Diabetes Mellitus is a chronic metabolic disorder caused due to either Insulin Deficiency or decreased sensitivity to action of Insulin. In pregnancy, this condition exists in a few varieties; (1) a known Diabetic woman becomes pregnant (2) a woman who has a history of pre-diabetes becomes Diabetic during pregnancy and (3) Gestational Diabetes Mellitus(GDM) when woman becomes Diabetic during pregnancy and after the pregnancy is over, her Diabetes disappears. However, GDM is now thought to be a forerunner of Type-2 Diabetes and almost 25% of GDMs eventually turn out to be Diabetic.

Pregnancy induces progressive changes in maternal Carbohydrate Metabolism. As pregnancy progresses, because of certain placental hormones, there is a compensatory increase in Insulin secretion. When this compensation is inadequate, Gestational Diabetes develops. Pregnancy that occurs in a woman who are already diagnosed with Diabetes is termed as ‘Pre-gestational Diabetes Mellitus’.

The magnitude of complications is lesser in women with GDM than Pre-gestational Diabetes Mellitus’. Ideally, all women should be screened for Diabetes during 24-28 weeks of gestation. However, it is best to screen once during all trimesters.

Woman at risk of GDM are:
1. Positive family history of Diabetes – parents, siblings, immediate aunts and uncles, grandparents
2. Previous history of being overweight baby (over 4kgs above the average)
3. Previous history of repeated pregnancy loss or still birth
4. Obesity
5. Being over 30yrs of age, while attempting to get pregnant
6. Frequent Candida infections
7. Polyhydramnios- Accumulation of amniotic fluid that surrounds the baby in the uterus

Effect of pregnancy on Diabetes: Pregnancy worsens Diabetes. Vascular changes like Retinopathy, Nephropathy and Coronary Artery Disease worsens during pregnancy.

Effects of diabetes on the mother:
During pregnancy: Increases risk of abortion, preterm labor, Urinary Tract Infection(UTI), Vaginal Candidiasis. There is also a high risk of Preeclampsia (high Blood Pressure during pregnancy) and a high chance of delivering a big baby. Worsening of Lungs, Kidney and Heart Disease may also occur.

During labor: High chances of difficulty faced during labor as well as a high chance of developing post- partum Hemorrhage or Sepsis.

Fetus: Risk of Fetal Congenital Malformation is high, especially Renal, Cardiac and Skeletal. This may also cause a delay in pulmonary maturity. Increases risk of Intrauterine Fetal Death (IUFD) and Intrauterine Growth Restriction (IUGR); birth injuries, Hypoglycemia, Respiratory Distress Syndrome and Jaundice in the post-natal period. GDM not only influences immediate maternal health but also increases future risk of Type-2 Diabetes in the mother and baby.

Prevention:
Prevention medicine starts before birth. Ideally, every woman should undertake pre-pregnancy consultations, where they are advised the following:
1. Folic Acid, Vitamin B12 and supplements to lower the risks of Congenital Malformations
2. Control of weight & diet, coupled with regular exercise prior to conception
3. Those already diagnosed with Diabetes should have good sugar control prior to conception, ideally using oral anti-diabetic drugs or preferably Insulin
4. Regular ante-natal visits, home sugar monitoring tests, serial lab tests, and ECG for vascular changes may be done, during the term of pregnancy. It is important to involve a Cardiologist and Dietician in management of Diabetes Mellitus
5. Tests for fetal wellbeing should be done serially. A Nuchal Translucency scan (NT) in the first trimester for screening Down Syndrome, is a must
6. With GDM being a ‘high risk’ during pregnancy, a woman should be treated, and delivery should be conducted in a hospital set-up with facilities of LSCS and NICU. A Neonatologist should attend to labor and baby in post-natal period.

It is well established that treatment of GDM reduces the risk of peri-natal complications. Both, lifestyle modification and Pharmacological Therapies have been shown to reduce Diabetes development by 50%. Breast feeding can also reduce Childhood Obesity.

Medical Nutritional Therapy and life style intervention: Nutrient intake plays a significant role in the health-related outcomes of all pregnant women. It is noted that calorie restrictions will help glucose control, but too severe a restriction is undesirable. Carbohydrate intake should be limited to 35-45% of total calories. Self-monitoring of blood glucose, particularly post meal monitoring, is recommended.

Insulin is recommended when women are unable to achieve the target glycemic goals or show signs of excessive fetal growth (baby becoming large).
 Overfeeding- too much of rich food, laden with harmful fats must be avoided
 Omega 3 Fats and Vit supplements can help overcome pregnancy related Depression
 Remember the growing fetus is an Obligate Parasite; whatever the nutritional contents of the mother’s diet, it will suck every single nutritional element required for its growth and development, depleting the mother of vital substances
 Milk, green leafy vegetables, fruits, nuts, iron containing foods and at least 2 tsp. of homemade ghee should be consumed regularly
 Avoid chivada, bhajiyas, sev, vadas gathiyas and sweets
 Reasonable physical activities such as careful walking or yogic exercises can be taken under supervision if permitted by the obstetrician.

Source: Press release
Image Source: Shutterstock

Published: May 16, 2018 12:13 pm



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