Gestational Diabetes And Pregnancy: Knows it’s Causes, Symptoms And Treatment

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Gestational Diabetes is a condition wherein there is glucose intolerance of varying levels, which occurs during pregnancy. In this endocrine disorder, the body is unable to appropriately utilize blood glucose (sugar). This results in higher blood sugar levels than the normal values, which can be harmful to both mother and the unborn child. Gestational diabetes differs from Overt and Pre gestational diabetes, in which the woman already has been diagnosed as diabetic prior to pregnancy itself.  Dr. Sunitha Mahesh, Senior Consultant – Feto Maternal Medicine & Medical Director discussed about Gestational Diabetes – What exactly is gestational diabetes? Why Should Pregnant Women Be Concerned?

Causes of Gestational Diabetes

​The main reason for developing GDM (Gestational Diabetes Mellitus) is because of increase in certain pregnancy hormones like human placental lactogen (hPL), Estrogen and Progesterone which are glucogenic in nature. There is also increasing insulin resistance, that is, the body may begin to become less sensitive to the hormone insulin, which controls blood sugar, which contributes to increase the blood glucose levels beyond those prescribed by American Diabetes Association/ World Health Organisation/ Diabetes in Pregnancy Study Group in India. Genetically, some women might be prone for developing GDM. Women with metabolic syndrome like Polycystic Ovarian syndrome have increased chances of developing GDM.

Diagnosis of Gestational Diabetes

​The earlier this condition is diagnosed, it is better, so that interventions in the form of diet and medications can be initiated to reduce the complications associated with this condition. At booking and once again between 24 to 28 weeks of pregnancy, women are subjected to a gestational diabetes screening. If the results are normal, women are reassured and they are advised to continue life style modifications with appropriate diet and with regular exercises.

​”Oral glucose tolerance test” is laboratory test advised to diagnose GDM. (OGTT). It is advised to fast for 10 hours (generally overnight, missing breakfast). A fasting venous sample is collected first for measuring the fasting blood glucose, following which, the woman is asked to consume 75 g glucose in 300ml of water. Then the woman is asked to give the blood sample after 1 hour and 2 hours. The woman is refrained from consuming food for these two hours. There are several variations prescribed by different international bodies on the way the test needs to be conducted. However, the final diagnosis is made if the values cross the threshold prescribed by the standard definition.

Effects of Gestational Diabetes

​GDM can cause several complications to both the mother and the fetus. Maternal complications include increase in the chance of developing Preeclampsia, as there is deficient placentation due to high blood glucose, (hyperglycemia). Pre-eclampsia is a form of hypertensive disorders of pregnancy wherein there is increase in blood pressure beyond 140/90 mm of Hg on two occasions 4-6 hours apart, after 20 weeks of pregnancy. There is also loss of proteins in urine known as proteinuria. It can harm the mother and the unborn child seriously, and imminent delivery sometimes becomes necessary to save the mother and fetus. There is also increase in risk of the mother developing genitourinary infections which can predispose to early rupture of membranes and preterm delivery.

​During pregnancy, there is also increase in risk of miscarriage in early pregnancy. During the period where the fetal organs are formed, high blood glucose can increase the risk of developmental problems. Developmental anomalies of the gastrointestinal and cardiac systems are commonly seen in uncontrolled diabetes. There is also increase in the fluid around the baby, condition known as polyhydramnios, which can increase the risk of preterm delivery.

​In the long run, women are more likely to acquire type 2 diabetes, and there is also increase in future cardiovascular risk. Over time, health issues such as diabetic retinopathy, heart disease, kidney disease, and nerve damage can result from having high glucose in the blood. Diet and medications are prescribed to either delay or help prevent 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 by diet. Class A2 describes gestational diabetes, which must be treated with insulin or oral medicines.

Treatment of Gestational Diabetes

​The main aim of treatment is maintain a normal blood glucose values throughout the pregnancy. The treatment strategy relies on having blood sugar levels monitored throughout the day, once the woman is diagnosed with gestational diabetes. The woman is asked to check the blood sugar levels before and after meals. Dietary advice include eating a diet high in nutrients and engaging in frequent exercise. In order to have good control of blood sugar levels, medications in the form of insulin injection is advised in varying doses and during meals. The woman is also educated about complications of low blood glucose levels which can happen sometimes and is instructed to keep a check on blood sugar levels. If the blood sugar levels are persistently too high or too low, please consult your doctor, who can advise you on what to do.

 


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