Gestational diabetes mellitus (GDM) has become a common problem among pregnant women in the country. The incidence of GDM is higher at 9% in the urban areas than at 4% in the rural areas, according to Dr Suganthi, Gynaecologist and Obstetrician of KG Hospital.
She made this statement while giving a power-point presentation on the topic “Gestational diabetes mellitus” for the benefit of the post-graduate medical students in KG Hospital auditorium recently.
The GDM is defined as any degree of impaired glucose intolerance first appeared during pregnancy. Women of young age are susceptible to get Type 1 DM and are prone to Ketoacidosis and hypoglycemia.
Women of older age are vulnerable to get Type 2 DM and are less prone to Ketoacidosis and hypoglycemia. About 35-40% of pregnant women are found to be Type 2 diabetics.
According to Dr Suganthi, the prevalence of GDM varies among different racial and ethnic groups within the country.
In America, 3.9% of pregnant white women and 8.7% of women of Asian origin get GDM, in Europe the incidence ranges from 0.6% to 3.6%, Australia – 3.6% to 4.7% (Indian women – 17.7%), China – 2.3% and Japan – 2.9% The variability is partly due to different criteria and screening regimens.
GDM causes many maternofetal complications such as spontaneous abortion, macrosomia (larger than average size baby), preterm delivery, respiratory distress syndrome and perinatal mortality.
GDM might also lead to neonatal complications such as morbidity associated with preterm birth, polycythemia and hyperviscosity, hyperbilirubinemia, cardiomyopathy, hypoglycemia and other metabolic abnormalities, respiratory problems or congenital anomalies.
The congenital anomalies may affect the central nervous system, the genitourinary tract, kidneys, intestine and may also cause cleft lip/palate. Dr Suganthi noted that earlier, in dealing with GDM, the World Health Organization guidelines were followed.
Nowadays, the guidelines of the International Association of Diabetes and Pregnancy Study Group (IADPSG) are being followed. The IADPSG recommends universal screening of pregnant women.
Pregnant women who are above 25 years, members of ethnic group, who have metabolic syndrome, who are using steroids, obese, who have previous poor obstetric outcome, and who are diagnosed to have glycosuria at first visit are categorized in the “high risk” group.
These issues could be managed through the following methodology: patient education, medical nutrition therapy, pharmacological therapy, glycemic monitoring, fetal monitoring and planning on delivery.
Fetal monitoring can be done as follows: screening for Down’s syndrome at 11-14 weeks; fetal echocardiogram at 18-22 weeks, assessing the growth and liquor volume at 26 weeks onwards; serial ultrasonography for accelerated growth at III trimester; and Nonstress Test (NST) at 32 weeks.
Dr Suganthi emphasized the need for the post partum follow-up such as checking blood glucose before discharge, advising lifestyle modification, conducting oral glucose tolerance test at 6-12 weeks, and giving preconception counseling for next pregnancy.