What is gestational diabetes mellitus, its causes, symptoms and treatment
Gestational diabetes is a common problem faced by many women during pregnancy, where they develop a resistance to insulin and have high blood sugar during pregnancy. It tends to occur around the 24th week of pregnancy, and becomes normal after the pregnancy is over.
Why it happens
“The condition arises because the action of insulin is blocked, probably by hormones produced by placenta (an organ that connects the developing baby to the wall of the uterus and provides nutrition),” says Dr Roshani Gadge, Diabetologist consultant, GadgeDiabetes Centre, Mumbai.
The symptoms may vary from excessive weight gain to frequent urination, excessive thirst, fatigue, and mood swings. However, these symptoms are not specific to gestational diabetics and are also common for non-diabetic mothers. “The most common cause is obesity and overeating, but these women already may be pre-diabetic, and the stress of pregnancy unmasks the condition,” says Dr Anil Bhoraskar, senior diabetologist, SL Raheja Hospital, Mumbai.
Because of the confusing nature of the symptoms, screening tests are the best way to detect it. “Most pregnant women are tested between the 24th and 28th weeks of pregnancy,” says Dr Gadge.
As a precautionary measure, Dr Bhoraskar recommends that women who desire to become pregnant should undergo a complete evaluation of their heath, be it blood pressure levels, lipids, and waist circumference to rule out pre-diabetes. “If you are pre-diabetic, you need special attention. You should alter your diet plan to incorporate heathy options and increase physical fitness,” he says.
How to treat it
The treatment options for gestational diabetes include regular monitoring of blood sugar at specific times or after a meal with a glucometer, ensuring blood sugar levels are strictly within specified limits with help of a well-balanced diet (should include proteins, minerals, vitamins, Omega 3 fats, and folates). Regular exercise can also help to control glucose levels.
“Initially, blood sugar can be controlled only with Metformin and no other oral agents. Later on, insulin is to be administered as required, which may be around 4-5 times a day,” says Dr Bhoraskar. As the pregnancy progresses, insulin requirements may change and insulin doses may need to be re-adjusted.
Gestational diabetes usually develops later in the pregnancy, so the immediate risk to the baby is not as severe as for those whose mother had diabetes before pregnancy (pre-gestational diabetes). But uncontrolled gestational diabetes can have serious consequences for both the mother and the baby.
Poorly managed glucose during pregnancy can lead to a significantly larger-than-average baby (foetal macrosomia), which makes normal birth difficult and risky. “The newborn remains at risk for shoulder injury and breathing problems. There also exists the risk of pre-eclampsia, a condition where high blood pressure threatens the health (and is some cases the life) of the mother and her baby,” says Dr Gadge.
While gestational diabetes in mothers normally disappears after birth, it can increase the risk of developing Type-2 diabetes in later years. “Almost 20% of patients with gestational diabetes mellitus develop Type-2 diabetes mellitus, and all the complications of vascular disease,” says Dr Bhoraskar.
Babies born to mothers with gestational diabetes also have a higher lifetime risk of obesity and developing type 2 diabetes, if they lead a sedentary lifestyle, explains Dr Gadge.
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