Any degree of glucose intolerance that manifests during pregnancy is referred to as gestational diabetes mellitus. Complications for both the mother and foetus are avoided by early detection and treatment. The estimated rate of GDM in India is 10-14.3%, which is significantly greater than the rate in the west.
Pregnancy is characterised by increased insulin levels and resistance to insulin action. In the early stages of pregnancy, euglycemia is maintained by the increase in insulin secretion and sensitivity. As the pregnancy advances, various hormone effects peaks and causes increased insulin resistance.
Risk factors for GDM:
- Diabetes in first degree relative
- History of glucose intolerance in previous pregnancy
- Previous infant with birth weight more than 4kg.
Screening for diabetes in high risk cases should be done as early as first antenatal visit. If negative, screening should be repeated at 24-28 weeks of gestation. Screening tests vary depending on health care provider but generally includes- oral glucose challenge test and glycated hemoglobin levels.
All pregnant females with GDM are advised diet modifications (medical nutrition therapy), moderate level physical activity ± insulin/oral anti diabetic medications.
DO’S and DON’TS:
- Adhere to the gestational diabetes diet, which calls for three meals and two to three snacks each day. Complex carbohydrates are found in whole grains such oats, bajra, jowar, and ragi as well as entire legumes, vegetables, and fruits with skin.
- Avoid simple carbohydrates with high glycemic load like foods with added sugars, honey, foods prepared from refined white flour, sweets, cakes, puddings, sweet biscuits, pastry, juice, soft drinks, chips, white bread, naan, pizza etc.
- Saturated fat intake should be less than 10% of total calories. Sources include ghee, butter, coconut oil, palm oil, red meat, organ meat, full cream milk etc.
- Avoid frying of foods, use low fat dairy products in place of whole milk or full cream products.
- Protein requirement in pregnancy is increased and include at least 3 servings of protein foods in a day. Sources include milk, milk products, egg, fish, chickn, pulses , nuts etc.
- High fiber foods help control blood sugar by delaying gastric emptying. Sources include flax seed, psyllium husk, oat bran, legumes, root vegetables (carrots) etc.
- Perform regular physical activity: moderate level physical activity improves glycemic control and reduction in the need for pharmacologic therapy. However, refrain from strenuous physical activity. Exercise of at least 20-30 minutes duration/day is needed.
- Regular blood sugar monitoring: monitor your blood sugar levels as advised by your endocrinologist using point of care glucometers. Glycemic targets defined are as follows: fasting glucose 80-95mg/dl, one hour post prandial glucose <140mg/dl, 2 hour post prandial glucose 100-120mg/dl.
- Take anti diabetic medications as advised: Insulin is the first line agent recommended for treatment of GDM. Metformin can be considered after first trimester of pregnancy. Insulin can be started any time during pregnancy if MNT and exercise have failed. If insulin is required in high doses, metformin is added. Common side effects that occur with metformin use includes: diarrhea, nausea, stomach pain, heart burn.
- Avoid hypoglycemia: Take diabetic diet as advised and make necessary adjustments in anti-diabetic medications as needed with the help of your health care provider to avoid hypoglycemia. Keep glucose powder/ sugar/jaggery handy to treat hypoglycemia if it occurs.
- Visit your health care provider regularly: Monitoring of fetal growth with regular antenatal scans as advised for any abnormal fetal growth.
- Sleep well and do not fret too much over glucose targets.
- Preparation for labour and delivery: GDM pregnancies are associated with delay in lung maturity of the fetus and may require steroid injections as advised by your health care provider. In hospital glycemic management may be necessary on individual basis. Close monitoring of blood sugars and optimal glycemic management with intravenous fluids± insulin infusion during labour and delivery is important.
- Follow up for diabetic risk assessment: Visit your Endocrinologist post-delivery as glucose levels return to normal and will need change in anti-diabetic medications. At 4-12 weeks post-partum, diabetes risk assessment is done using oral glucose challenge test and treated accordingly.
- Get lifelong regular screening for the development of type 2 diabetes or pre-diabetes every 1–3 years.
Views expressed above are the author’s own.
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