DIABETES IN PREGNANCY – THE NEED FOR EARLY DETECTION

The World Health Organization’s estimation of the prevalence of diabetes in adults indicates an expected total rise of more than 120% from 135 million in 1995 to 300 million in 2025. This includes Gestational Diabetes Mellitus (GDM) which is defined as ‘carbohydrate intolerance with first recognition or onset during pregnancy’ and Pre-GDM, a term that denotes known diabetic subjects who become pregnant.
The prevalence of diabetes in India is growing tremendously and so is its awareness. While knowing about diabetes in general is very important, we need to focus a little more seriously on gestational diabetes in pregnancy, as two generations are at risk and because prevention of diabetes starts from there. Women with GDM are at increased risk of future diabetes and their children are at risk of childhood obesity and diabetes later in life. This fact should warn the physicians and general public alike to the necessity to devote special attention to this problem.
GDM is associated with obstetric, maternal and neonatal complications. Uncontrolled diabetes in pregnancy leads to spontaneous abortions, birth defects – especially heart problems in the baby, preterm labor, big baby, hypertension, sudden in-utero death, delayed & difficult labor and consequently more bleeding during delivery. Mothers are at increased risk of urinary tract and vaginal infections and of developing type 2 diabetes in the future. Babies have immediate problems of respiratory distress, hypoglycemia (low sugar) and electrolyte imbalance and long term complications of obesity and diabetes. Hence, it is essential to screen all the pregnant women for glucose intolerance by oral glucose test. It is usually done between 24 -28 weeks of gestation and in selected high risk women even earlier.

A team approach is needed in management of Pregnancy in Diabetes with the obstetrician, diabetologist, dietician and pediatrician working in concert. Intensive monitoring, diet and insulin therapy are cornerstones for management. At the risk of developing Type 2 diabetes, it is important to educate pregnant women with diabetes (and their partners) about the condition and its management cannot be overemphasized.

All pregnant women must be aware of when to screen for GDM and GDM mothers must know about its implications for her and her baby, diet, lifestyle changes, self-glucose monitoring and insulin therapy. Fetal growth must be evaluated with ultrasound and fetal echo done to rule out cardiac problems. Maintenance of mean Plasma Glucose level ~105 mg% is ideal for good fetal outcome. This is possible if Fasting and Post prandial plasma glucose levels are around 90 mg/dl and 120 mg/dl respectively. Insulin is essential if medical nutrition therapy fails to achieve normal glucose levels.

Prevention of adverse maternal and perinatal outcomes in GDM is based on achieving maternal blood glucose as close to normal as possible. Gestational diabetes in prganancy for women require follow up. Glucose tolerance test with 75g oral glucose is performed after 6 weeks of delivery and if necessary repeated after 6 months and every year to determine whether the glucose tolerance has returned to normal or progressed. Diabetes in Pregnancy needs holistic care for good health of women and her child.