GestationalDiabetes

• Gestational Diabetes 

Gestational diabetes mellitus (sometimes referred to as GDM) is a form of diabetes that occurs during pregnancy  It is diagnosed when higher than normal blood glucose levels first appear during pregnancy. Women who have risk factors for gestational diabetes should be tested earlier in their pregnancy 

Causes of gestational diabetes:

Insulin resistance rises as pregnancy progresses and under normal circumstances. This is countered by increasing Insulin production from pancreatic beta cells 

Women with gestational diabetes inherently have a great degree of Insulin resistance compared to women without gestational diabetes and thus, coupled with reduced beta cell capacity to produce the required insulin response, leads to maternal hyperglycemia 

Normal pregnancy is a state of Insulin resistance:

Pregnancy can be associated with many metabolic, biochemical, physiological, hematological and immunological changes. With no complications at full term, these changes are reversible after delivery. Healthy women pregnancy can be associated with resistance to the action of Insulin on glucose uptake and utilization. Insulin resistance is defined as decreased ability of target tissues such as liver, adipose tissue and muscle to respond to normal circulating concentrations of Insulin 

It is reported that pregnant women require an additional energy of 300 kcal/day over routine energy intake while the average glucose utilized by a growing fetus at the 3rd trimester reaches approximately to 33 μmol/kg/min. Maternal Insulin resistance leads to more use of fats than carbohydrates for energy by mother and spares carbohydrates for fetus. Thus, the development of Insulin resistance serves as a physiological adaptation of the mother to ensure adequate carbohydrate supply for the rapidly growing fetus

Increased Insulin resistance is also associated with occurrence of premature labour, antepartum or postpartum hemorrhage and fetal complications like intrauterine growth restriction or fetal overgrowth and prematurity. Presence of Insulin resistance also increases risk of development of metabolic syndrome, diabetes mellitus, hypertension, hyperlipidemia, and cardiovascular disorders later in life (Sonagra et al., 2014).

Screening for Insulin resistance can be advised to all pregnant women. Insulin sensitivity can be improved in these women by modifying diet, lifestyle, amount and type of physical activity. Balanced diet providing required quantity of macro and micro nutrients with good amount of dietary fibers can be prescribed. Avoidance of sedentary lifestyle and increasing amount of activity should be advised before, during and after pregnancy. Mild exercises such as walking and climbing stairs, can be advised for women with increased Insulin resistance during pregnancy. Such intervention should be done at an early stage well before the Insulin resistance related complication develops

Risk factors of gestational diabetes

·        Pregnant women aged 40 years or over.

·        Pregnant women have a family history of type 2 diabetes or a first-degree relative (mother or sister) who has had gestational diabetes.

·        Pregnant women above the healthy weight range.

·        Pregnant women have had elevated blood glucose levels in the past pregnancy.

·        Pregnant women have had gestational diabetes during previous pregnancies

·        Pregnant women previously had Polycystic Ovary Syndrome

·        Pregnant women had previously given birth to a large baby (weighing more than 4.5kg).

·        Pregnant women are taking some types of anti-psychotic or steroid medications.

·        Pregnant women have gained weight too rapidly in the first half of pregnancy.

·        Gestational diabetes may also occur in women with no known risk factors.

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