Diabetes and Pregnancy

Description

Diabetes is a disorder in which levels of blood sugar, glucose , are abnormally high. Many changes occur in pregnancy that can alter levels of glucose and a certain type of diabetes, Gestational Diabetes Mellitus (GDM), may develop or become apparent for the fist time during a pregnancy.

There are a number of possible health problems related to GDM, if not properly dealt with. These include:

• Infants born to diabetic mothers have 5 times the normal risk of respiratory distress syndrome .
• Macrosomia and associated birth trauma are related to maternal hyperglycaemia (abnormally high glucose levels).
• Increased incidence of neonatal hypoglycaemia , hypocalcemia , and jaundice .
• The incidence of congenital anomalies is increased with first-trimester hyperglycaemia
• The mother has an increased incidence of preeclampsia , infection, postpartum bleeding , caesarean section .

Diagnosis and Treatment

A Glucose challenge test (GCT) is frequently performed as a routine screen for GDM in all pregnancies at 24 to 28 weeks of gestation. It should be performed earlier if symptoms are present. Some sources recommend screening at the first prenatal visit if there are risk factors. The GCT is repeated at 24 to 28 weeks if previous test is negative. A Glucose tolerance test (GTT) is performed as a follow-up to an abnormal GCT result.

In the management of gestational diabetes, dietary adjustment is the mainstay of therapy.

• Caloric intake should be 30 to 35 kcal/kg/day. Intake should be reduced to 24 kcal/kg/day if the patient is obese.
• The patient should avoid cakes, candy, and other fast-acting carbohydrates.
• Dietary composition should be 50% to 60% carbohydrate, 20% to 25% protein, and 20% fat, with high fibre content.
• Exercise has shown added benefit along with dietary therapy.

The information in this page is presented in summarised form and has been taken from the following source(s):
1. Virtual Hospital, University of Iowa Family Practice Handbook: Diabetes in Pregnancy: http://www.vh.org/