What is gestational diabetes? Who is at high risk for developing gestational diabetes?

Gestational Diabetes Mellitus is defined an as an ailment that is characterized by glucose intolerance with onset during pregnancy after 20 weeks of gestation. The normal value for fasting blood sugar is > 90 mg/ dl and Post meal 1 hr >140 mg/ dl & Post-meal after 2 hrs is > 160 ml/ dl. However, in women who are suffering from diabetes early in pregnancy have higher levels.

In uncomplicated cases, Oral Glucose Tolerance Test (OGTT) with 75 gm glucose is ideally advised during 22- 24 week of pregnancy. However, it should be done earlier in high-risk cases like. Gestational Diabetes Mellitus (GDM) with a previous family history of Diabetes should always opt for a Risk assessment done. A simple blood sugar test is advised to all pregnant women. They can opt for the same once a month.

Gestational Diabetes Mellitus can harm the pregnant mother and the baby adversely:

Gestational Diabetes Mellitus (GDM) is associated with wide variety of maternal disorders like hypertensive disorder and may need a cesarean delivery. It is also known to cause fetal complications and increase the risk of macrosomia, jaundice, congenital birth defect and intrauterine death. Diabetes during pregnancy needs extensive monitoring. All pregnant females should receive nutritional counseling to ensure that they keep diabetes at bay.

A healthy lifestyle & exercise during pregnancy is advised.

Targeted levels of Diabetes Management in Pregnancy:

Daily self-monitoring of glucose is a strong recommendation for maternal surveillance. This test should be done bi-monthly (if the women fall into the high-risk category) or monthly (if you don’t have any family history and are routinely checking).Assessment of growth helps in early identification of diabetes that may put the fetus at risk. Moreover, the fetus may benefit from insulin therapy.

Target maternal glucose level in pregnancy

:- < 95 mg/ dl (fasting plasma glucose)

:- < 140 mg/ dl   1 hour post pearlier

:- < 120 mg/ dl 2 hour post pearlier

Insulin is a pharmacological therapy that is mostly used to reduce fetal morbidity and  maternal hyperglycemia.

Obstetric Management for Gestational Diabetes Mellitus:

Fetal monitor by weekly fetal non – stress test (NST) is recommended to women suffering from Gestational Diabetes Mellitus (GDM). Please note that all women suffering from Gestational Diabetes Mellitus don’t have to undergo cesarean delivery. Though prolongation of gestation past 38 week increases the risk and in that case C – Section may be recommended.

Baby should be monitored for hypo glycerin & hypocalcaemia. Maternal glucose level should be assessed after 6 weeks of delivery.