Gestational diabetes is defined as high blood sugar levels in a pregnant woman who has no prior history of diabetes usually in the second half of pregnancy. Incidence is rising with time because of many reasons, lifestyle and genetics being the most important ones.
Pregnancy causes many hormonal changes in the body leading to diabetes like state and resistance to insulin. Placenta produces many insulin opposing hormones.
In our country, because of the high risk due to our ethnicity, the recommendation is of universal screening i.e. all pregnant women should be screened between 24-28 weeks of pregnancy or earlier if other high-risk factors are there. A test is usually a 75 gms glucose challenge test.
Risk factors for Gestational Diabetes:
History of gestational diabetes in previous pregnancy
History of unexplained stillbirth
Previous baby weight on higher side>4 kgs
Family history of diabetes
Patient with PCOS
Overweight i.e. BMI > 30
Symptoms associated with Gestational Diabetes:
Gestational diabetes usually does not have any sign or symptoms. Increased thirst or increased frequency of urination may be seen. Screening detects the disease. The test consists of a fasting sample, 1 hour and 2 hours after a measured amount of glucose. Glycosylated hemoglobin or HbA1c is also helpful to monitor long-term levels in the blood.
Obstetrician, endocrinologist, and dietician manage pregnancy with diabetes as a team.
Complications associated with Gestational Diabetes
Uncontrolled blood glucose can lead to many complications in mother, baby and increase chances of operative delivery.
Macrosomia- large baby
Preterm birth and respiratory distress syndrome
Hypoglycaemia in baby
High BP or preeclampsia
Risk of diabetes in later life of both mother and baby
Prevention associated with Gestational Diabetes
Eat healthily. High fiber diet with low fat and carbohydrates
Exercise- It is a must and cannot be overlooked. Maintain a healthy weight, avoid unnecessary weight gain, moderate 30 minutes exercise in a single session or in several short sessions per day.
Treatment of Gestational Diabetes
Diet- A healthy diet plan drafted by a qualified dietician is the key to success.
Exercise – Majority of women are controlled by a healthy diet and exercise alone. A few need medical if sugar still not in control. For this insulin injection is the best during pregnancy, though metformin is also a safe drug during pregnancy. For initiating and titration of insulin, you may be admitted to the hospital where the correct dose will be calculated and you will be taught how to inject and monitor sugars. You will also be told warning signs of hypoglycemia.
Though the incidence of diabetes is rising, you can have an uncomplicated pregnancy and safe delivery if you strictly follow your instructions of diet, exercise, monitoring sugar and keep all your appointments with the doctor.