Gestational Diabetes is defined as carbohydrate intolerance of variable degree that is first diagnosed during pregnancy regardless of the medication for insulin or persistence of diabetic state after delivery. It will include patient with undiagnosed pre-existing type– 2 diabetic state after delivery. It will include patient with undiagnosed type– 2 diabetes mellitus as well as those with diabetes with first onset of pregnancy.
Diabetes and Pregnancy – Gestational Diabetes:
Diabetes that develops when a women is pregnant is called gestational diabetes mellitus. It is generally accepted that women of Asia and especially Indian ethnicity are at high risk of developing gestational diabetes mellitus and subsequent Type II diabetes. The prevalence of diabetes is absent 15% in the pregnant women. In early pregnancy maternal oestrogen and progesterone increases and promote B cells hyperplasia and increases insulin. But as the pregnancy advances there is increased level of HCS, cortisol, prolactin, oestrogen and progesterone leads to insulin resistance cortisol has peak effect at 20 weeks.
The placenta is a system of vessels that passes nutrients from the mother to the foetus. Placental hormone prevent insulin from working, this is called insulin resistance. In order to keep metabolism normal during pregnancy the body has to make three times more insulin than normal to counteract the hormones made by the placenta. For most women this extra insulin is not enough to keep blood sugar levels normal. Then woman develops high blood sugar or GDM at around 20 to 24th week of pregnancy.
On the other hand the pregnancy can aggregate the diabetes and diabetes can exert adverse effects on the pregnancy. As such GDM has no symptoms but some patients can have fatigue, increased thirst, increased urination, weight loss despite increased appetite , nausea, vomiting, frequent infection in bladder, vagina and skin.
Complications Caused due to Diabetes in Pregnancy:
Diabetes poses risk both for the mother and baby so symptoms are according to complications. There is a range of complications women can face during ante partum and intra partum periods.
Ante partum i.e. before delivery:
Intra partum complications:
Peri Natal morbidity & mortality:
So screening is important in pregnancy women. The medical literature indicates that screening should be universal, high risk pregnancy should be scanned.
Routine screening should be done between 24 to 28 weeks. If there is previous history of gestational diabetes mellitus or any other risk factor then it should be done earlier at first prenatal visit.