Diabetes is a major medical complication of pregnancy and is associated with an increased risk of maternal and prenatal morbidity and mortality. It is estimated that diabetes complicates between 1 and 20% of all pregnancies worldwide. Gestational Diabetes Mellitus (GDM) is defined as the first onset of diabetes or glucose intolerance during pregnancy. GDM has become one of the common health problems affecting pregnant women today. Recent research indicates that between 10-20% of all pregnant women in urban areas in India have GDM.
GDM is not only associated with increased morbidity during the pregnancy but also increases the likelihood of subsequent diabetes in the mother and development of obesity and diabetes in the offspring. Thus GDM puts both the mother and child at risk. It is important to detect patients with GDM, because if unrecognized, the pregnancy may end in the prenatal death or fetal wastage. Therefore, screening for GDM is very essential. Ideally all pregnant women should undergo screening for GDM. However, as it is practically difficult at least the high-risk individuals should be screened for GDM.
Women with any of the following characteristics are at increased risk of being diagnosed with gestational diabetes, compared to women without any of these characteristics:
Gestational diabetes is diagnosed with a blood sugar screening test and the best test to do would be an Oral Glucose Tolerance Test [OGTT]. The World Health Organization (WHO) has proposed that if the plasma glucose concentration is above 140mg/dL, 2 hours after a 75 gm glucose load, a diagnosis of GDM should be made.
Infants of mothers with gestational diabetes are vulnerable to several complications, but the commonest are:
In addition, a lady with GDM may develop recurrent urinary tract infections, hydramnios, toxaemia etc.
Management of diabetic pregnancies (if diagnosis is known before the pregnancy) should ideally begin before conception and requires a close collaboration between obstetricians and diabetologists. Assessment and management of associated disorders such as retinopathy, nephropathy, and chronic hypertension are required. In the case of GDM, the traditional management approaches include a combination of diet, exercise, intensive insulin regimens and home blood glucose determinations.
Specific treatment should be determined by a physician based on:
In summary, with improved blood sugar control, GDM is no longer a disease to be feared. However, close follow-up with a diabetologist and Obstetrician is needed to ensure a successful outcome.
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Authors: Dr. V. Mohan, Chairman & Chief Diabetologist | Ms. Umasakthy, Registered Dietitian Latent autoimmune…
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