Online edition of India's National Newspaper
Sunday, Apr 06, 2008
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Online edition of India's National Newspaper Sunday, Apr 06, 2008 ePaper | Mobile/PDA Version |
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Tamil Nadu
The Happy Journey of motherhood is vitiated by Diabetes in about 5 – 10 % of the women. Gestational Diabetes Mellitus, the so called GDM is diabetes with onset or first recognition during pregnancy. GDM is associated with short- and long-term repercussions for both the mother and child and so, proper management of it is of paramount importance. Risk Factors For GDM Unmodifiable risk factors: Age, Genetics, Ethnicity, number of pregnancies and a short stature Modifiable risk factors: Obesity, lack of exercise, dietary fat, smoking and certain drugs like steroids. Diagnosing GDM The screening for GDM is done between 24 and 28 weeks when the diabetogenic effect of pregnancy is at its maximum with 50gm of oral glucose. A positive screening test, blood sugar more than 130 mg/dl 1 hour after glucose ingestion, necessitates confirmation of GDM through Oral Glucose Tolerance Test (OGTT) OGTT, the confirmatory method for GDM diagnosis, is done with 100gm of oral glucose and blood sugar estimated at 0, 1st, 2nd, 3rd hours after glucose ingestion. Complications Of GDM GDM is associated with complications for mother like prolonged labour, cesarean delivery, rise of blood pressure, increased bleeding, birth canal injuries and infections. The complications in the child include big baby (> 4kg), delivery complications, stillbirth, birth trauma, respiratory distress and metabolic abnormalities. Management Of GDM Diet is the mainstay of treatment in GDM. Diet planned with a help of a nutritional specialist should be less in fat and complex carbohydrates substituted for refined carbohydrates. Caloric composition includes 40-50% from complex, high-fiber carbo- hydrates, 20% from protein, and 30-40% from primarily unsaturated fats with 6 times a day meal plan. Physical Activity A meta-analysis that there is insufficient evidence to recommend, or advice against exercise in GDM Blood Glucose Monitoring As the growing fetus is more sensitive to glucose excesses rather than nadirs in the mother, thrice a day self estimation of capillary blood sugar is vital. Continuous Glucose Monitoring (CGM), a new technique of blood sugar estimation is more patient friendly rather than the conventional glucometers. Insulin When diet and exercise fail to contain blood sugar exacerbations or when GDM is diagnosed late in pregnancy, when there is not enough time for diet or exercise, exogenous insulin is used. Though conventionally human recombinant insulin is being used to control blood sugar, the newer insulin analogues like lispro, aspart are being increasingly used to address the shortcomings of human insulin. Delivery Macrosomia or big baby (>4kg) is a hallmark complication of GDM and this is associated with difficult labour. So, serial monitoring of baby’s weight through ultrasonographic estimation of fetal abdominal circumference is essential. If there are no complications and the blood sugar is under control, there is no need to pursue delivery before 40 weeks of gestation. After Birth As 10-50% of women with GDM develop Type 2 diabetes within 5 years, it is prudent to check the fasting and postprandial blood sugars at time of discharge from hospital after delivery and a 75g OGTT done after 6 – 12 weeks of delivery. Women who have already had GDM in a pregnancy are 30-69% more likely to develop GDM again in future pregnancies, so life style modification and awareness education are necessary for future pregnancies and prevention of diabetes in future. Dr.C.P.Rajkumar,M.D., Nalam Hospital, Theni.
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