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Understanding Diabetes in Pregnancy - Gestational Diabetes Mellitus (GDM)

Gestational diabetes mellitus (GDM) only happens during pregnancy. It means you have high blood sugar levels, but those levels were normal before you were pregnant. GDM is caused by the pancreas not being able to produce enough insulin to account for the increased requirement of insulin during pregnancy.

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:

  • Family history of diabetes
  • History of unexplained prenatal loss [death of baby from 7 months of pregnancy to few days after birth
  • History of having given birth previously to a very large infant, a stillborn child, or a child with a birth defect
  • Obesity or overweight
  • Having too much amniotic fluid (polyhydramnios)
  • Women over 25 years of age
  • Hypertension
  • Sedentary lifestyle
  • HDL Cholesterol less than 35 mg/dl
  • History of polycystic ovarian syndrome

Gestational diabetes is diagnosed with a blood sugar screening test. 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.

Management of diabetes patient 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:

Age, overall health, and medical history

  • Severity of the disease
  • Exercise to be modified as required
  • Meal plan & basic nutrition recommendations: A total calorie intake of 30-35 cal/ kg body weight is usually prescribed with adequate protein and fibre in the diet.
  • Importance of blood glucose monitoring and control: Maintenance of normal glycemic status before conception and during pregnancy is essential to prevent foetal complications and for good outcome, since the organogenesis is completed by 6th week after conception, at a time when most of the women are not even aware of their pregnancy.
  • Maintenance of fasting blood glucose level below 95mg and postprandial blood glucose below 120mg is ideal for good foetal outcome. Fructosamine assay gives information of the glycemic control over the previous 1-3 weeks and glycated haemoglobin (HbA1c) is a test which gives information about the glycemic control during the previous 2-3 months.
  • Insulin injections: Usually oral hypoglycemic tablets are withdrawn and insulin is introduced since tablets [medicines] can cross the placenta and stimulate the fetal β cell and may produce hypoglycemia in the neonatal stage. However, more recently, some diabetologists do use tablets such as Metformin or Sulphonylurea agents to treat GDM.

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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