India has approx. 62.4 million diabetics and this number is likely to increase to 101 million by 2030. It is estimated that about 16% of women who get pregnant every year develop diabetes during gestation period. So, considering the deliveries per annum being twenty-seven million, it is estimated that about three to four million women suffer from Gestational Diabetes every year. Of these three million women - 30% go on to develop type-2 diabetes in 5-10 years, and more than 50% become diabetic over a period of 20 years.

Risk Factors

  • Asian / Indian women are ethnically more prone to get diabetes
  • Overweight women (age group 30-39, 20% more than ideal body weight)
  • Family history of diabetes (parents or siblings)
  • Women with PCOS (polycystic ovarian syndrome)
  • Previously delivered a large baby or a stillborn
  • Having too much amniotic fluid (polyhydramnios)
  • Gestational diabetes in previous pregnancy

Screening for Gestational Diabetes

To combat the tsunami of Diabetes, World Diabetes Association recommends the universal screening of all pregnant women irrespective of risk factors during early and late pregnancy. Normal procedure to diagnose gestational diabetes is by WHO recommended OGTT (oral glucose tolerance test) wherein after giving 75gms of glucose drink, 2hr plasma glucose is measured and level ≥ 140mg/dl warrants treatment visits to lab to complete the test. DIPSI (Diabetes in Pregnancy Study group India) has come up with modified OGTT where pregnant women are given 75gm glucose load irrespective of last meal timing and 2hr plasma glucose ≥ 140mg/dl is considered for treatment. This test should be done during first visit to doctors clinic and repeated at 24-28 weeks and again at 32 -34 weeks to diagnose and incorporate early intervention.

Treatment

Gestational Diabetes Mellitus is a common medical complication during pregnancy. Due to large number of cases (second in world) in India, DIPSI stresses on the following guidelines to manage gestational diabetes:

  • Key in the Antenatal care is achieving good glycemic control by reassuring, psychological support, and educating patients about the implications of disease on child and maternal health.
  • Self-monitoring of blood sugar (SMBG) using glucometers is cost-effective and superior method than less frequent monitoring in the labs.
  • Target glucose level at Fasting – 90, 2hr PP – 140mg/dl
  • At least weekly monitoring should be encouraged

Normal sugar or Euglycaemia is achieved by:

  • Diet
  • Exercises
  • Oral medicines
  • Insulin

Any diabetic treatment and medication must be taken only in consultation with your Gynecologist/ Physician. Self medication can be dangerous. Also consult your doctor & dietician about the type of exercises and diet.

Diet

Dietary modifications are the mainstay of diabetes treatment modules. Carbohydrate, Proteins and, Fats are individually adjusted as per Caloric requirements depending on age, activity, pre-pregnancy weight and stage of pregnancy.  Approx.300 cal. above basal requirement is ideal to gain optimum recommended weight i.e. (normal weight 10-12kg, BMI ≥30,0-5 kg). Focus on carbohydrate controlled meal plan and overall healthy food choices with good cooking practices and portion control is emphasized. The carbohydrates that produce only small fluctuation in blood glucose and insulin levels (low Glycemic index foods) are recommended. 

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