Pregnancy - Diabetes Mellitus

November 14^th is the World Diabetes day.  In the present day of changed life style the incidence of Diabetes is increasing rapidly.  Asians, Indians in particular are more prone to diabetes because of their genetic constitution.  Along with diabetes there is also increase in diabetes in pregnant woman – gestational diabetes mellitus.

Diabetes in pregnancy could be two of types.  The woman who is diabetic has become pregnant or diabetes is diagnosed during pregnancy.  The diabetes which has its onset in the course of pregnancy will subside after delivery.  But these women are prone for diabetes in later life.  The risk factors for developing diabetes in pregnancy are:

• Ethnicity – Asians, Hispanics, Africans have more incidence.
• Diabetes in the family members – First degree relations.
• Obesity - over weight women.
• Age above 25 years.
• History of abortions, premature delivery, birth of overweight or underweight babies or abnormal babies in the previous pregnancies.

Gravida with any of the risk factors will have to undergo screening test for gestational diabetes mellitus (GDM). The obstetrician once recognises that a gravida is high risk for GDM will advise initial blood glucose test.  If this is normal – less than 100 mg% further screening test is done between 24 – 28 weeks (early in the 7^th month) of pregnancy.  The test is Glucose Challenge Test (GCT).  If this is normal further follow up test is done in the 9^th month.  If the result is abnormal another test Glucose Tolerance Test (GTT) is done.  Based on the report dietary suggestion, life style modification (exercise) and medication is instituted. 

Gestational diabetes complicating pregnancy is a high risk pregnancy, wherein the health of the fetus is affected adversely.   Certain complications of pregnancy like increased blood pressure – pre-eclampsia, premature delivery may increase. The chance of baby being large or of low birth weight is high.  This makes normal delivery difficult so operative delivery may required.  The possibility of still births and neonatal complications like respiratory disease or certain metabolic disturbances may also increase.  

Team management including physician, obstetrician, dietician and paediatrician will result in successful out come, healthy mother and baby.

In women who are diabetic and become pregnant the incidence of morning sickness, abortion, premature delivery, pre-eclampsia, very low birth weight or overweight baby, congenital malformations, still births and postnatal health problems to the baby will be high.  In these women early scans can help in diagnosing abnormal fetus.  When blood glucose levels are monitored and proper diabetic control is done fetal health will be improved. 

In the present day women are career oriented and marriage and child birth is being delayed to the third  decade.  These women should maintain healthy life style.  A healthy woman will give birth to healthy baby.