Gestational diabetes mellitus or GDM is a condition where there is increased glucose levels in maternal blood. In pregnancy it is quite normal to have an elevated glucose level than a normal adult, thus having positive urine test for glucose is quite normal. But having too much of glucose in blood is detrimental to the fetus.
GDM can cause variety of pregnancy complications as well as problems for the baby in the future. While in pregnancy high glucose levels in maternal blood results in high glucose levels in fetus, thus hormones like insuline, insuline like growth factor and growth hormone are produced in excess. This leads to increased growth and fat deposition in fetus. Intern this increased growth results in a macrosomic baby, who will eventually have problems while delivery such as "shoulder distocia".
Not only the problems at delivery, but these babies may develop developmental stigmata as well. Sacral agenesis is one of the commonest recognized malformations secondary to gestational diabetes mellitus. Just after birth these babies are at a high risk of developing neonatal hypoglycemia as a result of sudden cut off of glucose supply from the mother as well as due to high insuline production by baby's pancreatic beta cells.
As stated earlier, because these babies produce high levels of insuline before birth, they tend to exhaust their insuline reserves (beta cell function) later in life, thus they are at a high risk of developing Diabetes Mellitus as adults. If the baby is a girl, she will have high risk of developing GDM, thus this whole process goes in a vicious cycle.
Over the years there has been many researches on how best to treat gestational diabetes mellitus by many researchers around the world. Currently accepted way of treatment is to meticulously control blood sugar levels while monitoring closely.
As well as treatment, prevention plays a major role in maternal care. High risk mothers need to be identified and screened so that the condition can be diagnosed early and treatment can begin early to minimize any unwanted effects to the baby and the mother.
This diagram shows the protocol which we use to diagnose GDM in high risk, medium risk and low risk mothers.
So you may be wondering, "am i a high risk mother?". Following is a list of criteria we use to identity high risk mothers. If you have any of the following criteria, you should get pre-conceptional advice on the expected pregnancy and you should be screened as early as possible for possible GDM.
Once GDM is diagnosed, treatment should start immediately. Any delay can be detrimental to the fetus. Following a diagram showing a currently accepted treatment regime.
( MNT stands for Medical and nutritional therapy.)
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