Gestational diabetes
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Description[edit | edit source]
<ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title and is increasing Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title more common among older women, obese women and certain ethnic groupsCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. It usually presents after the beginning of the second trimesterCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title.Pathological Process
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In pregnancy, women develop insulin resistance, which stems from increased maternal adiposity and several hormones produced during pregnancy block the action of insulin at a cellular level, i.e. Tumor Necrosis Factor Alpha, human placental lactogen and placental growth hormone. As a result, blood glucose levels rise and more insulin is produced in response. As the pregnancy develops, the insulin demands increase further, and insulin resistance also increases due to rising levels of pregnancy hormones. However, this is a normal physiological change in pregnancy. Beta cells in the pancreas increase insulin production to compensate for this, and so in normal pregnancy blood glucose level changes are small compared to the large changes in insulin resistance. In GDM, women have been shown to have less of a degree of compensation at the Beta cell than non-GDM women Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. <10% of GDM women have been shown to have antibodies to pancreatic islets of Beta cells in their circulation. It has been postulated thaqt their GDM may stem from autoimmune damage to Beta cells Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. Some GDM cases have been shown to be due to genetic defects in Beta cells Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. Others may be chronic hyperglycaemia first detected at pregnancy, which may explain why most GDM women go on to develop Diabetes Mellitus (DM). The exact mechanism for increased insulin resistance is still largely unclear. Maternal obesity may contribute as upregulation of cytokines and adipokines impacts insulin pathways and skeletal muscle insulin sigalling is impaired Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title.
Consequences of Gestational Diabetes Mellitus[edit | edit source]
For Mother[edit | edit source]
GDM typically resolves after birth. However, there have been many studies detailing the increased risk of developing DM Type II after having GDM, particularly in the first 5 years postpartum Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title.
For Baby[edit | edit source]
Diagnositc Procedures[edit | edit source]
Risk Factors[edit | edit source]
Several factors have been identified which increase the risk of women developing GDM. These include:
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 GDM
Multigravid women
Excessive weight gain during pregnancy
Short stature
SmokingCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Local regimens use various screening tools in conjunction with these risk factors to identify women in need of further testing.
Screening for Gestational Diabetes Mellitus[edit | edit source]
GDM can only be confirmed by an abnormal glucose tolerance test. The World Health Organisation classify GDM as:
- A fasting blood glucose level of >7mmol/l
- A blood glucose level of >7.8mmol/l 2 hours after a 75g glucose drinkCite error: Invalid
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Medical Management / Interventions
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Medication
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Dietary Advise[edit | edit source]
Weight Management[edit | edit source]
The Role for Physiotherapy
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Physiotherapy in the Prevention of Gestational Diabetes Mellitus
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Physiotherapy in the Management of Gestational Diabetes Mellitus[edit | edit source]
Key Evidence[edit | edit source]
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Resources
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Case Studies[edit | edit source]
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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