Taking a closer look at Gestational diabetes mellitus

Out of the many noncommunicable diseases, diabetes take a prominent place so much so that we all know at least one person with diabetes. While diabetes comes as Type 1 and 2, there may be instances when it could get severe especially with age. Diabetes not only affects one’s health but it also affects an individual’s quality of life. Statistics have proven that o ver 425 million people are currently living with diabetes. Diabetes can be expensive for the individual and family.

While the focus has been diverted towards diabetes mellitus, gestational diabetes mellitus (GDM) is less spoken about. In view of the Diabetes Awareness Month which falls in November, the Diabetes Association of Sri Lanka (DASL) has planned out several programmes.

What is gestational diabetes?

Gestational diabetes is high blood sugar that develops during pregnancy and usually

disappears after giving birth. It can occur at any stage of pregnancy, but is more common in the second half. It occurs if your body cannot produce enough insulin to meet the extra needs in pregnancy. Expectant women can help control gestational diabetes by eating healthy foods, exercising and, if necessary, taking medication. Controlling blood sugar can prevent a difficult birth and keep you and your baby healthy.

Prevalence

According to the statistics collected by the DASL 1 in 4 persons have abnormal sugar levels. 2.1 million and 2.3 million people have diabetes and pre diabetes respectively. 21.8% abnormal blood sugars in total in Sri Lanka in the last prevalence study which was done in 2008. Every 1 in 7 births were affected by gestational diabetes. “The prevalence of high blood glucose in pregnancy increases rapidly with age and is highest in women over the age of 45. In 2017, there was an estimated 204 million women (2079 years) living with diabetes in the world. This number is projected to increase to 308 million by 2045. 1 in 3 women with diabetes were of reproductive age. 21.3 million or 16.2% of live births had some form of high blood sugar in pregnancy. An estimated 85.1% were due to gestational diabetes. The vast majority of cases of high blood sugar in pregnancy were in lowand middle-income countries, where access to maternal care is often limited.”

Risks to mother and foetus

Gestational diabetes mellitus (GDM) is a severe and neglected threat to maternal and child health. “Many women with GDM experience pregnancy-related complications including high blood pressure, large birth weight babies and obstructed labour. The mother can go on to develop type 2 diabetes within 5 to 10 years after delivery. The foetus can develop conditions such as low blood sugar, jaundice and low calcium. Babies may also have a large birth weight leading to obstructed labour.”

Detection and diagnosis

Risk assessment for GDM should be undertaken at the first prenatal visit. “Women with clinical characteristics consistent with a high risk of GDM (marked obesity, personal history of GDM, sugar in urine, or a strong family history of diabetes) should undergo glucose testing (see below) as soon as feasible. If they are found not to have GDM at that initial screening, they should be retested between 24 and 28 weeks of gestation.

Women of average risk should have testing undertaken at 24–28 weeks of gestation.”

Low-risk status requires no glucose testing, but this category is limited to those women meeting all of the following characteristics:

■ Age <25 years

■ Weight normal before pregnancy

■ Member of an ethnic group with a low prevalence of GDM

■ No known diabetes in first-degree relatives

■ No history of abnormal glucose tolerance

■ No history of poor obstetric outcome

She further said that a fasting plasma glucose level of >126 mg/ dl (7.0 mmol/l) or a casual plasma glucose >200 mg/dl (11.1 mmol/l) meets the threshold for the diagnosis of diabetes, if confirmed on a subsequent day, and precludes the need for any glucose challenge.

“Reclassification of the mother’s sugar status should be performed at least 6 weeks after delivery,” Dr. Warnapura continued. “If glucose levels are normal post-partum, reassessment of sugar level should be undertaken at a minimum of three-year intervals. Women with pre-diabetes in the postpartum period should be tested for diabetes annually; these patients should receive intensive lifestyle management therapy and should be placed on an individualized exercise programme because of their very high risk for development of diabetes. All patients with prior GDM should be educated regarding lifestyle modifications that lessen insulin resistance, including maintenance of normal body weight through lifestyle modification.”