Gestational Diabetes Mellitus: Its Influence On The Pregnant Mother & The Fetus, Surveillance & Management

Gestational Diabetes Mellitus: Its Influence On The Pregnant Mother & The Fetus, Surveillance & Management

Over the past decade, the obstetricians have seen a steep rise in the incidence of diabetes in pregnancy with prevalence rates ranging between 3.8%- 21%. Asian preponderance to metabolic syndrome has cropped up the newer age epidemic of ‘diabesity’. Changing lifestyles and dietary preponderances have fuelled the issue.

The need to emphasize on euglycemia in the mother arises to curb the transfer of epigenetics to the unborn fetus and thus lay the fetal origin for adult disease. Hence by treating a diabetic mother, we are also reducing the risk for the successive generations.

Periconceptional hyperglycemia poses the risk of anomalies in the fetus whereas gestational diabetes predisposes to stillbirth, perinatal complications and high birthweight. Hence prompt recognition & treatment of diabetes in pregnancy is quintessential.

The right window to look for euglycemia is in the periconceptional period. All couples seeking pre-conceptional counseling should be offered screening with glycosylated hemoglobin levels as well as 75g GTT( fasting & 2h). No opportunity should be left in achieving glycemic targets in planned conceptions as well as in ART pregnancies.

In pregnancy screening for diabetes should be in accordance with the WHO with 75g glucose and a 2h value of 140mg/dl. As Asians have higher insulin resistance fasting blood sugars alone cannot be used to screen them for diagnosing GDM. Long term reflections on glycemic control can be attained by monitoring glycosylated haemoglobin.

Medical nutrition therapy is pivotal in achieving glycemic targets in pregnancy and forms the cornerstone of therapy. A multidisciplinary approach with dietitian and lifestyle changes is required.

Prompt treatment with insulin when deviations from normalcy are obtained even after 2 week intensive MNT i.e. fasting sugars >90mg/dl & post-prandial levels > 120 mg /dl.

Intensive surveillance for infection ( urine cultures & vaginal swabs) every trimester and fetal surveillance with interval growth scans for detecting macrosomia should be performed.

Modified biophysical profile (NSTand AFI) should be performed 32 weeks onwards and the frequency of testing could be fortnightly / weekly based on the risk factors involved.

A multifaceted approach is required to change the epidemiological triad of agent, host and environment and the complexities of their interplay at the epigenetic level can be modified by achieving adequate glycemic control in pregnancy & pre-pregnancy thereby paving the way for a healthy fetus and a healthy future…

Written By: Dr. Smitha Avula
Date: November 14, 2016

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