DIAGNOSING GESTATIONAL DIABETES BECOMES EASY!!

Gestational diabetes is a condition where the blood sugars are elevated during pregnancy. This happens due to hormonal changes occurring during pregnancy. Hormones produced by the placenta help in providing more nutrients to the growing fetus. Some hormones act against insulin action and prevent the development of hypoglycaemia in the mother. To counteract this excess production of hormones against insulin the mother’s body produces more insulin. In most women these changes are not prominent enough to cause diabetes. Women are most vulnerable during the third trimester of pregnancy. In case the mother is not able to produce considerable amount of insulin to counteract the effect of these hormones they end up in what is called Gestational Diabetes.

So What? Why should we worry? Will it not go away after pregnancy?

Diabetes affects in various ways.....

It can result in

Birth defects affecting major organs like brain and heart

Miscarriage

Large baby leading to difficult labor

May need caesarean section.

The baby, once delivered may end up in severe hypoglycaemia due to increased amounts of insulin in the system.

Who all can develop Gestational Diabetes ???

• Overweight
• High risk ethinicity
• Patients in Prediabetes
• Family history of diabetes
• History of giving birth to large babies.
• Previously giving birth to a stillborn baby
• Having gestational diabetes with a previous pregnancy
• History of polyhydramnios
• Many women who develop gestational diabetes have no known risk factors.

How do we diagnose this condition??

High risk women should be screened for gestational diabetes as early as possible during their pregnancies.

All other women need to be screened between the 24th and 28th week of pregnancy.

The best test available is the oral glucose tolerance test. This test involves quickly drinking a sweetened liquid which contains calculated amount of sugar. Then blood samples are collected at an interval of one hour and 2 hours. 2 hour value more than 140mg/dl is considered indicative of gestational diabetes.

Let’s talk about the good news...

A simple solution to prevent  complications associated with gestational diabetes is by screening of pregnant women for gestational diabetes using Oral Glucose Tolerance Test and to keep the glucose level within prescribed  levels — fasting plasma glucose 90 mg/dl and two hours after meal — 120 mg/dl. The earlier ( 1999) WHO guidelines insisted a pregnant woman to come fasting for testing. The plasma glucose level was tested two hours after 75 mg of glucose was given to a woman. If the value was between 140 mg/dl and 199 mg/dl, the pregnant woman was diagnosed as having gestational diabetes. “The revised WHO guidelines retain the same value but the biggest difference is  that women need not come fasting for testing,” The rest of the procedure remains the same. The non-fasting plasma glucose level is tested two hours after 75 gm of glucose is given to the woman. “If the two-hour plasma glucose measurement is between 140 [mg/dl] and 199 [mg/dl], she is diagnosed as GDM

WHO’s non-fasting plasma glucose testing recommendation makes testing easy for pregnant women. The non-fasting test is patient-friendly and causes the least inconvenience to pregnant woman. The single-step procedure is easy to follow, economical, simple and evidence-based. This also reduces the incidence of nausea associated with intake of sweet liquids on empty stomach.

Screening for gestational diabetes should be done in the first trimester (at least by 12-16 weeks). Earlier, the screening was done at 24-28 weeks. The reason why WHO does not recommend the late screening (24-28 weeks) is because by the 12 week, the beta cells develop in the fetal pancreas. And these fetal cells respond to the elevated maternal glucose levels. As a result, when the fetus gets more than the required amount of nutrition (glucose), it gets converted into fetal fat; the fetus thereby gains weight and becomes big. So, the earlier the screening of pregnant women, the better the fetal outcome.

Dr.Riyaz Sheriff

Consultant Diabetologist