Gestational Diabetes prevalent in 18% of pregnant women is either overt or pre-existing but unrecognized before pregnancy and may develop due top pregnancy itself. Let’sunderstand why it is important to undergo screening for GDM and the treatments available.
Gestational diabetes mellitus (GDM) is development of diabetes (of any degree ) first diagnosed during pregnancy or commences with pregnancy. This GDM may be overt or pre-existing but unrecognized before pregnancy or developed due to pregnancy itself. GDM is prevalent in 18% of pregnant women. It increases progressively during pregnancy.
Risk factors: Woman who are obese, multiple previous childbirth, advanced maternal age, had diabetes in previous childbirth, had large baby at birth, polycystic disease and family history of diabetes are at greater risk of developing gestational diabetes. GDM screening is done on first antenatal visit to the clinic by fasting or random blood glucose or HbA1c on all women.
If fasting blood sugar is 126 mg/ dl_ or more, Hba1c is more than 6.5%, it is labeled as overt diabetes. However, if fasting plasma glucose is 92 mg/dL or more, then it is labeled as GDM. Women who are not previously diagnosed as overt or GDM are subjected to repeat testing. If she is found to have raised fasting glucose equal or more than 126 mg/dL on OGTT, then she is suffering from overt diabetes.
Why should a woman undergo screening for GDM?
Gestational diabetes mellitus is well documented to be associated with multiple complications in both mother and baby.
Risk to baby during pregnancy: Babies conceived in mothers with uncontrolled diabetes can develop serious congenital abnormalities or babies can be born large or with restricted growth, enlarged liver, enlarged heart, birth trauma like fracture or nerve palsy during delivery of large shoulders, hypoglycaemia in new born baby, breathing problems, jaundice at birth, congenital birth defects. In long run these infants have risk of Obesity, type 2 diabetes, cardiac disease, decreased brain or motor activity risk.
In mothers there is a risk of high blood pressure, increased water, and operative delivery. Later on these mothers become patients of type 2 diabetes mellitus and cardiac disease. Treatment of GDM has been shown to reduce the risk of serious birth defects, birth trauma, high blood pressure during pregnancy and large babies. ” There are various modalities of treatment available”.
Glucose self monitoring:
One can monitor one’s own blood glucose either fasting or after 1 hour of food and modify diet accordingly. Target is fasting blood glucose to be 95 mg/dl or less, 1 hour post food glucose to be 149 mg/dL or less.
Exercise:
Exercise improves the control of blood sugar. Even light exercise like walking after food can decrease blood sugar levels.
Lifestyle 6 diet modification:
Modification in one’s lifestyle and diet by daily exercise, avoiding fatty, fried, high sugar fruits, food, fast food and smoking and alcohol can help control blood sugar. Food with high fibre helps to control blood sugar better
Medical treatment:
Women who cannot control blood sugar on diet alone requires additional support in form of medicines which can be daily insulin or oral anti-diabetic medicines which are found to be equally effective and safe during pregnancy.
Prevention:
Any obese woman should undergo weight loss prior to conception to prevent developing GDM. Higher level of physical activity in pre-pregnancy or early pregnancy is associated with lower risk of development of GDM in several studies. Some studies have shown beneficial effect of probiotic in diet to prevent GDM.
Mode of delivery
GDM patients usually have large babies due to deposition of fat and such babies are at risk of birth injuries during vaginal deliveries. Caesarian section at 37/38 weeks is safer alternative. However, small for date babies can undergo vaginal delivery at institution under-supervision. With global increasing maternal obesity and advancing age of marriage there is a surge of GDM and requires adequate awareness amongst the women to have fruitful obstetric outcomes
