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Gestational Diabetes

Introduction :

Gestational diabetes refers to a diabetes developed during the gestation period (pregnancy) which may affect the pregnancy or the health of an unborn baby. Diabetes (Diabetes mellitus)is a condition of high blood sugar caused due to either insufficient insulin production or reduced response of the body’s cells to insulin produced, or sometimes both. Overall, there are four major types of diabetes:Type 1 Diabetes, Type 2 Diabetes, Gestational Diabetes and Secondary Diabetes.

Although the physiology of gestational diabetes is similar to type II diabetes, but blood sugar usually comes down to normal after delivery. It usually develops during the second trimester of pregnancy or as early as the 20th week. It should be noted that, having had a gestational diabetes may increase the risk of getting type 2 diabetes in the future. It has been estimated that the condition may affect almost 4 percent of all pregnancies.

Symptoms :

In most of the women, gestational diabetes does not produce noticeable symptoms. Thus, it becomes necessary to screen an expected woman for the elevated blood sugar as a part of pre-natal care. It is often recommended between 24 to 28 weeks.

Causes

The reason for developing a gestational diabetes is quite unclear. But it is believed that hormones produced by a placenta of a developing baby may impair the function of insulin, causing an abnormal rise in blood sugar of a pregnant woman. Usually, the pancreas of an expecting woman produces almost three times the normal amount of insulin to get rid of adverse events from hormones produced by fetus &placenta. In the case of pancreas failure to produce enough insulin, gestational diabetes may develop.

Risk factors

Although any pregnant women can be a victim of gestational diabetes, but the existence of several factors may increase the risk. These may include :

  • Being older than 25 years, at the time of pregnancy.
  • Belonging to non-white races like Indians, or Asians.
  • Being obese (BMI>30) – BMI is “body mass index”.
  • Having diabetes running through the family and/or generations
  • Having prediabetes (slightly raised blood sugar).
  • Having had gestational diabetes in past pregnancies.
  • Having had delivered a baby weighing more than 4.1 kg (in past pregnancy).
  • Having experienced unexplained stillbirth.
  • Having a baby with some or the either birth defect
  • Having raised blood pressure

  • Complications

    Appropriate approach and early treatment often result in a healthy pregnancy and a healthy baby. However, if not managed well, it may lead to significantly elevated blood sugar, which may be an obstacle in normal delivery and often needs a C – section.

    Complications affecting the baby :

  • Abnormally excess birth weight, which may increase the risk of birth injuries or may need a C - section to deliver a baby safely.
  • Early birth (preterm delivery), much before its due date.
  • Increased risk of developing a breathing problem (respiratory distress syndrome).
  • Hypoglycemia (reduced blood sugar) may occur in the early days after a birth, which often increases the risk of seizures.
  • Increases the risk of developing type 2 diabetes in later life.
  • Increased risk of being obese in later life.
  • If not treated, gestational diabetes can lead to death of the baby, either before or soon after the birth.

  • Complications affecting a mother/pregnant woman :

  • Increased risk of developing a hypertension.
  • Increased risk of preeclampsia.
  • Increased risk of developing type 2 diabetes in the future.
  • Increased risk of developing a gestational diabetes in further pregnancies.

  • Tests and diagnosis

    The routine screening of every pregnant women is important to trace out the possible complications that may affect one’s pregnancy. A screening for gestational diabetes is often considered in the early days of pregnancy if a woman is found to be suspected based on medical and pregnancy history. Those who are at moderate risk, can be screened later in the pregnancy (during 24 to 28 weeks).

    Diagnosis of gestational diabetes may involve following tests and procedures :

  • Glucose tolerance test : To measure the response of body cells to blood glucose. This involves drinking a sugary liquid and then measuring the blood sugar after about 1 hour. If the determined blood sugar level exceeds the normal range (130 to 140 mg/dL or 7.2 to 7.8 mmol/L), a woman should be considered for the further diagnosis to confirm the gestational diabetes.
  • Follow-up glucose tolerance testing : This involves measuring blood sugar, followed by fasting overnight. Later, drinking a syrupy solution and then tracing out the blood sugar level after every hour for at least 3 hours. If 2 readings exceed the normal range, then the woman is confirmed as having gestational diabetes.

  • Treatments

    A well strategic approach to treat gestational diabetes may include :

  • Keeping a close eye on your blood sugar level throughout the pregnancy – It is recommended to check your blood glucose level at least 5 times a day.
  • Measuring blood sugar : It can be practiced with the help of anbasic device called “Blood Glucose Meter”. An appropriate time for monitoring your blood sugar level is right before breakfast and about 2 hours after meals.
  • Drugs and medications : Some women with diagnosed gestational diabetes may have to take certain medications which can control blood sugar. However, Insulin are the best for treatment of Gestational Diabtes.
  • Insulin shots :In addition to a healthy diet and optimum physical activity, one may need insulin shots to reduce blood glucose level. It has been estimated that almost 10 to 20 percent of gestational diabetes patients require insulin shots to bring down their blood sugar level to the normal range.
  • Keeping an eye on baby : A close observation of baby's growth via ultrasounds and several other tests may help to plan a treatment regimen which can prevent further consequences associated with the baby.
  • Controlling high blood pressure : High blood pressure and diabetes are closely associated with each other. Therefore, the doctor may prescribe several anti-hypertensives to control your blood pressure.

  • A good management of gestational diabetes includes several lifestyle changes as an important aspect of a successful treatment. These may include :

  • Eating healthy : Nutritious food such as vegetables, fruits, whole grains, fiber-rich foods, are healthy while avoiding sweets.
  • Exercising : It is equally important during and after the pregnancy as it lowers blood glucose, either by glucose uptake or by improving sensitivity of body cells towards insulin. Apart from this benefit, exercise offers several benefits of keeping you energetic, maintaininga healthy weight, and staying in shape. Recommended exercise may include cycling, swimming, brisk walk, gardening etc.
  • Maintaining a healthy weight.

  • Prevention:

    Although the prevention of gestational diabetes cannot be assured with any preventive measure, maintaining good health before and during the pregnancy is always better. Habits such as eating healthy food, exercising and managing a healthy weight can reduce the risk of type 2 diabetes in the future.