Introduction
Gestational Diabetes Mellitus (GDM) is considered one of the most common conditions that affect women during pregnancy or gestation, where blood glucose levels are increased above normal limits (Baz et al., 2015). Blood glucose levels are controlled normally by insulin hormone (Kinalski et al., 2002). But some pregnant women may have higher levels of glucose that cannot be managed by insulin secreted in their bodies (Kleinwechter et al., 2014).
Diabetes Mellitus, other than GDM, could be one of two types, “type one” in which the body does not secrete insulin hormone at all and mostly called ‘juvenile diabetes’ (Toyoda, 2002), and “type two” in which the body does not secrete enough insulin and/or there is insulin resistance or the cells do not react to insulin) (Toyoda, 2002).
GDM usually arises after 28 weeks, in the third trimester, of pregnancy, and usually disappears after delivery of the baby (Association, 2010). Women with GDM are prone to the risk of preeclampsia and Caesarean section (Ross, 2006) in addition to developing type 2 diabetes later on (Dunne et al., 2003), so they should keep monitoring their blood glucose levels and manage it with their physicians at a regular basis (Kim, 2010). GDM symptoms and signs are very few in general and mostly diagnosed by screening tests blood glucose levels, which are mostly above normal limits, in blood samples withdrawn during pregnancy (Kalelioglu et al., 2007).
Epidemiology
About 3 to 10% of pregnant women are affected with GDM, according to several factors (Chanprapaph and Sutjarit, 2004). If they are not treated, they would deliver infants at high risk of clinical problems, for example being larger than normal (macrosomia) which may cause delivery complications), jaundice and hypoglycemia (Kinalski et al., 2002). This can also lead to seizures or being born dead (stillbirth) (Kinalski et al., 2002).
GDM could be treated and women can decrease these risks effectively by controlling of glucose levels in their blood (Erem et al., 2015). This control could be achieved by following a healthy eating plan and keeping active and physical exercises, and if this does not work, then using anti-diabetic medications (the safest one is insulin), would be necessary (Erem et al., 2015).
Classification
GDM could also be defined as a degree of intolerance of glucose during gestation period (Buchanan and Xiang, 2005). This definition may indicate that pregnant woman has not been diagnosed with diabetes mellitus previously, or she may have developed diabetes mellitus simultaneously with pregnancy (Buchanan and Xiang, 2005). Diabetes Mellitus could be classified into two groups according to this definition, which are Gestational Diabetes Mellitus (type A) and Pregestational Diabetes Mellitus (prior to pregnancy) (Association, 2010).
Furthermore, These two groups are classified according to their related risks and how to manage them (Association, 2010), where Gestational Diabetes Mellitus is divided into type A1 and type A2. Type A1 is diagnosed using oral glucose tolerance test which shows abnormal levels of glucose, however during fasting and after a meal by two hours (postprandial), it shows normal levels of glucose; so following healthy diet and practicing physical activities would be sufficient for management of this type (Mellitus, 2005). Type A2 is diagnosed using oral glucose tolerance test which shows abnormal levels of glucose and during fasting after a meal by two hours (postprandial), it also shows abnormal levels of glucose; so management would necessarily include the use of anti-diabetic medications such as insulin or other oral drugs (Abell et al., 2015).
Pregestational Diabetes Mellitus is also divided into many subtypes, these subtypes may affect different age group and last for different period of time (Table 1), as in subtype B, C and D (Association, 2010). Other may affect different organs of the body, which include subtype E, which is obvious with calcified (rigid) vessels in pelvic region, subtype F which affects the kidney, subtype R which affects the retina, subtype RF which affects both kidney and retina, subtype H which affects the heart, and subtype T which arises before transplantation of kidney (Association, 2010).
Subtype / Period / Age / onset
- B Less than 10 years Equals to or more than age 20
- C Between 10 to 19 years Equals to a range of age 10 to 19
- D More than 20 years Equals to or less than age 10
Table 1 Pregestational Diabetes Mellitus Subtypes
Pathophysiology
GDM develops because of a lot of hormonal changes and otherwise occurring during gestation, when there is not enough insulin secreted to control the rise in blood glucose levels and metabolize such glucose effectively. Insulin is a hormone formed in the pancreas. Insulin helps the body to use glucose for energy and helps control your blood glucose levels (Kinalski et al., 2002). When insulin binds to its receptors, it activates several protein processes necessary for the synthesis of glucose, glycogen and fatty acid synthesis, besides glycolysis process and metabolism of carbs and fats to get energy for cells (Poulakos et al., 2015).
It is unknown yet the exact mechanisms causing GDM (Poulakos et al., 2015). It is thought that pregnancy hormones may interfere with insulin action by binding to its receptors and replacing it, this is called insulin resistance (Kahn, 2003). As insulin activates glucose influx into most cells, then insulin resistance would prevents the occurrence of this action. And so glucose would remain in the bloodstream; this means the rise of glucose levels (Vambergue et al., 2002). As a consequence, more insulin would be needed to resolve this resistance; which could be about 1.5 to 2.5 times more in the normal pregnancy, to ensure enough glucose and nutrients supply to the fetus, so it can grow. This means also that insulin resistance is something normal which arises in the second trimester of pregnancy, but it could further progress to levels equivalent to type 2 diabetes levels (Becquet et al., 2016).
Placental hormones, like cortisol and progesterone, also may control the mechanism of insulin resistance during pregnancy, but estradiol hormone (estrogen sex hormone), prolactin hormone (luteotropin or Milk hormone), placental lactogen hormone (chorionic somatomammotropin), other placental hormones, TNFα (tumor necrosis factor alpha), resistin hormone (adipocyte-specific hormone), and leptin hormone (satiety hormone), are all involved also in decreasing of insulin resistance during pregnancy (Abell et al., 2015).
Complications
GDM risks affect both mother and her baby. These risks are associated and increased with unmanaged glucose levels which exceed normal limits and their effects. Treatment and good control of these levels can reduce many of these risks significantly (Lee et al., 2007). GDM, if not treated or managed, can cause problems for the baby. Babies might be born with a body larger than normal—a condition called macrosomia—as extra glucose in mother’s bloodstream crosses the placenta, which stimulates baby’s pancreas to secrete more insulin, which in turn makes the baby grow too large (Obstetricians and Gynecologists, 2000). Very large babies —of weight › 4 kg — are prone to the risk of being stuck in the birth canal during vaginal delivery, causing problems like shoulder dystocia; when baby’s head passes through the vagina, but baby’s shoulder gets stuck behind pelvic bone. Shoulder dystocia can be dangerous as baby may be unable to breathe easily while stuck (Draycott et al., 2008). These problems make C-section more preferred, or decide early delivery if this happens.
Babies also might be born early (preterm birth) with respiratory distress syndrome. GDM increases the risk of early labor and delivery before the due date. Dysmature babies are prone to this syndrome due to lung immature lung and its surfactant formation which, in turn, affects respiration (breathing) and makes it not easier (Baz et al., 2015). Babies suffering from this syndrome would need respiratory care until their lungs become mature and gets stronger (Brower et al., 2004). Babies also might be born with jaundice, in which the skin and eyes’ whites become yellowish in color. Jaundice usually disappears, when the baby gets enough breastfeeding with the help of phototherapy (Ross, 2006).
Babies also may develop hypoglycemia (Low blood sugar) shortly after birth because their bodies secrete higher amounts of insulin. Severe hypoglycemia may stimulate seizures in the baby, which may need intensive care and quick intervention with good feedings and administration of intravenous glucose solution to return blood sugar to normal levels (Cryer et al., 2003). Babies of mothers who have not treated or managed GDM may be subject to risk of developing Type 2 diabetes and obesity later on in their life (Bellamy et al., 2009). Untreated GDM also could lead to baby death either before birth or after a short time of it (Bellamy et al., 2009).
GDM, if not treated or managed, may also increase the mother risk of having high blood pressure (hypertension) and more levels of protein in urine (proteinuria), a condition called preeclampsia (Redman and Sargent, 2005). Preeclampsia usually occurs during the 2nd half or 3rd trimester of pregnancy. If it is not treated, it can cause a lot of problems for both mother and baby and may lead to death. The only way to cure preeclampsia is to give birth or to have a cesarean section to deliver the baby early (preterm birth) (Redman and Sargent, 2005, Sibai, 2003). If preeclampsia develops earlier, the mother may need for bed rest and medicines, which could be achieved by hospitalization for adequate care for both her and the baby (Redman and Sargent, 2005).
It may also increase the mother risk of getting depressed. Depression, in turn, can make her too tired and feel sad, nervous or unable to accommodate with the changes she is facing (Musselman et al., 2003). She may develop diabetes of type 2 and all of its related problems later on (Dunne et al., 2003), check Table 2 for a conclusion of these complications.
Fetal complications / Maternal complications
- Fetal distress/fetal death
- Birth injury due to shoulder dystocia and Macrosomia
- Delayed fetal development Neonatal hypoglycemia
- Neonatal hyperbilirubinemia Neonatal hypocalcemia Neonatal polycythemia
- Respiratory distress syndrome Hypertrophic cardiomyopathy
- Obesity/diabetes later Diabetic retinopathy
- Diabetic nephropathy
- Diabetic ketoacidosis
- Hypoglycemia (when using insulin)
- Spontaneous abortion Premature birth
- Pregnancy-induced hypertension Hydramnios
Table 2 Maternal and fetal complications in pregnancies with carbohydrate intolerance
Risk factors
Every woman should seek health care early, if possible — when she first think about trying to get pregnant — so her doctor can evaluate her risk of developing GDM. If she develops it, then she may need further more screening and checkups. These are most likely to occur during the third trimester (last three months) of pregnancy when the doctor will monitor blood sugar level of mother and baby’s health (MacNeill et al., 2001).
The most common is Polycystic Ovary Syndrome (PCOS), which is a common disorder of endocrine system which develops among women in child-bearing age. It is characterized by enlarged ovaries that contain small collections or follicles of fluid located in each ovary which could be seen during the ultrasound examination. It may lead to infrequent or prolonged menstrual periods, intense hirsutism, increased weight, and developing acne (Toulis et al., 2009). Other factor includes GDM history in the past, intolerance of glucose, previous diabetes, or abnormal fasting levels.
Risk also increase with one of first-degree relatives has a previous history of diabetes type 2, old maternal age which increases as a woman gets older especially for women whose age is over 35 or 45 years (Di Cianni et al., 2003), and ethnicity where non-white race has the highest risk factors including People from Africa, Islands of the Pacific, the Caribbeans, Hispanics, local native Americans, and South Asians (MacNeill et al., 2001). Among the factors also if there is a previous pregnancy which delivered a baby with a macrosomia (weight › 4 kg), if obstetric history is poor (Di Cianni et al., 2003), between smokers and obesity which means that body has excess fats, and body mass index (BMI) is 30 or higher (Mokdad et al., 2003), and other genetic factors where 10 genes at least involved with increased risk of GDM, when a certain polymorphism occurs to them, the most notable one is TCF7L2 gene (Zhang et al., 2013).
Risk factors are not usually demonstrable, nor symptoms in about 40 to 60 percent of women suffering from GDM; so all women must be screened. Some other women may suffer from some of the common symptoms of diabetes, like fatigue, tiredness increase of urination, nasal congestion, thirst, blurred vision, nausea and vomiting, fungal infections and urinary tract infection (MacNeill et al., 2001).
Most women who have well controlled GDM deliver healthy babies. However, GDM that’s not carefully managed can lead to uncontrolled blood sugar levels and cause problems for both the mother and the baby, including an increased potential for C-section delivery (Jensen et al., 2001).
Diagnosis & Screening
Blood tests are commonly used for diagnosing GDM. There are many screening and/or diagnostic tests for detecting high levels of plasma or serum glucose, as per WHO diagnostic criteria, (Table 3).
Condition 2-hour glucose Fasting glucose HbA1c
Unit mg/dl mg/dl mmol/mol DCCT %
Normal <140 <110 <42 <6.0
Impaired fasting glycaemia <140 ≥110 & <126 42-46 6.0–6.4
Impaired glucose tolerance ≥140 <126 42-46 6.0–6.4
Diabetes mellitus ≥200 ≥126 ≥48 ≥6.5
Table 3 WHO diabetes diagnostic criteria
Non-challenge blood glucose tests measure glucose levels in blood samples without challenging or forcing the person to drink a glucose solution, then blood glucose level is determined when fasting or two hours after a meal (postprandial), or at any random time, in contrast, challenge tests measure glucose levels in blood samples after forcing the person to drink a glucose solution (Mellitus, 2005).
Non-challenge blood glucose test, in which diagnosis of GDM is made, when a plasma glucose level is higher than 126 mg/dl after fasting, or over 200 mg/dl at any random time, and then confirmed on the following day, and no further testing is required after that (Nielsen et al., 2012). It is performed usually at the first antenatal visit. It has advantages like simple administration and inexpensive, however disadvantages are low performance, low specificity, moderate sensitivity, and high false positive results (Nielsen et al., 2012).
Screening glucose challenge test (O’Sullivan test) in which diagnosis of GDM is made, when a plasma glucose level is 140 mg/dl after 1 hour of drinking a glucose solution that contains 50 grams of glucose (Palmert et al., 2002). It is done between the gestational weeks 24–28. It has advantages like no previous fasting is required, simple and inexpensive , however disadvantages are glucose solution could cause nausea in some women, so artificial flavors could be added.
Oral glucose tolerance test (OGTT), is done, usually, at morning following fasting overnight (8-14 hours), the person must have unrestricted diet and physical activity during the last 3 days. The person will drink a glucose solution, containing 100 g of glucose, then withdrawing blood samples to measure glucose levels at the beginning and after one, two and three hours thereafter (Stumvoll et al., 2000). Diagnosis of GDM is then made, when fasting blood glucose level is larger than or equals 95 mg/dl, then 1-hour blood glucose level is larger than or equals 180 mg/dl, then 2-hour blood glucose level is larger than or equals 155 mg/dl then 3-hour blood glucose level is larger than or equals 140 mg/dl
Urinary glucose testing measures urine glucose levels which are considered high in women with GDM. Dipstick test, which is a stripe containing a reagent for detecting glucose in urine, is widely used, although it performs poorly; as the sensitivity of glucosuria for GDM in the first 2 trimesters is only around 10% (Goldstein et al., 2004).
Prevention
Ways that can lower the risk of getting GDM (Ratner et al., 2008) include losing extra weight as pregnancy could lead to a little increase of body weight, which is something good for baby health, but gaining too much weight in a very quick manner may increase the risk of getting GDM (Ratner et al., 2008). Increasing physical activity level before pregnancy is effective also for the prevention of GDM (Sanabria‐Martínez et al., 2015). Stopping smoking also may lower the risk of getting GDM. Monitoring blood glucose levels regularly. Also following a healthy eating plan, eating more grains, fruits, and vegetables, cutting down on fat and calories (Kim et al., 2007).
Healthy Eating Plan is an important factor of managing GDM (Reader et al., 2006). Following a healthy eating regimen or diet will help with controlling blood glucose levels to be within normal limits, providing adequate nutrition for mother and growing fetus, and achieving the convenient necessary changes of weight during pregnancy (Kim et al., 2007). Women with GDM are encouraged to eat small amounts and keep their weight healthy (Reader et al., 2006), eat carbohydrate in every meal, eat foods that provide nutrients especially needed during pregnancy, eat foods with high fiber content, and avoid foods and drinks of large amounts of sugar or high glycemic index ex. Basmati rices.
Carbohydrates are metabolized into glucose which is then used to produce energy. To well control glucose levels, it is necessary to distribute carbohydrate over three small meals and snacks daily (Zhang et al., 2006a). Foods containing carbohydrate include milk, yogurt, cereals, multigrain breads legumes like red kidney and baked beans, rice (Basmati), pasta, noodles, fruits, corn, potato, and sweet potato. Sucrose (table sugar), fruit juices, soft drinks, cakes, and biscuits have low nutritional value (Zhang et al., 2006a).
Eating fats, especially saturated fat, should be limited. Healthy fats should be used example, polyunsaturated oils, margarine, canola, olive oil, avocados and unsalted nuts. To avoid or decrease the intake of saturated fat, then low-fat dairy foods, lean meats should be selected and processed and takeaway foods should be avoided (Liang et al., 2010).
Protein should be served two times each day in a small amount, because of its importance for the growth of fetus and maintenance of mother health. It include lean meat, eggs, milk, low fat cheese and fish (Zhang et al., 2006b, Kim et al., 2007). These foods do not affect glucose levels of blood in a direct manner. (Zhang et al., 2006b).
Calcium & iron are increasingly required as pregnancy progresses. So should be served two times daily. (For calcium, one serve is equivalent to 200 g of yogurt, 250 ml milk, or 2 slices of cheese). The iron from red meat, chicken and fish are readily absorbed (Zhang et al., 2006b). In general, any of nutritious foods that do not cause increase of weight or cause glucose levels in blood can be eaten freely. Examples on these foods are fruits and vegetables (except corn, beans, potato, sweet potato, mentioned above) (Zhang et al., 2006b).
Water is considered the best drink for the body – it is recommended with fresh lemon for difference. Sugar-free or diet drinks are preferred for people with diabetes (Gray-Donald et al., 2000). However products containing caffeine and carbonated soft water can increase osteoporosis risk and alter the mood so should have just little of them (Gray-Donald et al., 2000) Alcohols are forbidden as it harms the baby . Alternative sweeteners are more preferred also than to natural sugars, examples are sucralose, aspartame and acesuphame potassium, for sample food plan, check Table 4.
Meal Choose from Plus
Option 1 / Option 2
Breakfast ½ cup untoasted muesli/All Bran®/ rolled oats (raw) 1-2 slices of toast multigrain, soy & linseed, wholemeal, white, heavy fruit bread
- OR 1 slice of toast with ½ cup baked beans 250ml low fat milk
- OR 100g low-fat fruit yoghurt
- OR 200g artificially sweetened yoghurt
Morning tea 4 Vitaweats® with a small amount of reduced fat cheese ½ English muffin
- OR 1 slice toast with a small amount of reduced fat cheese 1 serve of fruit, 1 apple, 1 pear, 1 small banana, 2 kiwi fruits, 4 apricots, ½ cup tinned fruit, 2 tablespoons sultanas
Lunch 2 slices of bread
- OR 1 medium bread roll with tuna, salmon, fresh chicken, egg, roast beef or reduced fat cheese 2/3 cup cooked rice (Basmati/Doongara)
- OR 1 cup pasta/noodles with tuna, salmon, fresh chicken, egg, roast beef or reduced fat cheese Plenty of salad or cooked vegetables (other than potato or corn) PLUS 1 serve of fruit
Afternoon Tea
250mls low fat milk 100g Low fat yoghurt
- OR 200g artificially sweetened yoghurt 1 slice heavy fruit loaf
- OR 1 crumpet
- OR ½ English muffin
Dinner 2/3 cup cooked rice (Basmati)
- OR 1 cup pasta/noodles 1 medium potato and a small corn cob A small serve of lean meat, fish, chicken or tofu, with plenty of salad
- OR cooked vegetables PLUS 1 serve of fruit
Supper ½ cup low fat custard
- OR 2 small scoops of low-fat ice cream 100g low-fat yoghurt
- OR 200g artificially sweetened yoghurt 1 serve of fruit
Table 4 Sample food plan
Moderate intensity physical activity is recommended for women with GDM as it can help to control glucose levels, however, it is more preferred to check that with physician prior to starting any activity during pregnancy. It helps also to lower insulin resistance (Sanabria‐Martínez et al., 2015). Practicing exercise, like walking, regularly will help to increase fitness of mother and be prepared more for delivery of her baby. It also helps to maintain glucose levels of blood under control (Sanabria‐Martínez et al., 2015).
Walking as a regular exercise could be achieved by Using a ‘pedometer’ (or a ‘step counter’), standing and moving a lot in the kitchen, taking the stairs not the elevator, walking to faraway stores for shopping instead of using car, making a ‘walking group’ with family or friends at a regular time, and practicing on gardening (Artal et al., 2007).
Glucose levels of pregnant woman usually return to normal limits after delivery, but there is still an increased risk for her to develop type 2 diabetes later in her life (Retnakaran et al., 2007). To decrease this risk or delay it, it is recommended to (Ross, 2006) achieve a healthy weight and maintain it, by eating only balanced, healthy and nutritious foods, as previously mentioned, and practicing physical activities to reduce any extra weight, for at least 30 minutes on most days, keeping checking glucose levels regularly at least every 1-2 years (Vijan, 2010).
Treatment & Management
Recent studies indicate that there is an evidence that good management and treatment of GDM can reduce its complications (Buchanan and Xiang, 2005). Primary complications on the baby included death, fracture of bones, nerve palsy and shoulder dystocia. Primary complications on the mother included the need for premature and/or cesarean delivery. These complications were significantly fewer after treatment, and the need for cesarean deliveries was limited .
The purpose of treatment is to reduce the risks of GDM for both mother and child. Controlling glucose levels can lower fetal complications (such as macrosomia) and increase maternal health (Artal et al., 2007). If a healthy diet, physical exercise, and oral medication are not enough to maintain glucose levels within normal, then treatment with insulin would be necessary (Westermeier et al., 2015).
Counseling before pregnancy is always a good way for a good lifestyle (Artal et al., 2007). Most women can manage their GDM by making healthy dietary changes and exercise activity, as mentioned above. Self-monitoring of glucose levels in blood is an important factor to guide therapy (Saudek et al., 2006). Treatment goals, in the first place, is to achieve normal blood glucose levels (Table 5).
Test Glucose levels (mg per dL)
- Fasting Less than 96
- One-hour after meal Less than 140
- Two-hours after meal Less than 120 to 127
Table 5: Treatment goals for Women with Gestational Diabetes
Some women need anti-diabetic drugs, whereas most commonly need insulin therapy (Artal et al., 2007). Self-monitoring could be achieved using a device called “handheld capillary glucose dosage system” (a device used for measuring blood Glucose levels) (Tang et al., 2000). Testing blood glucose levels is most commonly done once wake up in the morning (fasting) then 2 hours after each meal.
If monitoring indicates failure of maintain of glucose levels within normal limits using these ways, or if there are complications like macrosomia, then treatment with insulin would be necessary (Westermeier et al., 2015). Fast-acting insulin is commonly used just before eating on an empty stomach. Take care to avoid lowering blood sugar levels (hypoglycemia) when injecting excess insulin (Westermeier et al., 2015).
Certain oral anti-diabetic drugs might be safe or less dangerous in pregnancy on the growing fetus than poorly controlled diabetes (i.e The lesser of two harms) (Zhu et al., 2016). Metformin is better than glyburide. If glucose levels cannot be controlled enough with a single drug, then metformin and insulin combination would be better than insulin alone (Ashoush et al., 2016). Metformin is preferred as oral drug rather than insulin injections. Also, it helps with treatment of polycystic ovarian syndrome during pregnancy one of the risk factors of GDM (Song et al., 2016). Metformin also lowers the need for insulin and help to gain less weight (Song et al., 2016).
Medical Interview
When a pregnant woman is examined for the first time, her doctor should check her history concerning diabetes, and if she had developed it before in a previous pregnancy, and if she is at risk for GDM (Ito et al., 2015). Screening tests are done and if they give positive results, then GDM diagnosis is confirmed. After that she is referred to hospital or care center for further checks. These include measuring blood pressure, weight and heart rate every day during hospitalization, measuring uterine fundus height once every week, examination of pelvis for signs of premature birth, collecting vaginal culture, as well as blood testing and urine analysis (Kilgour, 2013). Pregnant woman with GDM may further be examined for glycoalbumin, HbA1c, once per month, anti- glutamate decarboxylase, anti-insulin, islet cell antibodies, once at early pregnancy, Uric protein, urinary glucose, twice every month, urine ketone bodies and albumin once every month, and measuring creatinine clearance to check for nephropathy in diabetic patients (Kim et al., 2007).
Measurement of baby growth using ultrasound, where the head circumference or biparietal diameter, femur length, and abdominal circumference of the baby are examined at suitable intervals. In case the baby appeared too larger than standard limits, pregnancy termination would be considered and early delivery is decided. Ultrasound is used also for screening for congenital anomalies, spine, nervous system, etc. It helps also to check the amount of amniotic fluid, and overall well-being of the baby (Naylor et al., 1996).
When insulin therapy is considered, a special care should be taken for the doses of insulin required during pregnancy, delivery, and after birth as they differs significantly. The need for insulin at the end of pregnancy is increased about two times. But during first-stage of delivery, it is decreased, then increases slightly in the second-stage, and finally decreases rapidly after birth (Itoh et al., 2016).
During delivery, an electrolyte solution containing 5% glucose is administered to the patient at a rate of 100–120 ml/hr, then she is administered intravenous insulin through an infusion pump. Blood glucose is measured at 1–2 hours intervals (Hiden et al., 2012).
Prognosis
GDM generally resolves once the baby is born. According to different studies, the potential of developing GDM in a second pregnancy, if first pregnancy developed GDM, is between 30 and 84%, especially within one year of the previous pregnancy, depending on ethnic background (Nohira et al., 2006).
Women with GDM are subject to an increased risk rate of developing diabetes mellitus in the future, Type 2 (Nohira et al., 2006).
This risk is highest in case of women who needed treatment anti- glutamate decarboxylase, anti-insulin, islet cell antibodies and/or insulinoma antigen-2, women who had more than two previous pregnancies, women who were obese, and women who need insulin to treat GDM have a 50 percent risk of getting diabetes within five years (Lee et al., 2007). Also, their children have an increased risk for obesity in childhood and adult phase as well as type 2 diabetes and glucose intolerance later in life (Lee et al., 2007)
Conclusion
Gestational Diabetes Mellitus (GDM) is considered one of the most common conditions that affect women during pregnancy, where blood glucose levels are increased above normal limits (Baz et al., 2015). It usually arises after 28 weeks, in the third trimester, of pregnancy, and usually disappears after delivery of the baby (Association, 2010). GDM develops when there is not enough insulin secreted during pregnancy to control the rise in blood glucose levels (Kinalski et al., 2002), and this comes by several causes including placental hormones, and insulin resistance.
GDM complications, if not treated or managed, affect both mother and her baby, which make C-section or early delivery more preferred. Complications on the baby includes, macrosomia, respiratory distress syndrome, jaundice, hypoglycemia, developing type two diabetes in the future, or baby death (Bellamy et al., 2009). Complications on the mother include hypertension, proteinuria, a condition called preeclampsia, that needs hospitalization to avoid the risk of preterm birth, and may cause depression or diabetes type two in the future and all of its related problems.
Risk factors include Polycystic Ovary Syndrome (Toulis et al., 2009), GDM history in the past, intolerance of glucose, previous diabetes, or abnormal fasting levels. They also increase with first-degree relatives has a previous history of diabetes type two, non-white race, obesity, smoking and genetic factors.
Blood tests are commonly used for diagnosing GDM. They could be either non-challenge blood glucose tests or challenge blood glucose tests. They include non-challenge blood glucose test, screening glucose challenge test (O’Sullivan test), oral glucose tolerance test, and urinary glucose testing (Nielsen et al., 2012).
Prevention of GDM is achieved by losing extra weight, increasing physical activity level, Stopping smoking, and following a healthy eating plan (Ratner et al., 2008).
GDM could be treated and women can decrease these risks effectively by controlling of glucose levels in their blood (Erem et al., 2015). This control could be achieved by following a healthy eating plan and keeping active and physical exercises, and if this does not work, then using anti-diabetic medications (the safest one is insulin), would be necessary (Erem et al., 2015).
Finally, For all women who are diagnosed with gestational diabetes, this can be upsetting and frustrating. However, working closely with physician and health care team can maintain glucose levels within the normal limits to provide the best outcomes ever for both the baby and mother.
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