A pregnant woman presents to her doctor with complaints of frequent thirst, excess fatigue, and is found to be prone to infections. The doctor examines her and orders for a few tests and diagnoses her with having developed ‘gestational diabetes mellitus’ or GDM. While diabetes has long been a health concern in the country, what exactly is gestational diabetes mellitus (GDM) and what does it mean? TNM spoke to experts to get a better understanding.
Several studies have shown that the prevalence of gestational diabetes is rising in India, with Indian women genetically predisposed to it. One study pegs the prevalence of GDM in south India to be 17.8% in urban women, 13.8% in semi-urban women and 9.9% in rural women.
“Gestational diabetes is nothing more than a condition in which a woman who is not diabetic and has normal blood sugar levels prior to pregnancy, develops diabetes during pregnancy as a result of several hormonal changes which take place in the body,” explains Dr Kavitha Lakshmi Easwaran, a Senior Consultant Obstetrician and Gynecologist at Motherhood Hospital in Bengaluru. “What should be noted is that most of these women revert back to a normal state after the delivery.”
She further explains that women undergo several changes during pregnancy. “A woman’s body is in what is known as a ‘diabetogenic state,’ as a result of all the different hormones and steroids which are involved. This makes her more prone to developing diabetes because it’s a delicate system,” she adds.
So does this mean that all women can develop diabetes during pregnancy? In theory, yes, but speaking from a practical aspect the doctor explains that women who present with insulin resistance or have a family history of diabetes are at a higher risk of developing GDM. Women who have polycystic ovarian syndrome (PCOS) are also at a risk because they present with insulin resistance as a result of their PCOS.
“Even if the woman does not have PCOS, but there is a family history of PCOS, it puts her at risk,” says Dr Kavitha.
Diagnosis and Treatment
As part of routine pregnancy check-ups, women are diagnosed by week 28 of the pregnancy, though in some rare cases a woman might develop GDM at a later time. Routine blood sugar tests will help doctors determine if a woman is presenting with any changes in her sugar levels from the norm.
An Oral Glucose Tolerance Test (OGTT) is done to determine this. 75 grams of sugar are given orally and then blood sugar levels are measured after 2 hours. This will determine whether there is an excess of glucose in the blood. Should a woman be found to be diabetic during her pregnancy, doctors will first put her on a strict diet to control sugars and encourage her to go for walks and other means of staying active. If this does not help maintain blood sugar control, the next option is to opt for medication with oral drugs such as metformin. Even with lifestyle modifications and oral medication, if sugar levels are not normalised, insulin is then given to the women to reach blood sugar control.
“It can be managed with the right exercise, diet and medication. Even after delivery if the woman returns to a normal state, several studies have shown that she will be at a higher risk of developing type II diabetes at a later point in life. So lifestyle modification becomes very important not just short term, but long term as well,” says Dr Kavitha.
Complications
What happens if GDM goes undiagnosed or is not treated?
“There are largely one of two problems that we usually see. First, the unborn child is at risk of developing congenital abnormalities. The second is that there is a chance of intrauterine death (IUD) or stillbirth occurring because of the fluctuation of blood sugar levels,” explains Dr Kavitha.
She also says that ideally a woman should get her thyroid and sugar levels tested 2 to 3 months prior to planning conception itself so that her general condition can be assessed.