- Gestational Diabetes Mellitus (GDM) is marked by impaired glucose tolerance (IGT) in pregnant women and poses risk for both the mother and the foetus.
- Long-term effects of GDM contribute to non-communicable diseases (NCD) and increases chances of Type 2 diabetes in future for both the mother and the child.
- Pregnant women with GDM to be diligently monitored for hypertension in pregnancy, proteinuria and other obstetric complications.
Prevalence of Gestational Diabetes Mellitus (GDM) that can impact the health of both the mother and the baby during and after pregnancy is rising in India and may affect every one in five pregnant women in coming years.
Expecting mothers in India suffering from Gestational Diabetes Mellitus (GDM) suffer from impaired glucose tolerance (IGT) and can even affect those women who were not diabetic before becoming pregnant. The incidence rate of GDM in India is likely to increase by 20 per cent.
“The prevalence of GDM does not need a woman to be diabetic before conception; neither it is a permanent state of ailment. However, experiencing diabetes during pregnancy poses a risk to both the mother and the child. The awareness about GDM and how it can set in, is rather poor, even among urban and educated people. As a reason, it has become a silent illness that keeps on growing in the expecting mother only to be detected at a later stage in pregnancy, when some complications arise. Women with GDM have a 70 per cent lifetime risk of developing type 2 diabetes during their lifetime as compared to a 10 per cent risk in the general population,” says Dr. Bhavana Mangal, Senior Consultant – Obstetrics and Gynaecology, Columbia Asia Hospital, Pune.
About 5 to 10 per cent of women with GDM develop type 1 Diabetes sometime in their life. These women have a slowly developing form of Type 1diabetes that is ‘unmasked’ during pregnancy. There is an immediate need to ensure that criteria are set for testing for GDM in pregnancy like family history, etc. This will help to assess the pregnancy better,” says Dr. Bhavana Mangal.
Some criteria for developing GDM can be obesity, a family history of type 2 diabetes in parent or sibling, an unexplained stillbirth or neonatal death in a previous pregnancy, a very large infant in a previous pregnancy (4.5 kg or over), gestational diabetes in previous pregnancy.
Gestational Diabetes Mellitus (GDM) paves way for maternal risks including polyhydramnios, pre-eclampsia, prolonged labour, obstructed labour, cesarean section, uterine atony, postpartum hemorrhage, infection and progression of retinopathy, which are the leading global causes of maternal morbidity and mortality. For the fetus, GDM in mother may risk spontaneous abortion, intra-uterine death, stillbirth, congenital malformation, shoulder dystocia, birth injuries, neonatal hypoglycemia and infant respiratory distress syndrome. In fact, long-term effects of GDM are important contributors to the burden of non-communicable diseases (NCD) in many countries and increases chances of Type 2 diabetes in future for both the mother and the child.
“One of the biggest reasons of GDM is our sedentary lifestyle and carbohydrate-rich food. As pregnancy changes the way hormones in female body works, the poor effects of our unhealthy lifestyle become visible. The risk increases for those who have a family history of diabetes. There are medical interventions available in form of nutritional therapy and insulin therapy but the best way certainly is to be aware of the possibility and start taking precautions beforehand,” says Dr. Bhavana.
|Remember about Gestational Diabetes Mellitus (GDM):
· The first testing for those fulfilling the criteria should be done during first antenatal contact as early as possible in pregnancy. The second testing should be done during 24-28 weeks of pregnancy if the first test is negative.
· It is important to ensure second test as many pregnant women develop blood sugar intolerance during the period of 24-28 weeks as only one-third of GDM positive women are detected during first trimester.
· If it could not be done during this time, then it can be done any time after 24 weeks of pregnancy. There should be at least 4 weeks gap between the two tests.
· Pregnant women with GDM to be diligently monitored for hypertension in pregnancy, proteinuria and other obstetric complications.
· Consult a dietician to modify diet and meet the calorific value needed for a pregnant woman depending on how active she is.
· Prefer complex carbohydrates like oats, bajra, jowar, ragi, whole pulses, vegetables and fruits with skins to simple carbohydrates like suji, refined flour, breads, pasta, noodles. Ensure at least 3 serving of protein food like milk and milk products, egg, fish, chicken, pulses (dal), nuts etc.
· Early symptoms of hypoglycemia may include tremors of hands, sweating, palpitations, hunger, easy fatigability, headache, mood changes, irritability, low attentiveness, tingling sensation around the mouth/lips or any other abnormal feeling.