Gestational Diabetes

May 15, 2019

Gestational Diabetes is high Blood Sugar that develops during pregnancy and usually disappears after giving birth. Diabetes in pregnancy includes pregnancy in both pre-existing Diabetes (pregestational diabetes) and gestational diabetes mellitus (GDM), which is diagnosed in pregnancy. Both situations are associated with maternal and foetal complications if not treated adequately. GDM is a severe and neglected threat to maternal child health. Poor maternal glucose control during the first eight weeks of pregnancy with subsequent hyperglycaemias and lipid peroxidation can have severe implications for the foetus, including birth defects.

Causes of Gestational Diabetes –

During pregnancy, the placenta makes hormones that can lead to a buildup of glucose in your blood. Usually, your pancreas can make enough insulin to handle that. If not, your blood sugar levels will rise and can cause gestational diabetes.

• Were overweight before you got pregnant
• Are African-American, Asian, Hispanic, or Native American
• Have high blood sugar levels, but not high enough to be diabetes
• Have a family history of diabetes
• Have had gestational diabetes before
• Have high blood pressure or other medical complications
• Have given birth to a large baby before (greater than 9 pounds)
• Have given birth to a baby that was stillborn or had certain birth defects

Risks and Challenges –

Risks faced by pregnant diabetic women –
• Hypoglycaemia
• Spontaneous abortion
• Premature or Obstructed labour
• Polyhydramnios
• Microvascular complications, e.g. Nephropathy
• Pregnancy-induced hypertension
• Maternal infections
• Increased chance of diabetic ketoacidosis

Challenges to self-care –
• Feeling of hopelessness
• Lack of self-understanding
• Suppressed joy
• Fear of untoward outcome
• Difficulty with self-monitoring of blood glucose (SMBG)
• Poor interpretation of insulin requirement
• Lack of proper diabetes education
• Lack of Motivation

Treatment of Gestational Diabetes

Gestational diabetes usually happens in the second half of pregnancy. Your doctor will check to see if you have gestational diabetes between weeks 24 and 28 of your pregnancy. Your doctor may test sooner if you’re at high risk. 

To test for gestational diabetes, you will quickly drink a sugary drink. This will raise your blood sugar levels. An hour later, you’ll take a blood test to see how your body handled all that sugar. If the results show that your blood sugar is higher than a certain cutoff (anywhere from 130 milligrams per deciliter [mg/dL] or higher), you will need more tests. This means testing your blood sugar while fasting and a longer glucose test that will be done over a 3-hour period.

If your results are normal but you have a high risk of getting gestational diabetes, you may need a follow-up test later in your pregnancy to make sure you still don’t have it.

Prevalence of Diabetes in pregnancy

• Varies widely depending upon the region of the country, dietary habits, and socio-economic status
• International Diabetes Federation (IDF) estimated that 16.8% of live births were affected by some form of hyperglycaemia in pregnancy in the year 2013; in India alone, out of 6 million cases, 90% cases were due to GDM
• The Global prevalence of hyperglycaemia in pregnancy in women (20-49 years) is 16.9% worldwide
• More than  90% of cases occur in low- and middle-income countries
• In India, Diabetes in pregnancy account for 2.4 to 21% of all the pregnancies due to wide differences in living conditions, socio-economic levels and dietary habits