Introduction
Gestational diabetes mellitus (GDM) is a condition of high blood glucose levels are detected for the first trimester during pregnancy. GDM is very common and some studies have reported that 10-20% of pregnant women in India have GDM.
Who are at risk of GDM?
Screening and diagnosis of hyperglycemia in pregnancy
All pregnant women should be screened at the first visit to antenatal clinic. Early in pregnancy screening is done usually at the booking visit to see if the woman already has diabetes complicating pregnancy which she did not know about. Screening can be done using either fasting plasma (FPG), glycosylated hemoglobin (A1C),or random plasma glucose(RPG). If a woman has high blood sugars early in pregnancy (FPG>7mmol/l (126 mg/dl), A1c >6.5% or RPG >11.1 mmol/l(200mg/dl) then she should be treated as having pre-existing diabetes.
All women who have normal blood glucose levels of sugar early in pregnancy should be screened again with an oral glucose tolerance test (OGTT) between 24-28 weeks of the pregnancy to rule out GDM. They should come to the centre in fasting state at least 8 hrs-10 hrs and should not consume anything except water before the test. Fasting blood and urine are collected, 75 gms of oral glucose is given to drink in 300 ml of water. Blood is then drawn at one and two hrs of the glucose load. If fasting plasma glucose is between 92-125mg/dl or 1 hr of glucose load >180mg/dl or 2 hrs level is >153mg/dl (International Association of Diabetes and Pregnancy Study Group, IADPSG criteria) the woman is said to have Gestational Diabetes.
Weight gain during pregnancy
All pregnant women should gain some weight during pregnancy and the recommended weight gain is decided by the Pre-pregnancy body mass index (BMI)
BMI = Weight (kg)/ Height in m2
Changes of body weight based on BMI
< 18.5 | Underweight |
18.5-22.9 | Normal |
23-24.9 | Overweight |
>25 | Obese |
(According to Asian Indian guidelines1)
Recommended weight gain according to pre pregnancy BMI
BMI | Weight gain |
<18.5 | 12.5-18 Kg |
18.5-24.9 | 11.5-16 KG |
25-29.9 | 7-11.5 KG |
>30.0 | 5-7 KG |
Managing Gestational Diabetes
Gestational Diabetes levels can be managed through balanced and healthy diet, medication and exercise. Medication is usually indicated if blood sugars do not come to normal with diet and exercise. Recommended levels of glucose are fasting<90mg/dl(5.0 mmol/l),1 hr<140mg/dl(<7.8 mmol/l),2 hrs <120mg/dl(<6.7 mmol/l)
General guidelines for healthy eating
Generally good nutrition is important during pregnancy and en effective way to manage gestational diabetes levels. A dietitian can guide to take portion size, right amount of protein, fat and carbohydrate.
Here are some general tips:-
Healthy plate
One way to decide how much to eat to divide the plate is given below. Up to half plate should contain vegetables and fruits, about one quarter of plate should be starch or grains and the reminder protein and calcium rich foods.
Healthy food plate
Example of Healthy food plate with South-Asian foods
Physical Activity
Aerobic activity of moderate intensity for 30mins/day on most days of the week has shown benefits in metabolic control. Start with light to moderate exercise. Any simple physical activity is better than no activity.2, 3
Caution
Insulin
Insulin is indicated when target blood glucose levels are not attained with diet and physical activity. Different types of insulin is prescribed by the Diabetologist.
Materials required for insulin injection
General guidelines for patient on bottle type insulin
General guidelines for patients on pen type insulin
Hypoglycemia during pregnancy
Only those on insulin during pregnancy are at risk of getting hypoglycemia.
Blood sugar drops when
Symptoms of Hypoglycemia
Treatment of Hypoglycemia
Prevention of Hypoglycemia
Monitoring blood sugar
Post delivery screening
After the delivery, blood sugar to be checked. If the blood sugars return to normal, women will no longer require insulin. For some women blood sugar will not come under normal range level after the baby is born this mean the diabetes is continuing after delivery also. They should be encouraged healthy eating and to follow proper medication if needed. All women need to check an oral glucose tolerance test between 6-12 weeks after the delivery in the fasting state to see whether the diabetes has gone into remission or not.
Breast feeding should be encouraged. Breast feeding improves blood sugar and has been shown to reduce the chances of developing diabetes in future.4
Breast feeding offers some protection against next pregnancy but it is not a guaranteed birth control method.
Reference
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