text: Pregnancy is a period of transition with important physical and emotional changes. This is principally a phenomenon of maternal adaptation to the increasing demands of growing foetus. Improper prenatal care may lead to some serious medical surgical complications like hypertension, diabetes, heart diseases, anaemia during pregnancy which can adversely affect the maternal and foetal wellbeing. Among those, Gestational Diabetes is the most common.
  The prevalence of gestational diabetes mellitus is increasing alarmingly in India. It is estimated that about 4 million pregnant women are affected with GDM in India. The DIPSI (Diabetes in Pregnancy Societies in India) has declared March 10 as GDM Day. This is for the first time ever that any country is declaring the GDM Day in the world to raise awareness about the link between maternal health and diabetes nationwide.
  What is GDM?
  Gestational diabetes mellitus (GDM) is a condition in which women without previously diagnosed diabetes exhibit high blood glucose levels during pregnancy. In other words, pregnant women who have never had diabetes before, but who have high blood glucose levels (more than 140 mg/dl) during pregnancy are said to have gestational diabetes.
  Gestational Diabetes is the most common medical disorder in pregnancy which can be defined as carbohydrate intolerance of variable severity with onset or first recognition during the present pregnancy irrespective of the fact that the condition persists after pregnancy or not. The condition may arise late in the second trimester or during the third trimester, but GDM can have devastating consequences for mother and baby if it is Left untreated.
  Why would it start when pregnant?
  Although there is no single cause of GDM, it can be largely attributed to pregnancy hormones. During pregnancy, certain level of hormonal changes occurs in a woman’s body. There is a surge of oestrogen, progesterone, cortisol. It is the accessory function of this hormone that leads to increase level of blood glucose.
  Pregnancy is a state of chronic low grade inflammation resulting in increased level of C- reactive protein (CRP) and interleukin- 6 which leads to insulin resistance. The pancreatic beta cells secrete a hormone called insulin which breaks down the glucose from food and delivers it to our cells. Insulin helps to keep the level of glucose in blood at a healthy level. But in case of insulin deficiency or diminished sensitivity to tissue, sugar builds up in the blood and leads to diabetes.
  Who are the potential candidates for GDM?
  Gestational diabetes can develop in any woman who is pregnant. But women over the age of 30 who are from ethnic group of East Asian, Pacific Island are at a higher risk.
  Other factors that may increase the chances of GDM include:
  Positive family history
  Having previous overweight baby (4 Kg)
  Obesity
  Previous stillbirth
  Presence of polyhydramnios
  How Gestational diabetes can be clinically manifested?
  Gestational diabetes generally has few symptoms and it is most commonly diagnosed by screening during pregnancy. But in some cases few symptoms may be present like frequent urination, nausea, thirst, excessive tiredness.
  What is the Screening test employed for GDM?
  Routine screening of blood glucose are done to all pregnant mothers but the potential candidates of GDM are undergone with Oral Glucose Tolerance Test (OGTT) -blood test which measures blood sugar levels 2 hour after drinking 75 g syrupy glucose solution (As per WHO and DIPSI recommendation). If the sugar level is higher than 140 mg/dL, 3 consecutive tests are done to confirm the diagnosis. If at least 2 of the blood sugar readings are higher than the normal values, the diagnosis of gestational diabetes will be confirmed.
  How can pregnancy diabetes be managed?
  Most women with gestational diabetes respond well to lifestyle therapy wherein a healthy diet plays a major role. Proper meal planning, portion control, wholesome snacking, eating regularly every two hours, spacing-out carbohydrates-rich food, monitoring protein intake and including healthy fats can help in managing gestational diabetes.
  For many women with gestational diabetes, insulin is used as a standard treatment where solely lifestyle therapy does not help in achieving the healthy blood sugar levels. Insulin is safe to use during pregnancy and does not cause any harm to the foetus. In cases oral hypoglycaemic agent (metformin) is also used along with insulin.
  In addition to this, it is advised to aim for 30 minutes of moderate exercise on most days of the week after the doctor’s consultation.
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