Diabetes Mellitus which is spreading in ‘pandemic’ proportions across the globe has amplified the prevalence of gestational diabetes mellitus (GDM), which is defined as diabetes occurring with the onset or first recognized during pregnancy. Global figures show an annual increase of 12%, with its prevalence in pregnancy doubling in the last eight years.
It is important to diagnose and treat GDM in pregnancy due to its adverse effects chiefly on the baby. These include miscarriages, birth defects, large babies leading to difficulties at birth and childhood obesity in later life and even the unexplained death of the baby. The mother too may experience frequent urinary and vaginal infections and may develop high blood pressure.
All women awaiting conception should have their blood sugar profile checked, preferably with an Oral Glucose Tolerance Test (OGTT), which involves repetitive blood sugar estimations after ingestion of a measured amount of glucose. Blood sugar levels must be optimally controlled and the mother-to- be should be on daily folic acid medication three months prior to conception.
If already pregnant, mothers in the ‘high-risk group’ should undergo this test immediately. These include mothers over the age of 35, those who are obese, have a family history of diabetes, have delivered heavy babies earlier and those whose previous pregnancy has ended with the death of the baby due to unexplained reasons. All other pregnant women should undergo an OGTT, preferably around the sixth month of their pregnancy.
Recent literature reviews indicate that up to 19% of pregnant women may have blood sugar levels higher than those recommended for optimal control.
The foundation of treatment for all patients is adherence to dietary control with the percentage of starchy foods trimmed down to less than 40% of the daily intake. However, over 50% of women will require medication when diet alone fails to reduce glucose levels. Insulin has long been the mainstay of drug therapy, which is self-administered two or three times a day, using the patient-friendly ‘pen-injectors’. This inconvenience of daily injections has been overcome in recent times, especially in the western world, with oral medications.
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| Image courtesy pre-diabetes.com |
Optimum blood sugar control should be maintained during the entire pregnancy and as there is variability in the blood sugar levels checked by the glucometer, this is best done by checking the venous blood in a laboratory.
As the baby may experience breathing difficulties and other complications at birth, delivery is best undertaken in a hospital where resuscitatory facilities are readily available. Breast-feeding should commence soon after birth. The commonly used oral anti-diabetic drugs are found to be compatible with breast-feeding.
An OGTT should be performed on the mother six weeks after delivery to check for the persistence of diabetes. If found to be an established diabetic, she should seek medical treatment life-long. As mothers with GDM have a 7.5 times higher risk of developing established diabetes later in life too, it is recommended that they undergo an OGTT each year, even when the test after delivery is found to be normal.
The promotion of a combination of breastfeeding, lifestyle changes with increased physical activity, weight loss and a healthy diet could significantly reduce the maternal risk of diabetes later in life.
A growing body of literature now supports a relationship between maternal high blood sugar levels and the risk of childhood obesity. The 20% reported incidence of high blood sugar levels in children, by the age of 16 years, born to these mothers , remains a matter of grave concern .
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