Gestational diabetes on the rise

Gestational diabetes on the rise

An increasing concern among experts in the city, gestational diabetes has seen a distinct rise in numbers in recent times.

What is Gestational diabetes?

Gynaecologist Dr Suman Bijlani says that Gestational Diabetes Mellitus (GDM) is a condition wherein diabetes is recognised for the first time during pregnancy. "Very simply, this means that a previously non diabetic woman develops high blood sugar levels in pregnancy. It usually starts in the second half of pregnancy, after about 24 weeks. Pregnancy hormones cause insulin resistance, thus glucose is utilised less effectively and excess glucose reflects in blood sugars and also leaks in urine. Most obstetricians screen all pregnant women between 24 and 28 weeks to detect gestational diabetes early," says Dr Bijlani.

Physician endocrinologist and diabetologist, Dr Deepak Chaturvedi says that human pregnancy is characterised by Increased Insulin Resistance, which helps ensure a steady glucose supply to the foetus. "Hormones like human placental lactogen, estrogen and progesterone contribute to this state. If these alterations are exaggerated then there is abnormal glucose tolerance leading to gestational diabetes. GDM can be diagnosed by a Glucose Tolerance Test. This can be done during the first visit and repeated on 24 weeks and then 32-34 weeks. Two hours GTT of more than 140mg/dl or above indicates GDM," says Dr Chaturvedi.

How does it affect the mother and baby?

If undetected or uncontrolled, diabetes can affect the foetus in many ways:

- The commonest problems of high blood sugars is overgrowth of the foetus, also known as macrosomia (large baby). These mothers often have a difficult vaginal birth or may need to be delivered by caesarean section.

- One peculiar problem of vaginal delivery associated with these large babies is 'shoulder dystocia', wherein, after the birth of the babys' head, the shoulder 'gets stuck'. These babies need to be delivered by special manoeuvres or may result in injury to the baby's hand, shoulder, neck or nerves; or injury to the mother.

- Both mother-to-be and foetus are at an increased risk of infections.

- Some expectant mothers may also develop high blood pressure or excessive fluid in the womb, which increases the risk of prematurity and caesarean delivery.

- In severely uncontrolled cases, poor foetal growth and sudden foetal demise inside the womb may result.

Adds Dr Bijlani, "The newborn should be transferred to an intensive care unit immediately after birth as blood sugars dip sharply as soon as the umbilical cord is cut. These babies need to be monitored for low blood sugars, electrolyte disturbances, delayed lung maturity, jaundice and other metabolic complications (chemical imbalances)."

The good news is that if gestational diabetes is diagnosed and managed promptly and blood sugars controlled effectively throughout pregnancy, the risk of complications is extremely low. The key message is that both the obstetrician and the expectant mother should be equally motivated to maintain a tight control of sugars round the clock to prevent harm to the foetus or mother. Most of the times, the mother's blood sugars return to normal within six weeks. But these women have a higher risk of developing Type 2 diabetes some time during their lifetime or during the next pregnancy. The baby of a mother with GDM is more prone to develop diabetes in later life.

What to keep in mind

- Your weight. - Maintaining calorie intake. - Having small frequent meals. - Staying active throughout your pregnancy. - Pre-conception screening and counselling.

Is there any way to avoid it? Pre-pregnancy counselling is highly recomended. Other than that, women should avoid excessive weight gain, exercise regularly and eat healthy during pregnancy to avoid gestational diabetes. A high fibre diet with small, frequent meals will avoid wide fluctuations in sugar levels. Obese women, those more than 35 years of age, women with PCOS, a family history of diabetes or GDM in previous pregnancy need to be more careful.

How is it treated? GDM cannot be 'cured but has to be 'managed'. This means that blood sugars need to be controlled round the clock throughout pregnancy. An experienced dietician will restrict simple carbohydrates, distribute meals skilfully with frequent snacking, include more fibre and strictly monitor caloric intake to avoid excess weight gain. Vigorous exercises and skipping meals may cause a sudden dip in sugar level (hypoglycemia), which is dangerous to both mother and foetus. "Many women need to take oral anti-diabetic medications, including insulin injections, which can be self-administered. Most women are encouraged to frequently monitor their blood sugars at home using kits. This is a convenient way to ensure smooth sugar control. Women with GDM need to visit their obstetrician more frequently, often weekly. The obstetrician keeps a close watch on foetal size, fluid levels in the uterus and blood flows apart from sugar control. Decision whether to deliver by natural passage or caesarean section depends on the size of the foetus, amount of fluid in the uterus, foetal health and other factors," says Dr Bijlani.

Is it a common occurrence in Mumbai? "With increasing PCOS, obesity, poor dietary habits and a sedentary lifestyle, it is a small wonder that GDM is fast becoming a common occurrence in Mumbai," says Dr Bijlani. Adds Dr Chaturvedi, "In developed countries, the occurence rate is almost 7%, in developing countries including India, the prevalence is almost 16-17%. In India, it happens almost equally in rural and urban areas in India.
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