Gestational Diabetes Mellitus in pregnant women.

Diabetes mellitus in pregnant women poses problems for the mother, fetus and child.[ JJSYPEKAEBBT]
Women with established diabetes may have menstrual problem and difficulties in
pregnancy. Pregnancy by itself worsens diabetic control and may cause certain diabetic complications to progress in women. Maternal diabetes is also hazardous for the fetus and carries increased risk for fetal loss and major congenital malformations.
However nowadays most women of childbearing age can realistically expect to become mothers of healthy children with intensive glycemic control. Improvements have
ranged from technological advances in fetal surveillance, [ultrasound scanning] home glucose monitoring and intensive insulin regimens and have enabled even women
with multiple diabetic complications to have successful pregnancies.
Diabetes mellitus in pregnancy is divided  into pre-gestational and gestational diabetes.If diabetes is found for the first time in a pregnant women,where it was not there before, is called gestational diabetes.Approximately 7% of all pregnancies are complicated by GDM[gestational diabetes mellitus]. Normal pregnancy reduces
insulin sensitivity because of diabetogenic effects of placental hormones. Gestational diabetes resolves after delivery, but may recur in subsequent pregnancies and a lifetime risk for developing type 2 diabetes is 30%.
INDICATIONS FOR DETECTION OF DIABETES IN PREGNANT WOMEN.
1]Family history of diabetes.
2]Glucose in urine sample.
3]History of unexplained prenatal loss.
4]History of large baby.
5]History of congenitally malformation infant.
6]Maternal obesity.
7]Maternal age more than 25 years.
8]Members of ethical/racial group with high prevalence of diabetes mellitus.
[such as African American, American Indian,Asian American, Hispanic/Latino, or pacific Islander.]
To prevent excess spontaneous abortion and congenial malformation in infants of diabetic mothers, diabetes care and education must begin before conception.There are no contraceptive methods that are specifically contraindicated in women with diabetes. The selection of a method should focus on methods with proven high degree of effectiveness. Once patient achieved stable sugar control than conception can be
discontinued and plan for pregnancy.
Management during pregnancy.
1]Quiet smoking/alcohol.
2]Home blood glucose monitoring.
3]Diet control/foliate supplementation.
4]Regular exercise.
5]Fetal monitoring by ultrasound scan.
6]Accurate insulin regimen.
7]Management of complications.
Diabetes is associated with a significant increase in the risk complications during
pregnancy and delivery.Appropriate management, including medical education, therapy
accurate insulin regiment and cautious obstetric management achieves a successful
pregnancy outcome for the mother and child.
Up date on 03/09/2010.
Gestational diabetes Cause
When you are pregnant your body gains weight and some hormone changes take place. But these changes are hard on your body to keep up with its need for a hormone called insulin. This condition negates the body from its energy needs.
Gestational diabetes diagnosis
Your health care team will check your blood glucose level. Depending on your risk and your test results, you may have one or more of the following tests.
1.Fasting blood glucose or random blood glucose test.
Here you are asked to fast before taking the test.You have go without food for at least 8 hours before the test.This test is known as fasting glucose test.
In random blood glucose test, your blood glucose may be checked at any time of the day.
With these tests its is possible to find gestational diabetes in some women, at the time other tests are also needed so as to not miss the prevalence of gestational diabetes.
2.Screening glucose challenge test.
In this, you are given a sugary beverage 1 hour before taking the blood glucose test. If the result is above normal, further tests are needed.
3.Oral Glucose Tolerance Test.
Here, from 3 days before the test, you have to have normal food. On the test day you have to fast for 8 hours before the test. On the test day your blood glucose levels will be checked. You will be given a sugary beverage to drink and blood glucose levels at intervals of 1 hour, 2 hours and 3 hours after the drink will be taken. If the levels are above normal twice during the test, you have gestational diabetes.
Above-normal results for the oral glucose tolerance test*

Fasting	95 or higher
At 1 hour	180 or higher
At 2 hour	155 or higher
At 3 hour	140 or higher

Note: Some labs use other numbers for this test.
*These numbers are for a test using a drink with 100 grams of glucose.
GESTATIONAL DIABETES TREATMENT?
Treatment is aimed at keeping the blood glucose levels at a target during pregnancy by
1] diet
2]exercise
3]insulin
1] DIET- A dietitian will give you a meal plan which you are to follow.This plan is aimed to keep your glucose level within the target.The broad guidelines will consist, among others, the following;
a]To Eat three small meals and one to three snacks every day.
b]To be careful in the amount of carbohydrate rich food you take and when to take it.
c]To include fiber in your food.
2]EXERCISE
Your health care team will guide you through the physical activity that you will undergo, after having a discussion and knowing you normal activity schedule.
3]INSULIN
Some women may require insulin in addition to the above to be within their blood glucose target.

Raghu Natrajan

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