Gestational Diabetes – the silent threat

Dr Varsha Khatry, Head-Medical and Scientific Affairs, Roche Diabetes Care, India elucidates on the risks that pregnant women are at if GDM is not diagnosed at early stages of pregnancy

Diabetes is a serious and worrying conditions plaguing India. The country has the second largest number of diabetes patients in the world. In 2017 about 73 million people suffered from the disease, according to the International Diabetes Federation. The worrying thing is that at current prevalence rates, this number is only set to grow, hitting 114 million by 2045 ¹, which would make the country home to the largest population of people with diabetes. The good thing is awareness about the disease is growing. However, one major blind spot remains – gestational diabetes.

Gestational Diabetes Mellitus (GDM), to refer to it by its proper medical name, is a form of diabetes that occurs during pregnancy. If not detected and treated, it can adversely affect the health of both the mother and the child. The consequences can be serious, even fatal.

GDM is a major cause of stillbirths. It is also responsible in many cases for neonatal deaths (death within 28 days of birth). It can cause babies to be born underweight or with deformities. Children whose mothers suffered from GDM when pregnant are also at a higher risk of obesity and diabetes. Moreover, about one third of children born of diabetic pregnancies develop glucose intolerance before the age of 17.²

The complications for the mother can also be serious. For instance, mothers suffering from GDM are more likely to have to undergo caesarean section births. They are also likely to have a seven-fold higher risk of developing type- 2 diabetes.² This risk increases steeply five years after delivery. They have a higher prevalence of metabolic syndrome and are at an increased risk of contracting cardiovascular diseases.

And Indian mothers are particularly prone to developing GDM compared to caucasian women, SV Madhu of the University College of Medical Sciences and GTB Hospital, Delhi, pointed out in an article published in the February 2018 journal of the Research Society for the Study of Diabetes in India. “Indian women have an 11-fold increased risk of developing glucose intolerance during pregnancy compared to caucasian women,” said Madhu in the article.

Her point is backed up by data. There is no national level data available on the prevalence of GDM. But, studies conducted by the Indian Council of Medical Research in rural areas of certain states put prevalence rates at between 6.7 per cent and 13.9 per cent.

Worldwide, one in 10 expecting mothers suffer from GDM. Government data says in India that is likely to be double the global average at one in five. As of 2010, there were an estimated 22 million women with diabetes, between the ages of 20 and 30 years. An additional 54 million women in this age group had impaired glucose tolerance or pre-diabetes with the potential to develop GDM if they became pregnant, the Government data said.

This paints a grave picture. But the good thing is the Government has recognised the threat GDM poses. It has been working to raise awareness and has issued a set of guidelines so expecting mother can detect and treat GDM in time.³

Importance of screening:

The guidelines say all pregnant women across the country must be screened for GDM. States are free to choose the initial districts and extend the coverage to the rest gradually. In the chosen districts, the screening must be universal from the district hospital downwards in the public healthcare system. The choice of initial districts will be based on logistical convenience and not their GDM profiles.

Regular testing:

The oral glucose tolerance test is to be done twice: once at the first antenatal contact as early in the pregnancy as possible and the second during 24-28 weeks of pregnancy if the first test is negative. The second test is important as many pregnant women develop blood sugar intolerance during this period. Only one-third of GDM positive women are detected during the first trimester. There should be a gap of four weeks between the two tests. After the 28th week of pregnancy, only one test at the first point of contact is to be done.

Treatment:

A pregnant woman testing positive must be put on medical nutrition therapy (MNT) and physical exercise for two weeks. MNT refers to carbohydrate-controlled balanced meals, which provides adequate nutrition to the mother and the foetus. It ensures adequate weight gain – 300-400 grams per week and 10-12 kg during pregnancy and maintains the blood sugar levels. She should walk or exercise 30 minutes a day. After two weeks of MNT and physical exercise, blood sugar levels should be tested two hours after a meal. If the blood sugar level is at or less than 120 mg/dl at least one test must be done in the second and third trimester. If the blood glucose level is 120 mg/dl or more, Metformin or insulin therapy should be started.

GDM needs to be taken seriously:

After all, it is nearly impossible to do anything about diseases that have a foetal origin, as Dr V Seshiah, a member of the expert committee that drafted the technical and operational guidelines for the National Health Mission’s (NHM) programme of universal screening of pregnant women for diabetes, said.
Catching it early and treating can not only save you money but also your child’s life.

Source:

1. International diabetes Federation
2. SV Madhu of the University College of Medical Sciences and GTB Hospital, Delhi, in an article published in the February 2018 journal of the Research Society for the Study of Diabetes in India
3. In November 2014, the government released the guidelines for diagnosis and management of GDM in pregnant women. These were revised in February 2018.