A Closer Look at Gestational Diabetes

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Gestational DiabetesPregnancy is a joyful time for women yet learning you have gestational diabetes can be worrying. HEALTH speaks with Specialist Obstetrician Gynecologist Dr. Lubna Fatimah about the signs of gestational diabetes and what women can do to protect themselves.

Defined


Dr. Lubna explains that GDM (gestational diabetes mellitus) means pregnant women who have never had diabetes before but who have high blood glucose (sugar) levels during pregnancy. “According to a 2014 analysis by the Center of Disease Control & Prevention, the prevalence of
gestational diabetes is as high as 9.2 percent, as cited by the American Diabetes Association,” she explains.

Genetic or Acquired

According to Dr.Lubna, GDM has both a genetic and an acquired factor, defined as glucose intolerance with onset or first recognition during pregnancy. “The prevalent value varies in different population or ethnic groups which means there is genetic susceptibility,” she says. “There are relatively few published studies of genetic susceptibility to GDM, although available data suggests that pregnancy complications have a familial tendency.” Moreover, in at least 30 percent of women with history of GDM there is a subgroup of women who may be genetically predisposed to develop GDM again.

Symptoms

  1. Fatigue
  2. Frequent infection (urine or vaginal)
  3. Increased thirst
  4. Increased urination
  5. Nausea and/or vomiting
  6. Weight loss
  7. Increased weight gain
  8. Increased baby weight (on USG)
  9. Increased liqour volume (on USG)
  10. High blood sugars on monitoring

According to Dr. Lubna, usually there are no symptoms or may be mild, hence it is necessary to have regular Antenatal checkup and a Glucose
challenge test will be done by your doctor in between 22nd Week to 24th Week to see if you are prone to have GDM in this pregnancy. Blood sugar in GDM usually returns to normal after the delivery.

Risk (Acquired) Factors Include

  1. Pre pregnancy overweight and obesity
  2. Family history of DM
  3. Advanced maternal age
  4. History of infertility is linked to an elevated risk of GDM
  5. PCOD, a contributor to ovulatory disorder has been linked to increased risk of GDM.

In short, Dr. Lubna explains that GDM is caused by hormonal changes in pregnancy with metabolic demands of pregnancy together with genetic and environmental factors.

Risk Factors Which Suggest a Patient Can Develop GDM in Pregnancy

  1. BMI greater than 30
  2. Previous Big baby greater than 4.5 kilograms
  3. Previous history of GDM
  4. First degree relative with diabetes
  5. Family origin with high prevalence of diabetes

Potential Dangers to the Mother and/or Baby

  1. Untreated, moderate or severe GDM increases the risk of fetal and neonatal complications.
  2. Risk of congenital malformation is slightly increased in infants of mother with GDM compared to general population.
  3. Macrosomia ( big baby) with difficult delivery and complication at the time of delivery.
  4. Increased risks of perinatal death with GDM due to unrecognized type 2 diabetes.
  5. Birth injuries
  6. Some neonatal complications.
  7. Also apart from increased birth weight, birth injuries, increased rate of induction of labor and Caesarian section rates, miscarriages,congenital malformations, still birth, and neonatal deaths, there is also risk of diabetes developing later in life.

Tips to Coping with Gestational Diabetes

  1. Firstly, all pregnant women with GDM should be given adequate information and advice on risk of GDM and how to reduce it with good glycemic (sugar) control.
  2. GDM does respond to changes in diet and exercise in most cases. Oral hypoglycemic agents/ insulin will be required only if diet and exercise do not respond or control.
  3. Patients with GDM should have regular antenatal checkups as advised so that blood sugar can be monitored and adequate control is obtained with diet or medications if needed.
  4. A diabetic diet is to be followed and exercises including weight loss for women with BMI greater than 27.
  5. Avoid excessive weight gain
  6. Self-monitoring of blood sugar  and to maintain blood sugar profile and bring it to the doctor during every checkup.
  7. Strict fetal movement monitoring to be done and report to the doctor if fetal movement is not felt well.
  8. Evidence suggests that there is a continuous linear relationship between maternal glucose and fetal growth which can be modified by glucose lowering therapies with diet and lifestyle changes.
  9. For women needing medication, treatment started with OHA (Oral Hypoglycemic Agents) and sometimes may require Insulin therapy too.

Lifestyle Changes to Avoid Gestational Diabetes altogether

  1. To avoid excessive weight gain to maintain BMI (normal), in fact if BMI is greater than 27 weight loss is advised.
  2. To have a healthy normal diet and avoid all food rich in sugar and high complex carbohydrates/fat.
  3. Regular exercise permitted by your doctor; in particular, upper body exercises.

Credit:

Dr. Lubna Fatimah

Specialist Obstetrician Gynecologist

Thumbay Hospital

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