Nashwa Al Ruwaini, a patient at Imperial College London Diabetes Centre, made lifestyle changes a priority to prevent high-risk pregnancies and long-term complications 
     
Abu Dhabi, United Arab Emirates, on 7 October 2021:   Emirati businesswoman Nashwa Al Ruwaini admits that before she had children, she had an insatiable sweet tooth, was a workaholic and lived a very stressful life. 
 
While her unhealthy lifestyle did not impact on her first pregnancy, the patient of Mubadala Health’s Imperial College London Diabetes Centre (ICLDC) – a global leader in diabetes treatment, education and research – had an alarming fasting blood sugar level of 195mg/dL in the second trimester of her second pregnancy in 2010, which signalled to doctors that she had gestational diabetes. 
 
Gestational diabetes is the type of diabetes that is first seen in a pregnant woman who did not have diabetes before she was pregnant, and is more common in the second and third trimester. The risk factors for gestational diabetes include being overweight and obese, lack of physical activity, prediabetes, a family history, polycystic ovary syndrome and previously delivering a baby weighing more than 4kg. The World Health Organization estimates that gestational diabetes affects about seven to 10 per cent of all pregnancies worldwide. 
 
For most women with gestational diabetes, the diabetes resolves itself soon after delivery. When it does not go away, the diabetes is deemed type 2 diabetes. Even if the diabetes does go away after the baby is born, half of all women who had gestational diabetes develop type 2 diabetes later. Their children are also at risk of developing childhood obesity and are six times more likely to develop type 2 diabetes.
 
Seeking to inspire other women
 
In the case of Nashwa, she went on to develop type 2 diabetes in 2012 after her third child and now wants to raise awareness about the dangers of a poor lifestyle and importance of proper diabetes management during pregnancy. She says that being diagnosed with gestational diabetes was the wake-up call she needed to turn her life around. 
 
“I always had bad eating habits, skipped meals and would have a big dinner right before bedtime. When I was told that I had gestational diabetes, I changed my ways because I was worried that the baby would have diabetes or would be affected by my high blood sugar levels. I followed the ICLDC clinical team’s instructions on diabetes management to the letter and was blessed with 
 
 
a beautiful child,” says Nashwa, who is the Founder and Chief Executive Officer of the Abu Dhabi-based media production and consultancy firm Pyramedia Group. 
 
“I learned that a workaholic like me, who is stressed and neglects her body’s need for good nutrition and exercise, can easily fall into the vicious trap of diabetes.”
 
Dr Tarig Abdalla, a consultant endocrinologist and diabetologist at ICLDC who has been assisting Nashwa in her diabetes management since the second pregnancy, says that along with the help of a diabetes educator and dietitian, they were able to reduce her blood sugar levels to the target range of 70 – 120 mg/dL for an uncomplicated pregnancy.
 
“Nashwa’s blood sugar level was quite high when she came to us, so we had to start her on insulin therapy and advised her on dietary and lifestyle measures. She managed quite well, and her baby was born the right size, which shows that she had good control of her blood sugar.”
 
Risks for mother and baby
 
Dr Abdalla explains that there is a high risk to the mother and baby if gestational diabetes is not in check during a pregnancy. 
 
“If it is uncontrolled, the baby is exposed to very high maternal glucose levels, so his or her pancreas will try to deal with this by producing insulin. This causes the child to grow in size and weight, making the delivery difficult, necessitating a C-section. Also, when babies produce too much insulin, sometimes they are born with hypoglycaemia (low blood sugar). This can cause seizures and requires immediate intervention with feeding or an intravenous glucose solution.”
 
Women can also face high blood pressure and preeclampsia, which is the sign of damage to other organs and can threaten the lives of both mother and baby. 
 
Nashwa says that she was fully aware of these risks and went for regular check-ups throughout the pregnancy. 
 
“I had to deal with hypoglycaemia while I learned how to manage my diabetes during the initial stages. I was constantly worried about how the diabetes might affect my child and I got regularly tested to ensure that my baby was not affected by my yo-yo blood sugar levels. Since I had gone through this once, I was better prepared during my third pregnancy. Throughout this time, I was supported by the team at ICLDC and continue to see Dr Abdalla every three months for an assessment.”
 
Dr Abdalla says there is a worldwide trend of increasing obesity rates and unhealthy lifestyle habits is fuelling the problem. He adds, “The numbers are also increasing because the diagnostic criteria have changed in the past decade.  Expectant mothers with a fasting blood sugar level of more than 95 mg/dL are considered to have gestational diabetes.”
 
But he stresses this diagnosis means women can turn things around on time. “Ninety per cent of women who have gestational diabetes can successfully manage their blood sugar with diet and 
 
 
lifestyle changes alone. This is positive news because it increases their awareness about type 2 diabetes and makes them adopt healthy habits for themselves and their children.”
 
Nashwa echoes her doctor’s advice, saying: “We should all take good care of ourselves, nourish our bodies with nutritious food, movement and rest. I’m always worried for my children too and try to lead by example. I’ve made eating a healthy diet and exercising regularly integral to our lives and keep a watch on the risk factors and symptoms of type 2 diabetes.”