Gestational diabetes is a condition characterized by varying degrees of glucose intolerance, which occurs during pregnancy. In this endocrine disorder, the body is unable to use blood glucose (sugar) properly. This results in higher than normal blood sugar levels, which can be harmful to both the mother and the unborn child. Gestational diabetes is different from overt and pre-gestational diabetes, in which a woman is diagnosed with diabetes before pregnancy. Dr. Sunita Mahesh, Senior Consultant – Feto Maternal Medicine and Medical Director discusses Gestational Diabetes – What exactly is Gestational Diabetes? Why should pregnant women worry?Also Read – Inflammatory bowel disease may increase risk for pregnant women: study
Causes of gestational diabetes
The main reason for developing GDM (gestational diabetes mellitus) is the increase in certain pregnancy hormones like human placental lactogen (HPL), estrogen and progesterone which are glucogenic in nature. Insulin resistance is also increasing, that is, the body may begin to become less sensitive to the hormone insulin, which regulates blood sugar, which contributes to the increase in blood sugar levels suggested by the American Diabetes Association / World Health Organization / Diabetes. Pregnancy Study Group in India. Genetically, some women are predisposed to developing GDM. Women with metabolic syndromes such as polycystic ovary syndrome are more likely to develop GDM. Also Read – Here’s how gestational diabetes increases your risk of developing heart disease
Diagnosing Gestational Diabetes
The earlier the condition is diagnosed, the better, so that interventions in the form of diet and medication can be initiated to reduce the complications associated with the condition. At booking and again between 24 and 28 weeks of pregnancy, women are screened for gestational diabetes. If the results are normal, women are reassured and advised to continue making lifestyle changes with proper diet and regular exercise. Also Read – Warning: These diseases can lead to obesity
“Oral Glucose Tolerance Test” is the recommended laboratory test to diagnose GDM. (OGTT). Fasting for 10 hours is advised (usually overnight, skipping breakfast). A fasting venous sample is first taken to measure fasting blood glucose, after which the woman is asked to ingest 75 g of glucose in 300 ml of water. The woman is then asked to give a blood sample after 1 hour and 2 hours. This keeps the woman from taking food for two hours. There are variations prescribed by different international organizations on the manner in which the test needs to be conducted. However, a definitive diagnosis is made if the values cross a threshold defined by the standard definition.
Effects of gestational diabetes
GDM can cause many complications for both mother and fetus. Maternal complications include an increased chance of preeclampsia, because of placental abruption due to high blood glucose (hyperglycemia). Pre-eclampsia is a form of gestational hypertensive disorder in which blood pressure rises above 140/90 mm Hg on two occasions 4-6 hours apart after 20 weeks of gestation. There is also a loss of protein in the urine known as proteinuria. It seriously harms the mother and the unborn child, and immediate delivery is sometimes necessary to save the mother and fetus. The mother is also at increased risk of genitourinary infections which predisposes to premature rupture of membranes and preterm delivery.
During pregnancy, the risk of miscarriage also increases in early pregnancy. During the period where fetal organs are forming, high blood glucose can increase the risk of developmental problems. Developmental abnormalities of the gastrointestinal and cardiac systems are common in uncontrolled diabetes. There is also an increase in fluid around the baby, a condition known as polyhydramnios, which can increase the risk of preterm delivery.
In the long term, women are more likely to develop type 2 diabetes, and also have an increased cardiovascular risk in the future. Over time, health problems such as diabetic retinopathy, heart disease, kidney disease, and nerve damage can result from high blood glucose. Diet and medications are prescribed to help prevent or delay type 2 diabetes.
Different forms of gestational diabetes
The two types of gestational diabetes are as follows: Class A1 refers to gestational diabetes that can be controlled only through diet. Class A2 describes gestational diabetes, which must be treated with insulin or oral medications.
Treatment of gestational diabetes
The main aim of treatment is to maintain the normal value of blood sugar throughout pregnancy. Once a woman is diagnosed with gestational diabetes, the treatment strategy relies on monitoring blood sugar levels throughout the day. A woman is asked to check her blood sugar level before and after meals. Dietary advice includes eating nutrient-dense foods and exercising frequently. In order to keep the blood sugar level under good control, it is advisable to take medicines in the form of insulin injections in different doses and during meals. Women are also educated about the complications of low blood glucose levels that can sometimes occur and are instructed to check blood sugar levels. If blood sugar levels are consistently too high or too low, please consult your doctor, who can advise you on what to do.
