Pregnant women who have never had diabetes before but have high blood glucose (sugar) level during pregnancy are said to have Gestational Diabetes.
It is a condition in which women without previously diagnosed diabetes exhibit high blood glucose levels during pregnancy (especially 3rd trimester).
Gestational diabetes (GDM) affects about 3-10% of pregnancies. After delivery about 50-60% of women with GDM are found to develop Type 2 diabetes within 10-20 years.
Gestational diabetes is caused when insulin receptors do not function properly.
This is likely due to pregnancy related factors such as Human Placenta Lactogen (HPL) that interferes with susceptible insulin receptors(insulin resistance) ,thereby increasing blood sugar.
Pregnancy itself is stressful and diabetogenic due to increased production of pregnancy hormones that are insulin antagonists e.g cortisol, placenta insulinase, estrogen, progesterone, etc.
Some identified risk factors for Gestational Diabetes includes:
Previous Gestational diabetes, impaired glucose tolerance, Impaired fasting glucose.
Family history revealing a first degree relative with type 2.
Maternal age >35yrs
Overweight, obese or being severely obese increases risk.
Previous pregnancy resulting in a child with macrosomia.
Previous poor obstetric history.
Typically, women with GDM exhibit little or NO symptoms (another good reason for universal screening) but some can demonstrate the well known diabetes symptoms such as:
increased thirst (polydipsia), increased urination (polyuria) , polyphagia, fatigue , nausea, vomiting etc.
Some also have urinary tract infections, history of repeated abortions, stillbirth(s), or delivery of oversized babies.
How Gestational Diabetes Affects You And Your Baby.
GDM poses a significant risk to mother and child. This risk is largely related to uncontrolled high blood glucose levels and its consequences.
Prompt recognition and care results in better control of these sugar levels and will reduce some of the risks considerably.
Abortions, polyhydramnios-due to large placenta, fetal size and its sequelae.
Macrosomia (fetal weight>4kg), which in turn increase risk of instrumental deliveries (forceps,ventouse) or problems during vagina delivery(shoulder dystocia).
Intrauterine fetal death in the last 4wks due to ketosis, hypoglycemia, placenta insufficiency.
Neonatal morbidity and mortality due to respiratory distress syndrome, jaundice, hypoglycaemia,hyperviscosity,hypocalcemia.
Pregnancy induced hypertension,Urinary tract infections and puerperal sepsis,obstructed labour,deficient lactation.
How can Gestational Diabetes be managed?
SIMPLY CONTROL YOUR BLOOD SUGAR
This can be achieved by using special meal plans (diabetic diet), scheduled physical activities (Exercise).
Dietary modifications are extremely important as a total of 1800calories/day and restriction of carbohydrate to 200g/day with less fat, more proteins and vitamins is advised.
Carbohydrate intake should be limited in the morning because of high blood glucose levels between 3-9am resulting from diurnal variant in plasma cortisol and glucagon levels.
Though,there are individual variations, endeavor to discuss your meal plan with your dietician and endocrinologist who will prescribe the appropriate insulin regimen.
The goal of treatment is to reduce blood sugar within normal limits thereby improving perinatal outcomes.
Frequent antenatal visits and foetal monitoring is strongly advised.
You don’t have to lose that pregnancy or suffer morbidities, though it might be true that after child birth you are free of gestational diabetes but while you still carry that baby———CONTROL YOUR DIABETES !!!
It is generally advisable that all pregnant women be screened for gestational diabetes at health facilities.
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