Gestational Diabetes Mellitus or GDM is a form of diabetes which is temporary in nature in most cases. It occurs when the body of a pregnant woman is unable to produce enough insulin to regulate sugar. In other words, GDM is defined by abnormal glucose tolerance in pregnancy. It is an exaggeration of the pregnancy-induced physiological changes in carbohydrate metabolism. Thus, it is also called carbohydrate intolerance and Glucose Intolerance is another name for it.

All pregnant women are tested for gestational diabetes between 24 and 28 weeks of pregnancy with 50gm screening GTT (glucose tolerance test) and if the test is abnormal the diagnostic test is a 100gm oral glucose tolerance test. However, an expectant mother would be tested earlier or more frequently if she is over 35 years old, overweight or has a family history of diabetes.

Causes

The actual cause of GDM is still unknown, but researchers relate this condition to pregnancy-induced as the placenta during pregnancy produces high levels of various other hormones and almost all of them impair the action of insulin in the cells, raising blood sugar. The pancreas is equipped to make the required amount of insulin to handle that. However, if it cannot then the blood sugar levels would increase to cause gestational diabetes.

Signs and Symptoms

Gestational diabetes is usually asymptomatic and is detected through routine screening tests during pregnancy. However, the following symptoms may be seen in an Uncontrolled GDM person:

  • Unusual thirst
  • Sugar in urine
  • Fatigue
  • Frequent urination
  • Blurred vision
  • Skin infections
  • Bladder infections
  • Vaginal infections
  • Unusual hunger

Who are at Risk?

Gestational diabetes is more likely to affect people those who:

  • Were overweight before getting pregnant and are not physically active
  • American, Asian, African-American and Hispanic
  • With a family history of diabetes
  • Have pre-diabetes
  • Have had GDM before
  • Have high BP, heart disease or any other medical complications
  • Gave birth to a baby with macrosomia and weighed more than 8 pounds before
  • Gave birth to a baby with birth defects or was stillborn
  • Have or had PCOS

Complications

A woman suffering from gestational diabetes may experience certain complications that include:

  • Giving birth to a big baby
  • Fetal overgrowth increases chances of C-section
  • Risk of preterm deliveries
  • High blood pressure (Preeclampsia)
  • Low blood sugar (Hypoglycemia) 
  • Risk of developing type 2 diabetes in the future

The baby may have some complications as well. These could be:

  • Low blood sugar
  • Breathing difficulties
  • Shoulder dystocia
  • Risk of developing diabetes in the future

Diagnosis

Gestational diabetes is more common during the second half of the pregnancy. Thus, the doctor would suggest a test between 24 and 28 weeks of pregnancy. A patient at high risk would be screened for gestational diabetes sooner. 

Screening for GDM:

  1. 50gm oral glucose load, administered between 24 and 28 weeks, without regard to time of day or time of last meal.

  2. Venous plasma glucose measured 1 hour later (blood collected from veins)

  3. Value of 140mg/dl or above in venous plasma indicates the need for a diagnostic glucose tolerance test.

Diagnosis of gestational diabetes mellitus:

  1. 100gms oral glucose load, administered in the morning after overnight fast lasting at least 8hrs but not more than 14hrs and following at least 3 days of unrestricted diet and physical activity.

  2. Venous plasma glucose is measured fasting and at 1, 2, and 3 hours. The subject should remain seated and should not smoke throughout the test.

  3. The diagnosis of GDM is made when two or more of the following venous plasma concentrations are met or exceeded: fasting 95mg/dl; 1 hour, 180mg/dl; 2hours, 155 mg/dl; 3 hours, 140mg/dl

Prevention

It may not be possible to prevent gestational diabetes in its entirety. However, healthier habits you can adopt before pregnancy, the better. These healthy choices may also reduce the risk of having it in future pregnancies or developing type 2 diabetes. Women must start eating a balanced and healthy diet in combination with regular exercise for at least 20 minutes per day to keep active. If a woman is overweight and trying to get pregnant, it would be much beneficial to lose weight. Gestational diabetes can be prevented even by losing a few kilos.

Treatment

The most important step of treating gestational diabetes is to control blood sugar levels. In order to achieve that:

  • The doctor will closely monitor the mother and the fetus
  • The mother must self-monitor her blood glucose levels at least four times a day
  • Oral Hypoglycemic agents or insulin therapy must be administered if required
  • Diagnosed cases should undergo nutrition counseling and exercise regularly.

Outlook

The blood sugar levels should return to normal after the delivery. However, if a woman has gestational diabetes, her chance of developing type 2 diabetes increases. Thus, all the women identified to have GDM should be screened at 6-12weeks postpartum with a fasting plasma glucose test or a 2 hours oral glucose tolerance test (75gm glucose load).

Nightingales offer home-based healthcare and medical services which include lab tests. Book a lab test and find out whether or not you have gestational diabetes. You can also go for a doctor’s consultation from the comfort of your home to get advice.

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