thank you for your health query.

Experts recommend that women should aim for a weight gain related to their pre-pregnancy BMI:
If your BMI was less than 19.8, you should aim for a weight gain of between 12.5 and 18kg.
If your BMI was between 19.8 and 26, you should aim for a weight gain of 11.5 to 16kg.
If your BMI was above 26, you should aim for a weight gain of 7 to 11.5kg.
Ideally the weight gain should be uniformly distributed throughout the pregnancy, however as your wife has gained adequate weight compared to pre pregnancy levels , please do not worry on that score.

As per the reports attached, your wife is having consistently abnormal GCT results, but a normal OGTT.
As per studies, even women who have abnormal GCT ( with a normal OGTT ) are at risk of complications of macrosomia ( increased fetal weight at birth ), increased chances of operative delivery because of this, increased neonatal complications after birth etc. However this risk is lower than that which exists for women with obvious gestational diabetes ( abnormal OGTT ).

As you are so concerned, and have posted your question and reports in such detail, I assume you would be interested in going through a few scientific studies on this subject. The terminology would be difficult for you to interpret if you are not a medical person, but please go through the conclusions atleast, particularly the last link :

Hence, this condition should be diagnosed and treated as mild gestational diabetes.

The goals of treatment are to keep blood sugar (glucose) levels within normal limits during the pregnancy, ( Aim for fasting blood sugar < 95 and 1 hour post prandial blood sugar to be < 140 mg/dl ). and to make sure that the growing baby is healthy.
Please consult an Endocrinologist / Diabetologist and a Nutrionist / Dietician at the earliest to formulate a treatment plan. Fetal monitoring in form of checking fetal growth, fetal weight and well being by clinical exam and ultrasound and colour doppler is also essential.

The mainstay of treatment is diet and exercise.
Most of the time, eating properly can keep your blood sugar (glucose) levels from becoming too high or too low. Eating properly can also help you avoid needing medications / insulin for further management
Your doctor and dietitian will create a diet just for you, based on:
The type of calories you need
Your weight (pregnant women who are obese may need a diet with fewer calories that other pregnant women)
How far along you are in your pregnancy
How fast and how large your baby is growing
Your activity level
Remember that "eating for two" does not mean eating twice as many calories. You usually need just 300 extra calories a day (such as a glass of milk, a banana, and 10 crackers).

The best way to improve your diet is by eating a variety of healthy foods. You should learn how to read food labels, and consult them when making food decisions. Talk to your doctor or dietitian if you are a vegetarian or on some other special diet.
In general, your diet should be moderate in fat and protein and provide controlled levels of carbohydrates through foods including fruits, vegetables, and complex carbohydrates (such as bread, cereal, pasta, and rice). You will also be asked to cut back on foods that have a lot of sugar, such as soft drinks, fruit juices, and pastries.
You will be asked to eat three small- to moderate- sized meals and one or more snacks each day. Do not skip meals and snacks. Keep the amount and types of food (carbohydrates, fats, and proteins) the same from day to day.
Carbohydrates should make up less than half of the calories you eat.
Most carbohydrates are found in starchy or sugary foods, such as bread, rice, pasta, cereal, potatoes, peas, corn, fruit, fruit juice, milk, yogurt, cookies, candy, soda, and other sweets.
High-fiber, whole-grain carbohydrates are digested more slowly and are healthier choices.
While vegetables (such as carrots, broccoli, and spinach) contain carbohydrates, they add much more to your health than to your blood sugar. Enjoy lots of them.
Carbohydrates in food are measured in grams. You can learn to count the carbohydrates in the foods that you like and that you eat.
Eat 6 or more servings a day: one serving equals 1 slice bread, 1 ounce ready-to-eat cereal, 1/2 cup cooked rice or pasta, or 1 English muffin.
Foods like bread, grains, beans, rice, pasta, and starchy vegetables serve as the foundation of your diet. They are loaded with vitamins, minerals, fiber, and healthy carbohydrates.
It is important to chose carbohydrate sources with plenty of fiber. Eat whole-grain foods such as whole-grain bread or crackers, tortillas, XXXXXXX cereal, brown rice, or beans. Use whole-wheat or other whole-grain flours in cooking and baking.
Eat more low-fat breads, such as tortillas, English muffins, and pita bread.
Eat 3 - 5 servings a day: one serving equals 1 cup leafy, XXXXXXX vegetables; 1 cup cooked or chopped raw leafy vegetables; 3/4 cup vegetable juice; or 1/2 cup of chopped vegetables, cooked or raw.
Choose fresh or frozen vegetables without added sauces, fats, or salt. You should opt for more dark XXXXXXX and XXXXXXX yellow vegetables, such as spinach, broccoli, romaine, carrots, and peppers.
Eat 2 - 4 servings a day: one serving equals 1 medium whole fruit (such as a banana, XXXXXXX or orange); 1/2 cup chopped, frozen, cooked, or canned fruit; or 3/4 cup fruit juice.
Choose whole fruits more often than juices. They have more fiber. Citrus fruits, such as oranges, grapefruits, and tangerines, are best. Opt for fruit juices without added sweeteners or syrups.
Choose fresh fruits and juices, which retain more of their nutritional value than frozen or canned varieties.
Eat 4 servings a day: one serving equals 1 cup milk or yogurt, 1 1/2 oz. natural cheese, or 2 oz. processed cheese.
Choose low-fat or nonfat milk or yogurt. Yogurt has natural sugar in it, but it can also contain added sugar or artificial sweeteners. Yogurt with artificial sweeteners has fewer calories than yogurt with added sugar.
Dairy products are a great source of protein, calcium, and phosphorus (to keep calories and cholesterol in check, though, choose low-fat dairy products).
Eat 2 - 3 servings a day: one serving equals 2-3 oz. cooked meat, poultry, or fish; 1/2 cup cooked beans; 1 egg; or 2 tablespoons peanut butter
Choose fish and poultry more often. Remove the skin from chicken and XXXXXXX Select lean cuts of beef, veal, pork or wild game.
Trim all visible fat from meat. Bake, roast, broil, grill, or boil instead of frying.
Foods from this group are excellent sources of B vitamins, protein, iron, and zinc.
Sweets are high in fat and sugar, so keep portion sizes small.
Eat sweets that are sugar-free.
Ask for extra spoons and forks and split your dessert with others.
Go easy on butter, margarine, salad dressing, cooking oil, and desserts. But don't cut fats and oils from your diet entirely. They provide long-term energy for growth and are essential for brain development.
In general, you should limit your intake of fatty foods, especially those high in saturated fat such as hamburger, cheese, bacon, and butter.

Your doctor, nurse, or dietitian may ask you to keep track of what you eat. Maintain a food diary.
It is important to monitor blood sugar regularly, going for atleast weekly fasting and post prandial blood sugar levels, and aiming to keep them within normal limits.
Walking is usually the easiest type of exercise, but swimming or other low-impact exercises can work just as well. Exercise is an important way to keep blood sugar in control, and physical activity in pregnancy has been found to decrease the risk of developing gestational diabetes.

As she is having breathlessness on walking, she can try walking slowly instead of brisk walk. More important is the total number of calories burnt, and not the speed of walking.

If diet and exercise fail to achieve target blood sugars, then oral antidiabetic drugs / insulin maybe added later on.

I hope I have provided an elaborate answer, and please feel free to ask any further questions.
All the best and be well.

Above answer was peer-reviewed by
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