Gestational diabetes

Gestational diabetes is a special type of diabetes that occurs exclusively during pregnancy. Like all other forms of diabetes, gestational diabetes also gives rise to increased blood sugar and complications out of the increased level of it. This type of diabetes is short lived, the glucose level returns to normal soon after the delivery of the baby.

Gestational diabetes affects about 4% of all the pregnant mothers, an estimated 135,000 cases of gestational diabetes reports each year in the United States. The exact cause of this disease is not known. But it is hypothecated that some placental hormones blocks the action of insulin in the mother’s body although it helps to grow the baby inside the womb. This problem of refractoriness of hormone action is called Insulin resistance. It becomes hard for the mother’s body to use the full benefit of insulin. There is three times increased demand of insulin in the mother’s body. Without the presence of enough effective insulin, glucose can not be converted to glycogen (its stored form) and it starts building up in the blood. The end result is hyperglycemia. Gestational diabetes generally develops after three months of pregnancy (second trimester). But it may occur as early as 20^th week and can start at the last trimester of pregnancy also. Primigravida (mothers having first pregnancy) of more than 25 years, those who have a positive family history of gestational diabetes in their close relation, obese mothers are prone to develop this disease. Hispanic, black and American Indian women are racially prone to develop gestational diabetes.

Gestational diabetes occurs when the structure of the baby is formed inside the uterus but it is still in the preliminary stage. So it does not cause any kind of developmental abnormality as seen in the mothers who are suffering from diabetes before pregnancy. Nevertheless, poorly controlled or untreated gestational diabetes can harm the growing baby. The insulin level can not lower the blood glucose in mother. Although mother’s insulin does not cross placenta, glucose and other nutrients easily do and there is increased glucose level in the baby’s blood. This causes the baby’s pancreas to secrete extra insulin to get rid of this extra glucose. As the baby is getting more energy in terms of glucose, this extra energy is stored in the baby’s body as fat and the mother delivers a flabby child (Macrosomia) which of course is not healthy. Macrosomic child can injure themselves to their shoulder at the time of normal delivery besides low blood sugar level owing to high concentration of insulin. These babies are prone to breathing problem, jaundice and obesity. They may develop maturity onset diabetes (type II diabetes) in due time. Gestational diabetes may be a predisposing factor for pre-ecclampsia for the mother.

Screening of gestational diabetes is very important those who possess the risk factors. Glucose challenge test is to be done during 24^th and 28^th weeks of pregnancy. Blood glucose level below 130-140 mg/dl is considered normal in all occasions.

Regarding treatment of gestational diabetes, planned diet and regular exercise are the two most effective approaches. Diet should be rich in fresh vegetables, fruits and cereals. Plenty of water is to be taken. Pregnancy exercises can be undertaken after consulting your gynecologist. Exercise helps to reduce blood sugar level. Any kind of anxiety and stress must be avoided.

If these two methods fail to control the raised blood glucose level, subcutaneous insulin injection is the last option for management of gestational diabetes.