Gestational diabetes occurs during pregnancy & seen in approximately 10% of all pregnancies. It usually appears between 20 – 28 weeks (5th – 7th month) of gestation and usually resolves after delivery of the baby. Gestational diabetes is similar to type 2 diabetes in that there is both insulin resistance and an insufficiency of insulin secretion. Insulin resistance in pregnancy is caused by anti-insulin effect of some of the pregnancy hormones. Gestational diabetes results when the mother’s production of insulin is not enough to overcome the effect of these hormones.
Following are the risk factors for gestational diabetes:
1) Strong family history of diabetes especially in parents
2) Obesity (BMI > 30 kg / m2)
3) Advanced maternal age (women above 35 years of age)
4) Gestational diabetes in previous pregnancies
5) History of large baby (i.e. birth weight more than 3.5 Kg)
6) History of Polycystic ovary disease (PCOD), Infertility treatment etc.
Women with high risk should be screened as soon as possible after pregnancy has been confirmed & again at 24 – 28 weeks of gestation. Screening & diagnosis of gestational diabetes is done with the help of oral glucose challenge test or oral glucose tolerance test (OGTT).
Complications and risks of gestational diabetes :
• Risks to mother:
o High blood pressure
o Polyhydramnios (excess of amniotic fluid)
o Caesarian Section (due to large size of the baby)
o Mother has high risk of developing gestational diabetes in subsequent pregnancies & type 2 diabetes in future.
• Risks to baby:
o Large baby (as excess blood sugar is transported to the baby, baby secretes more insulin to lower this glucose load which is responsible for large size of the baby)
o Hypoglycemia (low blood sugar levels) immediately after birth
o Complications like jaundice etc.
o Birth defects (if blood sugar is not properly controlled especially in early pregnancy)
o There is an increased risk of obesity & diabetes in late adolescence / early adulthood
Successful management of gestational diabetes requires that blood glucose is monitored regularly and maintained in the normal zone with the help of following strategies:
1) Balanced diet which is low in simple carbohydrates & sugars but rich in fibers
2) Exercise as allowed by Obstetrician
3) Regular medications or insulin as prescribed by the doctors
4) Blood Pressure and urine protein monitoring
Post pregnancy Advice:
• Breast feeding must be encouraged
• Weight gain to be avoided – avoid calorie dense foods after delivery
• Ideal body weight should be achieved & maintained
• Women should be screened for type 2 diabetes at 6 weeks after delivery by oral glucose tolerance test & if normal, it should be repeated every 3 years
• Diet, exercise, weight management and regular monitoring are of great value for prevention of gestational diabetes in subsequent pregnancies &/ or type 2 diabetes in future.
REMEMBER- PREVENTING GESTATIONAL DIABETES IS PREVENTING DIABETES FOR THE TWO!