Diabetes mellitus in Pregnancy - Gestational diabetes mellitus, effect on pregnancy, diagnosis and management

What is gestational diabetes:-

Diabetes mellitus is a metabolic disorder that is characterized by increased sugar levels in blood as a result of defective insulin secretion, insulin action, or both.

diabetes mellitus is the most common medical complication of pregnancy.

Pathophysiology of gestational diabetes:-

Insulin resistance is the main reason for the complication of gestational diabetes mellitus.

What are the risk factors:-

Following are the risk factors that must be always kept in mind if someone preparing to take chance for pregnancy; 

Strong family history of diabetes

Obesity,body mass index (BMI) > 30 kg/sqm

Previous gestational diabetes.

Previous history of polyhydramnios.

Overage female

High cholesterol-containing diet 

Sedentary lifestyles

Effects of diabetes on pregnancy:-

Effect of pregnancy on diabetes:

Hyperglycemia

Increased insulin resistance

Increased chance of infections

Increased chance of diabetic complications like retinopathy, nephropathy, cardiovascular diseases.

Effect of diabetes on pregnancy:

Effect on mother:

Miscarriage

Hypertension and pre-eclampsia

Urinary tract infections.

Obstructed labour due to macrosomia

Effect on foetus:

Macrosomia

Intrauterine growth retardation

Hyperglycemia

Stillbirth/perinatal mortality

Polyhydramnios

A birth injury like shoulder dystocia, fracture

Congenital anomalies like neural tube defect, microcephaly, cardiac and renal anomalies.

Prematurity

Respiratory distress syndrome

Hypoglycemia

Hypocalcemia

Hyperbilirubinemia

Diagnosis of gestational diabetes mellitus:-

History:

Past history of diabetes 

Family history

Advanced maternal age

Radiology:-

Routine foetal ultrasonography as an antenatal check-up.

Blood test:

Total leucocyte count

Haemoglobin

Thyroid function

Blood sugar level:

OGT Test - Oral glucose tolerance test

Random blood sugar

Fasting blood sugar

Postprandial blood sugar 

Hb1Ac- glycosylated haemoglobin

Biochemistry:

Kidney function test

Liver function test

Urine test:

Routine microscopy

Benedict's test for sugar

Culture and sensitivity

Management of gestational diabetes:-

Dietary management:

It's very important to manage gestational diabetes by nutrition and diet. So foods with a lower glycemic index should be given. And required calories, protein, and fat are must be provided in the diet.

Avoid foods with a high glycemic index.

Avoid high cholesterol-containing food.

Avoid high-fried, cooked food.

Also read:-    What should be the diabetic diet plan?

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Medical management:

Insulin is the drug of choice for the treatment of gestational diabetes.

Oral hypoglycemic drugs are not safe during pregnancy. There are many adverse effects of oral hypoglycemic drugs.

Exercise:

In spite of the above management with diet and oral and drugs the regular aerobic and anaerobic exercise is also very necessary for the regulation and maintenance of blood sugar levels.