Gestational diabetes

Original Editor - Clara Caplice Top Contributors - Clara Caplice, Redisha Jakibanjar, Nicole Hills, Lucinda hampton, WikiSysop, Manisha Shrestha, 127.0.0.1, Kim Jackson and Kanza Imtiaz

Description

Gestational diabetes (GM) is hyperglycaemia with blood glucose values above normal but below those diagnostic of diabetes. Gestational diabetes occurs during pregnancy

• Women with gestational diabetes are at an increased risk of complications during pregnancy and at delivery. These women and possibly their children are also at increased risk of type 2 diabetes in the future.
• Gestational diabetes is diagnosed through prenatal screening, rather than through reported symptoms.
• It is more common among older women, obese women, and certain ethnic groups. It usually presents after the beginning of the second trimester.
  

Epidemiology

GMs prevalence varies widely in the literature, but is thought to affect 4-7.5% of all pregnancies  and is increasing.  

Gestational diabetes affects around 2 to 10% of pregnancies in the United States of America.

Women with gestational diabetes (GDM) have an increased 35 to 60% risk of developing diabetes mellitus over 10 to 20 years after pregnancy

Pathological Process

In pregnancy, the placenta produces hormones that help the baby grow and develop. These hormones also block the action of the woman’s insulin. ie insulin resistance. Because of this insulin resistance, the need for insulin in pregnancy is 2 to 3 times higher than normal. Those already with insulin resistance may not be able to cope with the extra demand for insulin production and the blood glucose levels will be higher resulting in gestational diabetes being diagnosed.

When the pregnancy is over and blood glucose levels usually return to normal and the gestational diabetes disappears, however this insulin resistance increases the risk of developing type 2 diabetes in later life.

Consequences of Gestational Diabetes Mellitus

For Mother

Gestational diabetes mellitus is related to higher rates of:

• Cesarean section
• Gestational diabetes mellitus in subsequent pregnancies

Gestational diabetes mellitus typically resolves after birth. However, there have been many studies detailing the significantly increased risk of developing type II diabetes mellitus after having gestational diabetes mellitus, particularly in the first 5 years postpartum .

For Baby

• Macrosomia (child born much larger than usual): leads to higher rates of injury to mother and baby , higher rates of childhood obesity 
• Fetal hyperglycemia and hyperinsulinemia
• Preterm delivery
• Intensive neonatal care
• High neonatal body fat percentage
• Clinical neonatal hypoglycemia 

Risk Factors

• Older age
• Ethnicity (namely black, Native American, Pacific Islander, Hispanic, South or East Asian, and Indigenous Australian)
• High pre-pregnancy BMI
• Family history of diabetes
• Previous episode of gestational diabetes mellitus
• Multigravid women
• Excessive weight gain during pregnancy
• Short stature
• Smoking

Screening for Gestational Diabetes Mellitus

Gestational diabetes mellitus can only be confirmed by an abnormal glucose tolerance test.

The World Health Organization classify gestational diabetes mellitus if one or more of the following criteria are met:

• Fasting plasma glucose 5.1–6.9 mmol/L (92–125 mg/dL)
• 1-hour plasma glucose 10.0 mmol/L (180 mg/dL) following a 75 g oral glucose load 2-hour plasma glucose 8.5–11.0 mmol/L (153–199 mg/dL) following a 75 g oral glucose load

Medical Management / Interventions

Diet

• Dietary interventions have long been a cornerstone of treatment for GDM. Women diagnosed with GDM are routinely referred to a dietician. The challenge of GDM management for dieticians is striking the delicate balance between keeping maternal insulin low without restricting fetal growth. A Cochrane review in 2008 examined three trials investigating the effects of diet on preventing GDM, found inconclusive results .

Medication

• When dietary management fails, insulin is considered the safest treatment, as free insulin cannot cross the placenta.  Although insulin is time tested first-line therapy, its use involves practical challenges. Recent evidence is supportive of the use of OHA (oral hypoglycaemic agents ), especially metformin and glibenclamide. Metformin, when compared with insulin, is associated with less weight gain, better satisfaction, and acceptance and with a lower risk of maternal hypoglycemia.

Exercise

• see section below

Physiotherapy in the Management of Gestational Diabetes Mellitus

Exercise is proven to reduce blood sugar, fasting blood glucose, and glycated hemoglobin.

Recent evidence suggests that :

• A program of either aerobic exercise or resistance training appears equally effective, as long as it is performed at least at a moderate intensity or greater, for 20 to 30 minutes, three to four times a week, to provide a repeated stimulus that facilitates improved blood glucose uptake and induces increases in insulin sensitivity.
• The exercise program should suit an individual's preference for adherence to exercise
• Greater supervision, either face-to-face or via phone follow-up, and use of home-based exercises involving little or no equipment like brisk walking, yoga, resistance exercise with bands are appeared to be associated with higher levels of adherence.
• Exercises given should include large muscle groups and less pressure on joints like walking, static cycling, swimming.

Physiotherapy in the Prevention of Gestational Diabetes Mellitus

Regular exercise has shown to prevent the occurrence of gestational diabetes mellitus.

• Ming wk, et. al (2018) had concluded that regular exercise (light-to-moderate) for 30–60 min, three times a week, during pregnancy is safe and worthy of promotion in normal-weight women with uncomplicated, single pregnancies. .
• A randomized clinical trial has shown that cycling exercise initiated early in pregnancy and performed at least 30 minutes, 3 times per week, is associated with a significant reduction in the frequency of gestational diabetes mellitus in overweight/obese pregnant women.
• There was a significant reduction in GDM due to higher physical activity.

Some examples to be considered:

1. Exercises that are considered safe:

• Walking
• Swimming
• Stationary cycling
• low-impact aerobics
• Yoga, modified
• Pilates, modified
• Running or jogging
• Racquet sports
• Strength training

2.Exercises that should be avoided:

• Scuba diving
• Sky diving
• Hot yoga or Hot pilates
• Activities with a high risk of fall (skiing, off-road cycling, gymnastics, horseback riding)
• Contact sports( ice hockey, boxing, soccer, and basketball)

See also

• Physical Activity and Pregnancy