Gestational diabetes is one of the common complications of pregnancy. More than a million cases occur in India every year.
What is gestational diabetes?
Any diabetes or raised blood sugar levels detected during gestation or pregnancy is called gestational diabetes. Diabetes might or might not have existed before the pregnancy. It includes both diabetes that might be controlled with diet alone or with insulin.
What is the incidence of this complication of pregnancy?
The incidence of this condition varies from 3.8% to 21% in various parts of India. Southern India has a higher incidence and prevalence is more in urban areas in comparison to rural regions. Asian women, particularly ethnic Indians are at a higher risk of developing it.
Why does it happen?
When you eat, your body breaks down carbohydrates from foods into a sugar called glucose. The pancreas makes a hormone called insulin, which helps move sugar into your cells to give you energy.
During pregnancy, your body produces several kinds of the hormone. The placenta produces lactose and as a result, the body’s cells utilise insulin less effectively, a condition called insulin resistance. More insulin (as much as thrice the normal levels) is required and when your body is unable to produce insulin in the required amounts, it is unable to utilise glucose for energy and the blood levels of sugar rise.
What are the symptoms of gestational diabetes?
In most women, there are no obvious symptoms, but the following might be present: Dry mouth with increased thirst, frequent urination, especially at night, tiredness, repeated infections, such as thrush (a yeast infection) and blurred vision.
What are the risk factors for developing gestational diabetes?
You may be more likely to get this disease. If you,
- Overweight before you got pregnant.
- Gain weight very quickly during your pregnancy.
- Have a parent, brother, or sister with type 2 diabetes and pre-diabetes
- Had gestational diabetes in a past pregnancy and over age 25.
- Gave birth to a baby weighing more than 9 pounds.
- Had a baby who was stillborn.
- Have a condition called polycystic ovary syndrome (PCOS).
- Are African-American, American Indian, Asian, Hispanic, or Pacific Islander.
How will I know whether I have GD?
A simple blood sugar level test can indicate whether you are at risk. All pregnant women should be assessed for high blood sugar especially those with any of the risk factors. The test should be repeated between 24 and 28 weeks of pregnancy if it is negative initially. The disease usually shows up by then.
A fasting blood glucose level of more than 126 mg/dl or a random level of more than 200 mg/dl is enough to make the diagnosis. If the test is negative and diabetes must absolutely be ruled out in high-risk patients than oral glucose tolerance test can be done.
What is oral glucose tolerance test?
This is a test done by giving 100 gms of glucose orally and then checking the blood glucose level after 2 hours, then 4 hours, then 5 hours. It gives a clearer picture of the severity of diabetes.
How can diabetes affect my pregnancy?
You can be at increased risk of hypertension and it’s complications. You might have to undergo a Caesarian section if birth is delayed beyond 38 weeks or because of the size of the baby.Your baby can be at risk for foetal growth disorders, macrosomia or large sized body.
Your baby can be at risk for fetal growth disorders, macrosomia or large sized body. Your baby can develop low blood sugar or hypoglycemia after birth, jaundice, polycythemia and hypocalcemia.Your baby faces the risk of intra-uterine death during the last 4-8 weeks of gestation. This risk your baby faces the risk of intra-uterine death during the last 4-8 weeks of gestation. This risk increases when fasting glucose levels exceed 105 mg/dl (5.8 mmol/l) or pregnancy progresses past term.
What are the long-term risks associated with GD?
If you are obese you face the risk of the development of type 2 diabetes after pregnancy. Your baby could face the risk of being obese or diabetic in late adolescence and young adulthood.
How to manage GD?
Daily self-monitoring of blood glucose (SMBG) is the best way to monitor blood glucose levels. Monitoring of blood pressure and urine protein monitoring to detect hypertensive disorders. Assessment for asymmetric foetal growth by ultrasonography, particularly in the early third trimester, may aid in identifying foetuses that can benefit from maternal insulin therapy. Nutritional counselling, by a registered dietitian, when possible. This should include the provision of adequate calories and nutrients to meet the needs of pregnancy. It should also be adjusted to the maternal blood glucose goals that have been established. Noncaloric sweeteners must be used only in moderation.
For obese women, a 30–33% calorie restriction has been shown to reduce hyperglycemia and plasma triglycerides with no increase in ketonuria. Restriction of carbohydrates to 35–40% of calories has been shown to decrease maternal glucose levels and improve maternal and fetal outcomes.
Insulin is the therapy that has most consistently been shown to reduce fetal morbidities when given to the mother. Insulin therapy may be given on assessment of blood sugar levels. Measurement of the fetal abdominal circumference early in the third trimester can identify an excess risk of macrosomia and an indication for maternal insulin therapy.
Human insulin should be used when insulin is prescribed, and self-monitoring of glucose levels should guide the doses and timing of the insulin regimen. Oral glucose-lowering agents are generally not recommended during pregnancy. Women without medical or obstetrical contraindications should be encouraged to start or continue a program of moderate physical exercise as a part of treatment for GDM. This has been shown to lower sugar levels. Caesarian delivery is only done when there is a prolongation of gestation past 38 weeks. Breastfeeding, as always, should be encouraged in women with GDM.
Assessment of glycemic status should be performed for at least 6 weeks after delivery. If glucose levels are normal post-partum, reassessment of glycemia should be undertaken at a minimum of 3-year intervals.
Exercise programs are recommended because of very high risk for development of diabetes. All patients should be educated regarding lifestyle modifications that lessen insulin resistance, including maintenance of normal body weight through diet and physical activity. Medications that worsen insulin resistance (e.g., glucocorticoids, nicotinic acid) should be avoided if possible. Patients should be advised to seek medical attention if they develop symptoms suggestive of hyperglycemia.
Low-dose estrogen-progestogen oral contraceptives can be used in women with prior histories of GDM, as long as no other medical contraindications exist. Offspring of women with GDM should be followed closely for the development of obesity and/or abnormalities of glucose tolerance.