WOW Health | Gynaecology

Gestational Diabetes Mellitus

Gestational Diabetes Mellitus (GDM ) is defined as carbohydrate intolerance of variable severity with onset or first recognition during pregnancy. In this condition blood sugar level becomes high.
When we eat, our digestive system breaks down most of the food into a sugar called glucose. With the help of insulin (a hormone produced by pancreas) from blood, glucose enters the muscles, fat and other cells where it is burned to give energy. If the body doesn’t produce enough insulin or if the pancreatic cells have a problem responding, too much sugar (glucose) remains in blood, instead of moving into the cells and getting converted into energy.

In pregnancy, due to hormones produced by placenta, the body naturally becomes more resistant to insulin, so that more glucose is available to nourish the growing baby. In most pregnant women, pancreas start secreting more insulin and blood sugar remains normal. If the pancreas can’t keep up with the increased demand for insulin during pregnancy, blood sugar levels starts rising because it fails to enter the cells. This results in gestational diabetes (incidence 3.8 – 21% in India). Gestational diabetes needs to be recognised and treated early because it can cause health problems for both mother and baby.

Babies of women having GDM are likely to be bigger than average (macrosomia), have premature birth, have birth trauma, perinatal death and even death while in the uterus. Baby may also have low blood sugar (hypoglycemia) and trouble breathing (respiratory distress) after birth. The mother is also more prone to have high blood pressure, excessive fluid around baby (polyhydramnios), more chances of a caesarean delivery and associated risks with it.

Unlike other types of diabetes, gestational diabetes is not permanent. Once the baby is born, the blood sugar will most likely return to normal. However, having gestational diabetes does make developing diabetes in the future more likely.

Anyone can develop gestational diabetes. But those who are elderly, overweight, have a close relative who has diabetes, herself had gestational diabetes before, had delivered a overweight baby or had unexplained birth of a dead baby are more likely to have this problem. The risk of developing GDM can be reduced by adopting a healthy lifestyle, eating a balanced diet and regular exercise.
Gestational Diabetes does show any symptoms. Therefore, screening test is recommend between 24 and 28 weeks pregnancy for all pregnant women. If someone has high risk factors for gestational diabetes, screening test may be done at the beginning of the pregnancy.

The most common test for screening of gestational diabetes is the oral glucose challenge test. This test measures how efficiently the body produces insulin. On the day of the test, glucose drink is given and one hour later blood sugar is checked.

If blood sugar is high (above 140 mg/dl) a longer test called the oral glucose tolerance test is done. For this test, the pregnant woman has to fast overnight. In the morning fasting blood sugar is measured and a glucose drink is given and then every hour for two to three hours blood sugar is measured. If the result of at least two tests are abnormal, diagnosis of gestational diabetes is made.
Regarding treatment, many women can manage their gestational diabetes by following an exercise plan and eating a balanced, healthy diet. However, about 15 percent of women with gestational diabetes need to take medication to balance their blood sugar (anti-hyperglycemic medication). Insulin injections are the most common medical treatment for gestational diabetes which is usually given with major meals. Nowadays even oral hypoglycaemic drugs are prescribed.

Monitoring blood sugar is a vital part of treatment plan. Initially 4-5 times blood sugar monitoring is recommended to make sure that the blood sugar remains within normal range.
The most important thing one can do to ensure a healthy pregnancy is to follow the treatment plan recommended by doctor. This includes sticking to recommended diet, regular monitoring of blood sugar, regular exercise and attending to all prenatal appointments.

Women with gestational diabetes who can keep their glucose levels in check go on to have a successful pregnancy and a healthy baby.

Dr. Veena Shrivastava is a Professor in the Department of Obstetrics and Gynaecology, Nepal Medical College and Gynaecologist in Nepal International Clinic. Send her your queries at