It’s 5 am and it’s been a week since I saw the 2 blue lines on my home pregnancy kit, the elation has not yet died down. I creep to the refrigerator to see what I can snack on because hey I’m pregnant and I can eat to my heart’s content! Half a loaf of banana bread-bingo! And the early morning binge-eating begins….
Gestational Diabetes is defined as Diabetes Mellitus which makes its first appearance during pregnancy. The blood sugar values which we consider abnormal are different in the pregnant population from the normal adult population. This is because, 2 individuals are involved in the management, the baby as well as the mother.
As most of you are aware, India is the diabetic capital of the world. According to the International Diabetes Federation Atlas 2015, an estimated 69.2 million Indians are diabetic, which as per the WHO assessment, stood at 63 million in the year 2013. The estimates depict that diabetes prevalence has alarmingly doubled and so far has grown by over 100% in the past 15 years. That is why we are trying to arrest diabetes from the in-utero stage.
What?? How can I be diabetic? I just breezed through my 1st trimester and now this? So now I have to be really careful about what I eat, how much I eat and continue working out so the sugar levels stay in control, this is confusing!
In addition to these disturbing figures, GDM cases are poised to rise to 101.2 million by 2030. Not just that, women also have a high prevalence of diabetes. Of the 65 million people with diabetes and 77 million people with pre-diabetes in India, approximately 45% are women.
Due to this high prevalence, screening is essential for all Indian pregnant women. DIPSI – Diabetes In Pregnancy Study group India – recommends that as a pregnant woman walks into the antenatal clinic, she has to be given a 75g oral glucose load and at 2 hrs a venous blood sample is collected for estimating plasma glucose. This one step procedure of challenging women with 75 gm glucose and diagnosing GDM is simple, economical and feasible. A value of above 140 mg% is said to be diagnostic and between 120 – 140 mg % is classified as impaired glucose tolerance. This GCT is to be done at first visit, at 24 – 28 weeks and at 32 – 34 weeks.
Worst experience during my pregnancy-taking a glucose tolerance test, yuck! They make you guzzle down sugar water and then keep poking you with needles to get blood samples. I mean, how bad can it be if my sugar’s a little high-not likely to affect the health of my child is it?
When the mother has diabetes, the baby’s blood sugar also tends to be high, the baby tends to be heavier and tends to have Type II Diabetes at an earlier age.
A team approach is ideal for managing women with GDM. The team would usually comprise an obstetrician, diabetes physician, a diabetes educator, dietitian, midwife, and pediatrician. Intensive monitoring, diet, and insulin are the cornerstone of GDM management.
So I successfully battled this problem, with the help of a strict diet, exercise, vigilant doctors and a supportive family, I managed to get through the remaining months without having to take treatment. Now I’m a happy (though sleep-deprived) mom, with a healthy baby.
Medical Nutrition Therapy is offered to all cases of GDM. When this fails to adequately control the blood sugar, or she is too near term, or her levels initially were high, the mother is put on Insulin injections. A combination of plain insulin or a combination with intermediate/ long-acting insulins can be given. FDA has not approved Metformin even though it is safely being used.
With good control, the mother can be taken to term and she can have a normal delivery too. The importance of Antenatal Surveillance cannot be over emphasized.
Control of the blood sugar during pregnancy can go a long way in controlling the prevalence of diabetes in India. Let’s all work towards a diabetes free India.
Three years down, 2 blue lines again, this time I’d planned to be careful and avoid GDM right from the start. All went well until the 7th month, again the routine lab tests showed high blood sugar and I had to be put on treatment- so much for prevention! Anyway, this time to the final result was good- another healthy baby. However, the doctor’s last words have stayed with me…unless you remain careful about the lifestyle, you are bound to get Diabetes in future…
Dr Mini Nampoothiri is an Obstetrician and Gynaecologist practicing with Apollo Hospitals in Navi Mumbai. She is also the Vice President at NMOGs and has practiced at Terna Sahyadri Hospital, Surya Hospital, and MGM Hospital prior to joining Apollo.