Gestational diabetes

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Pregnant women who were not diabetic before but who have high blood sugar levels during pregnancy are said to have gestational diabetes (GD). Normally, the disease affects women quite late in her pregnancy, around the 24^th week. The disease does not show noticeable signs or symptoms. In some cases however, gestational diabetes may cause excessive thirst or increased urination.

32 million people are living with diabetes in India, and more than 16 percent of pregnant Indian women have gestational diabetes. And the prevalence percentage of gestational diabetes mellitus (GDM) is increasing rapidly. According to a study published in the Journal of the Association of Physicians of India, an overall prevalence of GDM in their study area is about 17% in Chennai, 15% in Trivandrum, 21% in Alwaye, 12% in Bangalore, 18.8% in Erode and 17.5% in Ludhiana. The study also indicated that Indian women have high prevalence of diabetes and their relative risk of developing GDM is 11.3 times compared to white women. Further, Asian women are ethnically more prone to develop glucose intolerance compared to other ethnic groups.

It has also been seen that pregnant women in the age group of 30 to 39 years had greater prevalence of GDM as compared with those in the age group of 20 to 29 years. Considering all these facts, the researchers suggest screening all pregnant women for glucose intolerance.

Causes

Scientists are not sure what causes gestational diabetes (GD) but the most likely theory is that hormones from the placenta may be responsible for the same. The placental hormones help the baby develop but they may also block the action of mother’s insulin in her body. This causes insulin resistance. Since the body cannot make and use the insulin required for pregnancy, high levels of glucose build up in the blood and cause gestational diabetes.

Risk Factors

Knowing the risk factors for GDM can help you to incorporate early intervention measures.

• Women who have a history of infertility have an increased risk of developing GDM.


• Studies have found that low socioeconomic status women in India are at an increased risk for gestational diabetes.


• Women with irregular menstrual cycles are more prone to gestational diabetes.


• Overweight and obese Indian women are more prone to develop GDM say researchers at Sree Chitra Tirunal Institute for Medical Sciences, Thiruvananthapuram.


• Increased BMI and insulin resistance is also linked to polycystic ovary syndrome (PCOS), especially in Indian subcontinent Asian women and is a predictor for GDM.


• Family history of diabetes in first-degree relatives from the mother’s side of the family is significantly associated with a risk of GDM, besides, subsequently developing type-2 diabetes later on in life.


• History of UTI (urinary tract infection) and history of moniliasis (an infection caused by fungi of the genus Monilia or Candida) are also associated with GDM.


• Polyhydramnios, another risk factor for GDM, is a condition in which an excess of amniotic fluid builds up in the amniotic sac. It is typically diagnosed when the amniotic fluid index (AFI) is greater than 24 cm. 

Diagnosis

Oral glucose tolerance test (OGTT) measures the body’s ability to use glucose and it is the normal procedure to diagnose GDM. The World Health Organization (WHO) proposes using a 2-hour 75g OGTT, with a threshold plasma glucose concentration of greater than 7.8 mmol* /L (140 mg/ dL) at 120 minutes as screening for gestational diabetes.

*Millimole

The procedure is simple and cost effective, but the disadvantage is that the pregnant woman has to come in the fasting state to undergo the OGTT. So, Diabetes in Pregnancy Study Group India (DIPSI) came out with a modified version of WHO OGTT wherein pregnant women are given 75 g oral glucose load irrespective of their last meal timing and 2-hour plasma glucose greater than or equal to 7.8 mmol/L (140 mg /dL) is diagnosed as GDM.

This is because after a meal, a non-GDM woman would be able to maintain normal glucose levels despite glucose challenge due to brisk and adequate insulin response. Whereas, in a woman with GDM who has impaired insulin secretion, glucose levels increases with a meal and with further glucose load, plasma glucose levels will rise further.

Treatment

Due to high prevalence of GDM in India, it is necessary to closely monitor and control blood sugar when you are pregnant and in the risk category.  The Diabetes in Pregnancy Study Group India (DIPSI) lays down the following guidelines to manage GDM –

1. Know the implications of GDM for your baby and yourself. Learn how to monitor blood glucose yourself. It may be inconvenient to always seek professional help.


2. Reduce stress and anxiety. Develop techniques to cope with denial and anxiety issues. If necessary seek professional help.


3. You need to intake adequate calories and nutrients to meet the needs of pregnancy. The expected weight gain during pregnancy is 300 to 400 gm/week and total weight gain is 10 to 12 kg by term. Avoid excess weight gain and post prandial hyperglycemia (increase in blood sugar levels after meals). Your calorie requirement is 30 to 40 calorie per kilogram of your ideal body weight.


4. Distribute your calorie consumption especially the breakfast. It is best if you split the usual breakfast into two equal halves and consuming the portions with a two hour gap in between.

Complications

Although GD does not cause birth defects the way diabetes (mothers who had diabetes before pregnancy) does, it still can hurt the baby. Since it occurs in the later stages of pregnancy, the body of the baby is already formed but the baby is still growing and developing.

What happens is, the blood sugar (glucose) levels are high in the mother with gestational diabetes and this blood glucose goes through the placenta and into the baby’s blood. Now, the pancreas in the baby begins to produce more insulin so as to process the extra glucose and convert it to energy. The baby thus gets more energy than is required for growth and development. The extra energy is then stored as fat leading to ‘macrosomia’ or fat baby and causing health problems such as –

• Damage to their shoulders during birth


• Very low blood sugar levels at birth because of extra insulin produced by the baby’s pancreas


• Higher risk of breathing problems


• Higher risk for obesity (because of excess insulin production)


• Higher risk for type-2 diabetes as adults (because of obesity and excess insulin)

Prevention

Know that, nothing you had done triggered the onset of gestational diabetes for you. But what you can do is avoid potential complications by monitoring your blood sugar and modifying your diet accordingly.

It is a common belief in India that eating eggs, pineapples and few other fruits can cause abortion. But it’s very far from true! Ripe fruits and vegetables in moderate quantities should be essential part of your diet. And egg is a very rich in protein and other essential nutrients, and if your doctor does not say ‘no’ to it, go ahead and make it a part of your diet.

And of course, most pregnant Indian women know how they are cajoled into eating a lot of carbs because ‘you need to eat for two’. That’s a potentially dangerous habit during pregnancy. You need only 300 calories extra for carrying the baby. Excess carb intake will only result in extra glucose in your blood leading to blood sugar and insulin sensitivity problems.

In the same way, you might want to avoid consuming lot of ‘ghee’ because it is an unsaturated fat and it does not serve any other purpose other than making you overweight or fat. And being fat or overweight is one of the significant risk factors of gestational diabetes.

Along with nutrition therapy and / or insulin therapy it is also necessary to get regular physical exercise. Your well wishers and relatives may advise you to restrict your physical activities to the minimum so as not to hurt the baby inside. But for sure, it is a myth. Regular physical activity helps lower your blood sugar by moving the glucose into your cells and also by increasing your sensitivity to insulin. Aim for moderately vigorous exercise on most days of the week, but first check with your doctor.

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