Understanding Gestational Diabetes:
Gestational diabetes mellitus (GDM) occurs when higher levels of pregnancy hormones interfere with the body’s ability to produce enough insulin to maintain normal blood sugar levels. If left unmanaged, this can lead to health complications during pregnancy eg pre eclampsia and increase the risk of developing diabetes later in life.
Recommended levels of blood glucose in pregnancy are
• Fasting plasma glucose under 95 mg/dL, • 1 hour postprandial under 130-140 mg/dL, and
• 2 hours postprandial below 120 mg/dL.
Women detected to have diabetes early in pregnancy receive the diagnosis of overt, non-gestational, diabetes (glucose: fasting ≥ 126 mg/dl, spontaneous ≥ 200 mg/dl or HbA1c ≥ 6.5%) before 20 weeks of gestation.
Risk Factors for Gestational Diabetes:
Several risk factors are associated with gestational diabetes, including being overweight or obese before pregnancy, having a previous history of gestational diabetes, delivering a very large baby (9 pounds or more) in a previous pregnancy, having high blood pressure, having a history of heart disease, and being diagnosed with polycystic ovary syndrome (PCOS). Testing and Diagnosis Guidelines:
The American College of Obstetricians and Gynaecologists (ACOG) recommends early testing and screening for gestational diabetes in all pregnant women. Women with identified risk factors should undergo screening for gestational diabetes between 24 and 28 weeks of gestation.
Diagnosis is typically made using an oral glucose tolerance test (OGTT), which measures blood sugar levels at specific intervals after drinking a 75g glucose solution.
The latest ACOG guidelines consider the following as indicative of gestational diabetes:
• Fasting plasma glucose levels ≥92 mg/dL,
• 1 hour plasma glucose levels ≥180 mg/dL, or 2 hour plasma glucose levels ≥153 mg/dL.
Managing Gestational Diabetes:
Proper management of gestational diabetes primarily involves lifestyle modifications, dietary changes, regular exercise, and, if necessary, medication. Here are some essential aspects to consider:
1. Dietary Changes: A diet that with reduced carbohydrates, higher lean protein, healthy fats, and ample fibre is crucial for maintaining stable blood sugar levels. Working with a qualified dietitian can help in creating an individualised meal plan. The overall caloric intake must be adequate to meet expected weight gain targets trimester wise.
2. Weight Gain: Discuss weight gain targets with your healthcare provider to ensure optimal health for both the mother and the baby.
3. Regular Physical Activity: Work with a prenatal exercise consultant who can guide you with exercises. You will need clearance from your gynaecologist before proceeding. Exercise during pregnancy
4. Medication: If lifestyle modifications and dietary changes are insufficient, insulin may be prescribed to regulate blood sugar levels.
Postpartum Care:
After childbirth, women who had gestational diabetes should monitor their blood glucose levels. Insulin resistance tends to improve following delivery, allowing for potential adjustments in medication dosage.
GDM greatly increases the risk of developing diabetes in your next pregnancy and in the future when you are no longer pregnant. One third of women who had GD will have diabetes or a milder form of elevated blood sugar soon after giving birth. Between 15 and 70 percent of women with GD will develop diabetes later in life.
A follow-up oral glucose tolerance test is recommended 4 to 12 weeks postpartum to rule out the development of type 2 diabetes.
Assessment of glucose parameters (fasting glucose, random glucose, HbA1c or optimally oGTT) are recommended every 2-3 years in case of normal glucose tolerance.
Women who have high blood pressure or preeclampsia during pregnancy also are at greater risk of heart disease and stroke later in life.
Conclusion:
Proper management of gestational diabetes is vital to ensure a healthy pregnancy for both the mother and the baby. Adhering to the latest ACOG guidelines for testing, diagnosis, and management is key.
Remember, with personalised care and guidance from healthcare professionals, women with gestational diabetes can successfully navigate their pregnancy journey and reduce the risks associated with the condition .
References: https://www.acog.org/womens-health/faqs/gestational-diabetes https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/37101032/
