Gestational Diabetes: Far from ‘Sweet Motherhood’

By Zeenat Farooq

Gestational Diabetes (GD) or Gestational Diabetes Mellitus (GDM) defines a condition in which an expectant mother develops blood sugar levels which are higher than normal (120 mg/dl). When a woman becomes pregnant, there are so many metabolic and physiological changes which occur inside the body. More important here is that there are some hormones which are secreted by the placenta which leads to rise in the blood sugar levels of the mother. This actually happens to meet the increasing demands for Glucose by the foetus, but if the body of a mother is not able to cope with the increased sugar levels, by not producing enough Insulin, there is build-up of Glucose in maternal blood which surfaces in the form of Gestational Diabetes.

Usually, an expectant mother is screened in the eighth week of pregnancy for Gestational Diabetes, but if the mother is obese, or has a family history of Diabetes Mellitus, she might be screened early in order to avoid the complications which may arise later on.

Risk Factors Associated with Gestational Diabetes

Following factors increase the chances of an expectant mother to develop Gestational Diabetes:

1. If the expectant mother is more than 25 years of age at the time of conceiving.
2. If the expectant mother belongs to the ethnic backgrounds like Latin American, Asian and African American.
3. If the expectant mother is obese and has a family history of Diabetes.
4. High stress levels in expectant mother which lead to shooting up of blood Glucose levels and persistent activation of some key genes involved in inflammatory and immune function.
5. Prolonged use of steroidal medicines, smoking and alcoholism.
6. If a woman has had Gestational Diabetes during earlier pregnancies.
7. Gender of the developing foetus also affects the likelihood of mother to develop Gestational Diabetes.
8. A low Magnesium concentration in the diet of mother since it affects the action of Insulin on target cells.

Metabolic Changes Associated with Pregnancy

A number of metabolic changes occur during pregnancy, which are in accordance with the dual need of feeding for the mother and the developing foetus. For example, cravings of mother increase for foods which are a stimulus for increased calorie consumption. Also, Lipolysis (digestion of body Lipids for use as a fuel to meet the energy needs) also increases to spare the glucose for foetus since Lipids do not cross placenta to serve as foetal energy source. But these changes can also increase chances of developing Gestational Diabetes, since increased calorie consumption leads to build up of unused energy.

Effects of Gestational Diabetes on Expectant Mother

1. Pre- Eclampsia: This is a disorder which affects expectant mothers in the third trimester, and is characterized by high Blood Pressure and high levels of Protein in the Urine. This condition affects 10-25% of all expectant mothers with GD.
2. Higher risk of catching infections like Chorioamnionitis (inflammation of foetal membranes due to bacterial infection) and Postpartum Endometritis (infection of the membrane of uterus).
3. Heightened Postpartum Bleeding i.e., bleeding after child birth. This happens because the baby is over nourished and hence oversized which leads to some damage to Uterine and Cervical muscles.
4. Caesarean section usually becomes a necessity because the size of the foetus imposes limits on the possibility of normal delivery.
5. Weight gain, Hypertension, increased chances of miscarriage.
6. Higher risk of developing Type-II Diabetes Mellitus in the long run.

Effects of Gestational Diabetes on Foetus

The developing foetus may develop the following abnormalities during term (when the foetus is inside the body of the mother) and also after birth (Neonatal Abnormalities).

1. Neonatal Hypoglycaemia in the child after birth.
2. Macrosomia (big baby syndrome. Size of baby more than 4 Kg). This can cause a number of complications in the mother, as already stated, and also in the foetus like congenital abnormalities, anomalies in a number of organs, poor mental development, oedema etc.
3. Jaundice, Polycythaemia, Hyper-viscosity Syndrome, Hypomagnesaemia and Hypocalcaemia (decrease in the levels of magnesium and calcium in the body).
4. Birth trauma (due to Macrosomia) due to abnormal size of foetus and increased stress on the new born at the time of birth.
5. Prematurity, Hyaline membrane disease, Respiratory distress, Bradycardia, long term effects on cognitive development.
6. Metabolic Syndrome, Insulin resistance, risk of developing Type-II Diabetes later in life, increased risk of developing cardiovascular diseases.

Pregnancy Management

In the wake of all these issues, the concept of pregnancy management becomes even more important.  It is very important for a woman if she is planning on having a baby to get herself immunized and screened for all the routine infections and also for fatal diseases like HIV, Hepatitis etc. Also, once the pregnancy sets in or even before that, the mother should adopt necessary habit and lifestyle changes like avoiding processed food consumption, reducing Sodium intake, taking more fresh fruits and vegetables, performing routine exercise, meditation, avoiding stress, quitting smoking and alcoholism, avoiding un-necessary consumption of medicines especially Steroidal medicines and Pain Killers, and so on in order to ensure proper health of both the mother and the baby, and also to avoid long term complications associated with Gestational Diabetes.

(Author is a Research Scholar at Department of Biotechnology, University of Kashmir.)

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