Dealing with Gestational Diabetes: How does it affect the mother and the baby

Health consequences of GDM for mom and baby

• Cesarean and operative vaginal delivery
• Macrosomia
• Shoulder dystocia
• Neonatal hypoglycemia
• Hyperbilirubinemia

An observational study conducted across several countries, including more than 23,000 women, found increased adverse pregnancy outcomes with increasing glycemia. Women who had GDM earlier are at risk of developing diabetes years after the pregnancy. Their children are also at risk of developing diabetes and obesity. Hence, it is essential to focus on gestational diabetes in pregnant women to mitigate short and long-term consequences for both the mother and the child.

Risk factors for GDM

According to the Australasian Diabetes in Pregnancy Society guidelines, the risk factors of GDM include:

• Previously elevated blood glucose level
• Previous hyperglycemia in pregnancy
• Family history of diabetes mellitus
• Maternal age more than 40 years
• Ethnicity (Asian, Middle Eastern, and African)
• High pre-pregnancy body mass index (BMI)
• Previous history of macrosomia
• Polycystic ovary syndrome (PCOS)
• Use of medications such as corticosteroids and antipsychotics

American Diabetes Association (ADA) recommendations for screening for GDM

• Pregnant women with risk factors of diabetes should be screened for type 2 diabetes mellitus at the first prenatal visit
• Pregnant women with no history of diabetes can be assessed for GDM at 24 to 28 weeks of gestation
• Pregnant women diagnosed with diabetes should be assessed for persistent diabetes at 6 to 12 weeks after childbirth
• Women with a history of GDM should be evaluated every three years throughout their lifetime

Strategies to diagnose GDM

Considering the high prevalence of GDM, and the maternal and fetal morbidity associated with untreated or inappropriately managed GDM, the timely diagnosis of GDM will allow the initiation of appropriate treatment to prevent and minimise the ill effects of uncontrolled GDM on the mother and child in the short term and long term.

The oral glucose tolerance test (OGTT) is the most common glucose tolerance test, which measures the body’s response to blood glucose. It is used to diagnose diabetes, gestational diabetes, and prediabetes. In this test, the plasma glucose is assessed 2 hours after ingesting 75 g of oral glucose dissolved in 300 ml of water. The blood glucose assessment is done with a standardized plasma glucometer. Blood glucose levels of ≥140 mg/dL confirm the diagnosis of GDM.

Conclusion

Gestational diabetes can raise the odds of pregnancy complications. Diagnosis of GDM may help devise management strategies to improve maternal and fetal outcomes.