Dr. Sushmita Ganguli

Gestational Diabetes Mellitus (GDM) is a medical condition that develops during pregnancy when the body finds it difficult to produce enough insulin to meet the requirements of pregnancy. Though the ailment can be temporary, it can profoundly affect both mother and child.  This condition affects about 2-10% of pregnancies. This article aims to give an overview of the condition and how to navigate the pregnancy with gestational diabetes.

Often, during pregnancy, the placenta which acts like a bridge between the baby and the mother’s blood supply, produces hormones that interfere with the insulin levels of the mother. Insulin is a hormone responsible for regulating the blood sugar levels. Eventually, it creates high blood sugar levels or hyperglycemia. Generally, this condition develops around the 24^th week of pregnancy but in a few cases, it can occur earlier too. Gestational diabetes mellitus usually resolves after the birth of the baby.

Types of GDM:

GDM is classified as A1GDM and A2GDM.

• A1GDM is a condition managed without medications and with the support of a healthy and balanced diet.
• A2GDM is managed with the support of medications.

Signs and Symptoms of GDM:

The noticeable signs and symptoms include increased thirst, frequent urination, and tiredness or fatigue.

Risk factors of GDM:

The common risk factors or determinants for gestational diabetes are listed below. It is noteworthy that the absence of certain risk factors also can lead to the development of this condition.

1. A positive family history of parents or siblings having diabetes can increase the risk of gestational diabetes.
2. Women who are overweight or have a body mass index (BMI) over 30 are more likely to develop gestational diabetes.
3. If there is a history of gestational diabetes in the first pregnancy, it emerges as a risk factor to develop again.
4. Women over 35 years of age are more susceptible to developing this condition.
5. A history of other metabolic diseases also poses a risk factor for gestational diabetes.
6. Hispanic, African American, Native American, and Asian women tend to develop gestational diabetes.
7. If the weight of the first baby is more than nine pounds, it is also a strong risk factor for this condition.

Diagnosis of GDM:

It is advised to undergo routine screening for diabetes during the prenatal care. The investigations include making a sugary solution drink by a pregnant female and checking her blood sugar levels. Based on these results, a glucose tolerance test is further conducted in the second trimester to confirm the diagnosis.

Complications of Gestational Diabetes:

This condition can have several effects on both the mother and child.

Effects on mother:

1. This condition can lead to the further development of preeclampsia during pregnancy wherein high blood pressure can damage the liver and kidneys.
2. Gestational diabetes also increases the risk of caesarean section delivery.
3. Pregnant women with a history of gestational diabetes during pregnancy, have a greater risk of developing type 2 diabetes later in life.

Effects on baby:

1. Babies born to mothers with gestational diabetes have a higher risk of developing low blood sugars after birth.
2. It can also lead to a condition called macrosomia, where the baby grows larger than average. This further leads to a complication known as shoulder dystocia where the baby’s shoulder gets stuck during delivery.
3. There is also a high risk of developing jaundice and breathing disorders such as respiratory distress syndrome in such babies.

Treatment and Management:

To ensure healthy pregnancies and deliveries, managing gestational diabetes is critical. These include the following measures:

1. Monitoring blood sugar levels is vital. The tests need to be done pre- and post-meals.
2. Checking the urine sugars for ketones is also a vital part of the treatment.
3. Healthy eating habits such as a balanced diet with adequate quantity are essential to keep blood sugar levels in check. Junk and processed food should be avoided.
4. Regular physical activities such as walking, and yoga should be encouraged.
5. Managing weight before planning pregnancy is also a preventive measure for this condition.
6. Along with the above measures, oral medications or insulin should be taken if needed, under the supervision of a healthcare professional.

With the prevalence of lifestyle factors in today’s world, gestational diabetes mellitus can be properly managed with due care and attention during the prenatal period. It plays a critical role in early detection and timely clinical intervention. With proper care and guidance, pregnant women can have healthy pregnancies and give birth to healthy babies. A healthy well-balanced diet with a routine active lifestyle is vital to manage this condition. It’s always advisable to seek medical help and discuss the concerns with a medical expert to smoothly sail through the pregnancy.

References:

1. Jovanovic L, Pettitt DJ. Gestational diabetes mellitus. Jama. 2001 Nov 28;286(20):2516-8.
2. Catalano PM. Trying to understand gestational diabetes. Diabetic Medicine. 2014 Mar;31(3):273-81.
3. Reece EA, Leguizamón G, Wiznitzer A. Gestational diabetes: the need for a common ground. The Lancet. 2009 May 23;373(9677):1789-97.