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GDM - Pregnancy and Blood Sugar

There are many problems faced by the mothers during the period of pregnancy. One such complication faced during this period is glucose intolerance. This condition is not the normal diabetes mellitus faced by other people, this situation is different as the woman is pregnant at that period of time. Diabetes mellitus is a condition in which high blood glucose level results from defects in insulin secretion, insulin action or both.

Gestational Diabetes Mellitus (GDM) is explained as glucose intolerance that begins or is first detected during pregnancy. Women who have had GDM have a 35% to 60% chance of developing diabetes in the next 5 to 10 years . Lifestyle modifications aimed at reducing or preventing weight gain and increasing physical activity after pregnancy may reduce the risk of subsequent diabetes.

Insulin resistance usually begins in the second trimester and progresses throughout the remainder of pregnancy. And insulin is also reduced by as much as by 80% . placental secretions of hormones, progesterone, cortisol, placental, lactogen, prolactin, and growth hormone, are major contributors to the insulin resistant state seen during pregnancy.

The person should check for preexisting diabetes and the preconception care is also essential. If it remains untreated during the first few weeks’ gestation, it is associated with spontaneous abortion and birth defects. If it is untreated during the second or third trimester, it is associated with fetal macrosomia, birth injury, late-term fetal death, maternal preeclampsia, neonatal hypoglycemia, future diabetes and obesity in children.

Blood glucose concentrations may be variable in women especially with type I diabetes. As a result, test glucose frequently, plan snacks and/or adjust evening insulin to avoid nighttime hypoglycemia and also watch for hypoglycemia in case of missed or delayed meals. During pregnancy, treatment to normalize maternal blood glucose levels reduce the risk of adverse maternal, fetal, and neonatal outcomes. Extra glucose from the mother crosses the fetal placenta and the fetus ' pancreas responds by releasing extra insulin to cope with excess glucose. The excess glucose is converted to fat, which results in macrosomia ( it is a condition in which the newborn is much larger than average). The fetus may become too large for a normal birth resulting in the need for cesarean delivery.

Neonatal hypoglycemia during birth is another common problem. The above normal levels of maternal glucose has caused the fetus to produce extra insulin. However, after birth the extra glucose is no longer available to the fetus, but until his or her pancreas can adjust, the neonate may require extra glucose through intravenous feedings for a day or two to keep blood glucose level normal.

The usual recommendation for screening is between 24 and 28 weeks of gestation. GDM is diagnosed most often during the second or third trimester of pregnancy because of the increase in insulin-antagonist hormone levels and insulin resistance that normally occurs at this time.

The usual recommendation for screening is between 24 and 28 weeks of gestation. GDM is diagnosed most often during the second or third trimester of pregnancy because of the increase in insulin- antagonist levels and insulin resistance that normally occurs at this time. However, the number of women with undiagnosed diabetes has increased and therefore it has now been recommended that women with risk factors for diabetes should be screened for undiagnosed Type 2 Diabetes Mellitus at the first prenatal visit. In some women, diabetes may be diagnosed in the first trimester of pregnancy but in most such cases diabetes likely existed before pregnancy, but was undiagnosed.

An oral glucose tolerance test (OGTT) is recommended for screening of GDM between 24th and 28th week of the pregnancy, but for high risk women the screening should be conducted earlier in pregnancy. An OGTT is performed by measuring the plasma glucose concentration while fasting and two hours after ingesting a drink containing 75 grams of glucose.

GDM does not cause congenital anomalies. (Such malformations occur in women with diabetes before pregnancy who have uncontrolled blood glucose levels during the first 6 to 8 weeks of pregnancy when fetal organs are being formed. Because GDM does not appear until later in pregnancy, the fetal organs were formed before hyperglycemia became a problem). When optimal blood glucose levels are not being maintained with medical nutrition therapy or the rate of fetal growth is excessive, pharmacologic therapy is needed. Research supports the use of insulin, insulin analogs and metformin during pregnancy. Women with GDM should be screened for 6 to 12 weeks during postpartum and should have lifelong screening for the development of diabetes or prediabetes at least every 3 years.

Thanks Giving

This article is written and submitted to The E Today by Shrushti Mehta.

We thank her for her research and analysis and hope to see the awarenesses about health and nutrition being spread ahead to larger mass of our citizens.

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