This World Diabetes Day, let’s talk about the implication of Diabetes on Pregnant Women.
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 pregnancy is called gestational diabetes. The diabetes might or might not have existed before the pregnancy. It includes 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. 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?
During pregnancy your body produces several kinds of hormone. The placenta produces lactose and as a result the body’s cells utilize insulin less effectively. This condition is called insulin resistance.
More insulin (as much as thrice the normal levels) is required. When body is unable to produce insulin as required, it’s unable to utilize glucose for energy. As a result 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,
- Repeated infections, such as thrush (a yeast infection)
- Blurred vision.
Risk factors for developing gestational diabetes?
You may be more likely to get this disease if:
- Overweight before you got pregnant.
- Gain weight very quickly during your pregnancy.
- You have a parent, brother, or sister with type 2 diabetes.
- Pre-diabetic (blood sugar levels are high but not high enough)
- Had gestational diabetes in previously.
- You gave birth to a baby weighing more than 9 pounds, over age 25.
- Had a stillborn baby.
- Have a condition called poly-cystic ovary syndrome (PCOS).
How will I know whether I have GD?
A simple blood sugar level test. All pregnant women should be assessed for high blood sugar. The test should be repeated between 24-28 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 for diagnosis.
How can diabetes affect pregnancy?
- 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.
- Baby can be at risk for fetal growth disorders, macrosomia or large sized body.
- Your baby can develop low blood sugar or hypoglycaemia after birth, jaundice, polycythemia and hypocalcaemia.
- 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.
- Assessment for asymmetric fetal growth by ultra sonography, particularly in early third trimester, may aid in identifying fetuses that can beneﬁt from maternal insulin therapy.
This includes 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.
- 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.
- 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.
- Breast-feeding, 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.
- Medications that worsen insulin resistance (e.g., glucocorticoids, nicotinic acid) should be avoided if possible.
- Offspring of women with GDM should be followed closely for the development of obesity and/or abnormalities of glucose tolerance.
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