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Understanding Gestational Diabetes: Causes, Management, and Implications

Gestational diabetes mellitus (GDM) is a condition characterized by high blood sugar levels that develop during pregnancy, typically around the 24th to 28th week. While it can pose risks to both the mother and the baby, proper management can lead to healthy outcomes for both parties. This blog will explore the causes, symptoms, management strategies, and potential implications of gestational diabetes.

What causes gestational diabetes mellitus?

Although the cause of GDM is not known, there are some theories as to why the condition occurs.

The placenta supplies a growing fetus with nutrients and water, and also produces a variety of hormones to maintain the pregnancy. Some of these hormones (estrogen, cortisol, and human placental lactogen) can have a blocking effect on insulin. This is called contra-insulin effect, which usually begins about 20 to 24 weeks into the pregnancy.

As the placenta grows, more of these hormones are produced, and the risk of insulin resistance becomes greater. Normally, the pancreas is able to make additional insulin to overcome insulin resistance, but when the production of insulin is not enough to overcome the effect of the placental hormones, gestational diabetes results.

What Causes Gestational Diabetes?

Obesity

Family History

Age: Women over 25 years old are at higher risk.

Previous GDM

Ethnicity: African American, Hispanic, Native American, and Asian American women have a higher risk.

Polycystic ovary syndrome (PCOS)

Symptoms of Gestational Diabetes

Often, gestational diabetes does not present noticeable symptoms; many women discover they have it during routine screening tests. However, some potential signs may include:

  • Increased thirst
  • Frequent urination
  • Increased hunger

These symptoms can easily be attributed to normal pregnancy changes, which is why regular screening is essential.

Effects of Diabetes on mother

During Pregnancy

  • Spontaneous Abortion
  • Preterm Labour
  • Infections
  • Pre-eclampsia
  • Polyhydrominos
  • Maternal Distress
  • Diabetic retinopathy
  • Diabetic nephropathy
  • Diabetic neuropathy
  • Coronary artery disease
  • Ketoacidosis
  • UTI

During Labour

  • Prolonged labour
  • Shoulder Dystocia
  • Perineal injuries
  • PPH
  • Operative interference
  • Uterine inertia

Pueperium

  • Pueperal sepsis
  • Lactation failure
  • Subinvolution

Long Term

  • Type 2 Diabetes (50% chances)
  • Renal and Cardiovscular disorder

Effects of Diabetes on fetus

  • Fetal Macrosomia
  • Growth Restrictions
  • Congenital Anomalies
  • Chemical Imbalance After birth
  • Sudden fetel demise
  • Chronic Fetel Hypoxia
  • RDS
  • Long term Sequele

Managing Gestational Diabetes

Management of gestational diabetes focuses on maintaining blood sugar levels within target ranges through lifestyle modifications and, if necessary, medication. Here are key strategies:

Management of Pregnant Women with GDM

MNT (MEDICAL NUTRITION THERAPY)

The total calorie requirement 40% carbohydrate, 20% protein and 40% fats (mainly unsaturated fats)

CARBOHYDRATES

  • Essential for a healthy diet of mother and baby.
  • Spread carbohydrate foods over 3 small meals and 2-3 snacks/day.
  • Complex carbohydrates preferred over simple carbohydrates.
  • oats, bajra, ragi, jowar, whole pulses, vegetables & fruits with skin

FATS

  • Saturated fat(ghee, coconut oil, butter) intake less than 10% of total calories
  • Dietary cholesterol less than 300 mg/dL.
  • In obese – lower-fat diet slows the rate of weight gain.

PROTEINS

  • Requirement is increased (additional 23 g/day) for fetal growth.
  • At least 3 serving of protein foods are required every day.
  • Egg, fish, chicken, pulses, milk

FIBRES

  • Help control blood sugar by
  1. Delaying gastric emptying
  2. Retarding glucose entry into blood stream
  3. Reducing PP rise in blood sugar.
  • flax seed, bran, milk, legumes, pectins, psyllium

Physical Activity

Regular physical activity helps regulate blood sugar levels. Aim for at least 30 minutes of moderate exercise most days of the week. Activities such as walking, swimming, or prenatal yoga can be beneficial.

INSULIN THERAPY

  • First line all to ACOG & MOFHW
  • Gold standard in the treatment of GDM and pregestational diabetes

 

OHA’S

Drugs used are

Injection site

  1. Front & lateral aspect of thighs & abdomen
  2. Lateral aspect of arms
  3. Given subcutaneously

Monitoring Blood Sugar Levels

  • Regular monitoring of blood glucose levels is essential. Most healthcare providers recommend testing:
  • Before meals: less than 95 mg/dL
  • One hour after meals: less than 140 mg/dL
  • Two hours after meals: less than 120 mg/dL
  • Keeping track of these readings helps in adjusting dietary and activity plans as needed.

OHAs

  1. Glyburide (sulphonylurea group)
  2. Metformin (biguanide)

Both the drugs cross the placenta. However, no teratogenic effect has been observed as yet

  1. METFORMIN
  • MOA-peripheral insulin sensitivity, counteracting insulin resistance
  • Use after 20 wks of gestation in GDM DOSE-500 mg BD, maximum-2gm/day
  • Use if benefit outweighs potential risks (NICE)

Advantages

  1. Reduction in insulin dose (MIG TRIAL)
  2. Less hypoglcemia
  3. Reduction in total weight gain (MIG TRIAL)
  4. Complaince

No difference in perinatal outcome compared to insulin 

  1. GLYBURIDE
  2. MOA- Insulin secretion, induce better insulin sensitivity and suppress production of hepatric glucose.
  3. Dose-5-10 mg BD 2.5 mg/day – upto 20mg
  4. No added advantage over insulin

WHEN TO DELIVER (ACOG 2017)

  • CONTROLLED ON DIET ≥39weeks -expectant management upto 40+6weeks
  • CONTROLLED ON MEDICATION-deliver at 39 weeks to 39+6weeks
  • POORLY CONTROLLED-delivery between 37weeks and 38 +6weeks -delivery between 34 weeks and 36+6weeks if-
  1. failure of in- hospital glycemic control.
  2. abnormal fetal testing

Conclusion

Gestational diabetes is a manageable condition that requires proactive monitoring and lifestyle adjustments. By adhering to a healthy diet, engaging in regular physical activity, and following medical advice, women with gestational diabetes can ensure their health and that of their babies. Continuous education and support from healthcare providers play a vital role in navigating this condition effectively.

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