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Gestational Diabetes Mellitus


What Is Gestational Diabetes?

 Gestational diabetes is a condition during pregnancy which is caused by the body not being able to use insulin due to a hormone produced during pregnancy.

 Any degree of glucose intolerance with onset or first recognition during pregnancy.

 The placental hormones make insulin less effective, which called insulin resistance. Gestational Diabetes symptoms usually disappear after delivery.

 What Are The Causes Of Gestational Diabetes Mellitus?

 The exact causes of diabetes mellitus during pregnancy are not know. Some of the theories are:
  • Glucose is the primary fuel utilized by the fetus. There is increased utilization of glucose by the fetus

  • Hormones like estrogen, cortisol, and placental lactogen which are produced by the placenta during pregnancy have a blocking effect on insulin.
Risk factors of Gestational Diabetes Mellitus

Some of the factors that increase the chance of getting gestational diabetes mellitus include:
  • Being obese
  • Family History of GDM
  • Previous history of GDM
  • Age greater than 25
  • History of impaired glucose intolerance
Effect of Gestational Diabetes Mellitus on Pregnancy

Effects on the mother include:
  • Increased risk of preeclampsia
  • Increased infections like UTIs, Chorioamnionitis, Endometritis
  • High risk for postpartum hemorrhage
  • Increased rates of cesarean delivery
  • Polyhydramnios
Effects on the fetus:
  • High risk of perinatal death - Due to chronic intrauterine hypoxia.
  • Intra-Uterine growth restrictions 
  • Macrosomia - birth weight exceeds 4kg which can result in shoulder dystocia, traumatic birth injury
  • Increased chance of congenital malformations
Diagnosis Of Gestational Diabetes Mellitus 

Screening should be done at 24-28 weeks of gestation.

Oral Glucose Tolerance Test: We give the patient a 50-gram glucose check after an hour to see how the body reacted to the glucose. If the blood glucose level exceeds 140mg/DL we perform an oral glucose tolerance test. This means having a 3-hour glucose tolerance test.
  1. Fasting period - blood glucose level greater than 105mg/dl
  2. First hour - blood glucose level greater than 190mg/dl
  3. Second hour-blood glucose level greater than 165mg/dl
  4. Third hour-blood glucose level greater than 145mg/dl
Diagnosis is made when two of the above are met.

Treatment of Gestational Diabetes Mellitus

Oral hypoglycemic are not used for gestational diabetes mellitus,
Instead, multiple daily injections are preferred. Hospitalization is required for poorly controlled diabetes. 

Exercise is usually advised to control diabetes.

Elective delivery at 38-40 weeks of gestation. we should check for fetal lung maturity before delivery. Cesarean delivery is not needed unless there is macrosomia or unfavorable cervix.

More than half of the women with gestational diabetes mellitus ultimately develop overt diabetes.
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