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Written By: Editorial Team | Updated : May 24, 2022 10:41 AM IST
Gestational diabetes (GDM) is a typical form of diabetes seen for the first time in pregnancy. Due to the diabetogenic stress created by pregnancy hormones, there is a huge increase in insulin resistance and the body is unable to sufficiently compensate for it despite increasing insulin secretion manifold. The pregnancy hormones reduce or block the effectiveness of the mother's own insulin, resulting in GDM. While in most cases, glucose levels come back to normal after delivery, for some women it may continue as type 2 diabetes. The International Diabetes Federation study shows that 1 in 4 live births are affected by hyperglycaemia in pregnancy and of these 83.6% are due to gestational diabetes. While GDM is growing at an equally fast pace as type 2 diabetes, it can be managed with correct treatment.
Glucose monitoring and therapy adjustments are recommended to protect against hyperglycemia related pregnancy complications. This is a critical aspect of improving the chances of a safe pregnancy and of reducing complications. According to the National Institute of Diabetes, the mother's A1C should be under 6.5 per cent before conception, and preferably under 6.0 per cent as the pregnancy progresses. While it can be overwhelming to strictly regulate glucose levels before and during pregnancy, the good news is that today, there are technological innovations that can keep the glucose levels in check.
To maintain tight glucose control, multiple pricks a day for glucose monitoring can get cumbersome. Today, sensor-based technologies in the diabetes management space have transformed diabetes care and glucose monitoring. Patients can wear a small sensor on their arm and scan and check their glucose levels multiple times a day without the need for finger pricks. They can also share real-time data with their caregiver. Such sensor-based technologies also give detailed patterns and trends of glucose variations for the entire 24 hours. This helps in making informed decisions and increasingly self aware of one's condition.
Studies have proven that CGM helps improve the health of mothers and babies through better management of maternal glucose levels. Babies of mothers who use CGM devices are also less likely to have abnormally high birth weight and severely low glucose levels after birth. This means, there are fewer admissions to newborn intensive care units and shorter infant hospital admissions.
Non- compliance with treatment is a leading factor behind poor GDM control. Lack of awareness and apathy towards consultation too plays an important role. Monitoring blood glucose levels during pregnancy is a necessity and not a choice. Pregnant women who are prone to gestational diabetes are encouraged to learn to make use of tools available and have every option of remote care available at their disposal.
Obesity, advanced age, family history of diabetes, and history of prediabetes or polycystic ovaries are the key factors. GDM can also be due to giving birth to a large baby weighing more than 3.5 kg in a prior pregnancy. Additionally, poor eating habits, lack of exercise and stress can worsen the condition. It can pose health risks for both the mother and child. If neglected, it can make the child vulnerable by being overweight at birth, create breathing problems, jaundice, low blood sugar levels, premature birth and even stillbirth. Children exposed to uncontrolled diabetes in the womb also have a greater risk of developing non-communicable diseases (NCDs) like diabetes, obesity, and hypertension in the future. GDM, therefore, is aptly labelled the mother of all non-communicable diseases as it impacts two generations. Primordial prevention of type 2 diabetes should therefore start with the prevention of GDM.
In most women, GDM can be effectively controlled with lifestyle management, exercise and proper diet. However, some women may need pharmacotherapy as advised by their doctor. Intensive blood-glucose monitoring is a very important aspect of GDM management as they need to be maintained in a very tight range all through the pregnancy. Any glucose variations especially the after-meal spikes can be detrimental to both the mother and her unborn baby.
The recommendations provided are not to be considered as a substitute for a doctor's advice. Please do consult your doctor for more information.
(The article is contributed by Dr Shalini Jaggi, Director & Diabetologist, Lifecare Diabetes Centre, New Delhi)
