With increasing burden of Diabetes in the society, there has been increase in number of cases of Diabetes Milletus in pregnancy – commonly called as Gestational Diabetes Milletus (GDM). It is defined as glucose/carbohydrate intolerance detected for the first time during pregnancy. Its incidence has been noted to be 2-15% and Indian women are said to be more susceptible.
Screening for GDM
- All pregnant women (universal screening) should be screened at their first antenatal visit.
What test should be done?
- Glucose Tolerance Test (GTT). In this test, pregnant women is asked to take 75mg of glucose with water. Three samples of blood and urine are collected – before eating glucose, one hour after eating glucose and two hours after eating glucose. No food is allowed during the test.
What if someone is diagnosed with GDM or impared glucose tolerance?
- Intially, lifestyle modification is prescribed including diet and exercise
- Diet modifications include decrease in intake of carbohydrates, sugar, fired and fatty food. Soups, sprouts and roasted grams (chana) may be taken more liberally. All “whites” to be avoided including white rice, maida, sugar, etc.
- Exercise regimen to include a 30-minute walk after each meal. Whatever exercise is adopted, it should be comfortable for the pregnant women.
- Such lifestyle changes are sincerely followed for 2 weeks and doctor should be re-visited with fasting and post breakfast blood glucose reports.
What to do if blood glucose levels continue to remain high?
- Along with lifestyle modifications, some drugs and/or injections of insulin are prescribed according to the blood glucose levels. Aim of the treatment regimen is to maintain fasting blood glucose levels <90mg/dl and 2hrs after meal <120mg/dl.
Things to remember while on insulin
- Beware of hypo (hypoglycemic) attacks
- Always keep sugar candies with you for help during hypo attacks
If you are suffering from GDM, your OBG specialist would like to see you more often during the antenatal period. There is significant risk associated with GDM during pregnancy, including:
- Polyhydramnios (more water around baby in the womb)
- Fetal malformation
- Big baby (macrosomia)
- Sudden death of the baby
- Malpresentation (wrong postion of the baby in the womb)
Post Delivery
- GTT is repeated at 6-8 weeks after delivery (post partum) and then annually.
Risk of Diabetes Milletus
- Women suffering from GDM have increased risk of developing Diabetes Milletus later in life
- Babies born to mothers with GDM also have increased risk of developing Diabetes Milletus during their lifetime.
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