Health clinic: Gestational diabetes and Polycystic ovary syndrome

QUESTION: I AM 22 weeks into my first pregnancy and have put on weight quickly – 5kgs. My mother had gestational diabetes during both her pregnancies and I am worried this might happen to me.

ANSWER: Gestational diabetes develops during pregnancy (usually in the third trimester, after 28 weeks) when the body is not able to make enough insulin. The lack of insulin causes the blood-sugar level to become higher than normal. This usually resolves after delivery, but some women will remain diabetic. Gestational diabetes occurs in 2%-5% of pregnancies. The symptoms include:

Tiredness.

A dry mouth and thirst.

Frequent need to pass urine.

However, not all pregnant women will experience symptoms.

Gestational diabetes is more likely with:

Increasing age.

High body-mass index before pregnancy (three-fold risk for obese women).

Smoking doubles the risk.

Change in weight between pregnancies — an inter-pregnancy gain of more than three units (BMI) doubles the risk.

Short interval between pregnancies.

Family history of type 2 diabetes or gestational diabetes.

Many pregnant women worry about weight gain, which varies because every woman’s body will respond differently. It will also depend on your pre-pregnancy weight. For women with a normal pre-pregnancy weight, a gain of 10-12.5 kg over the pregnancy is associated with the lowest risk of pregnancy complications.

It is important to have a healthy diet during pregnancy; you need 2,500 calories a day. Your diet should include bread, pasta and rice, lean meat, fish and eggs and fruit and vegetables. Include foods that contain iron, calcium and folic acid.

Cut down on fizzy and sugary drinks, but make sure that you are getting enough fluids. Reduce your intake of coffee, biscuits, crisps, cakes and chocolate. Some form of gentle exercise is advised every day, so walk for 10-15 minutes.

It is important that your obstetrics team is aware of your family history and, if you have not already done so, you need to advise them at your next visit. They will be able to reassure you and to monitor you throughout your pregnancy.

QUESTION: My sister, who is in her mid-30s, has been trying to conceive for the last year. She was recently diagnosed with polycystic ovary syndrome, though she has no symptoms. Could you explain what this is?

ANSWER: Polycystic ovary syndrome (PCOS) is a common condition and it affects how the ovaries work. Characteristic features include acne, facial hair and hair loss. The ovaries are glands that produce two hormones, oestrogen and progesterone, which control the menstrual cycle.

Each month, several tiny swellings, called follicles, develop: one grows fully and releases an ova (egg) into the Fallopian tube. Women with PCOs will experience at least two, and sometimes all three, of the following:

Development of 10 or more follicles in the ovaries.

Some women do not have a period every month and others have no periods.

The balance of hormones in the ovaries is affected and they produce more of the male hormone, testosterone.

Symptoms of PCOS include irregular periods, no periods, difficulty in conceiving, excessive hair growth and weight gain. It is thought that up 33% of women have PCOS, but the figure may be higher.

For many women, who do not have any symptoms, they first become aware they have PCOS when they experience difficulties in conceiving.

A healthy lifestyle is important for woman with PCOS, particularly if they are overweight, so:

Eat a healthy diet with a variety of foods and at least five portions of fruit and vegetables daily.

Include at least 30 minutes of exercise everyday.

Lose weight if you are overweight.

Stop smoking.

I am sure that your sister’s GP will have discussed her condition with her, and may refer her to a gynaecologist who specialises in the care of women with PCOS.


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