The Journey from Gestational Diabetes to Diabetes Mellitus

What condition is Gestational Diabetes Miletus (GDM)

Gestational diabetes is a diabetic complication diagnosed for the first time during the gestational period. A disorder that occurs when a hormone produced by the placenta hinders the body from adequately utilizing insulin. Instead of being utilized by the cells, glucose accumulates in the circulation leading to glucose and insulin imbalances. It is considered the most frequent metabolic issue affecting gestation.

 

Prevalence Of Gestational Diabetes:

Approximately 7% of all pregnancies, resulting in over 200,000 cases worldwide, are affected each year, although the prevalence can range from 1% to 14% of all pregnancies. The variable degree of glucose intolerance impacts both the pregnancy and the well-being of newborns.

Association of Gestational Diabetes and Diabetes Miletus:

The chance of acquiring diabetes type 2 mellitus (T2DM) in the future is strongly associated with gestational diabetes. Women who have undergone GDM are more likely to acquire DM type 2. According to recent evidence, nearly half of women with a history of GDM will acquire type 2 diabetes within 5 to 10 years following pregnancy.

Cause & Onset of Condition:

Although there is no established etiology of gestational diabetes, there are a few theories that explain why the disorder occurs.

The placenta provides nourishment and water to the growing fetus while also producing a variety of hormones that help in maintaining and continuing pregnancy. Some of these hormone’s estrogen, cortisol, and human placental lactogen may hinder insulin action. This is known as the contra-insulin effect, and it normally begins between 20 and 24 weeks of pregnancy.

As the pregnancy progresses, the placenta expands and the hormone secretion is also intensified, increasing the likelihood of insulin resistance. Normally, the pancreas can produce more insulin to combat insulin resistance, but gestational diabetes occurs when insulin production is insufficient to counteract the influence of placental hormones.

Risk Factors Contributing to Gestational Diabetes Miletus:

Several variables contribute to the higher likelihood of developing T2DM after GDM:

· Pre-Diabetic: GDM is primarily triggered by insulin resistance, which occurs when the body's cells become less receptive to insulin. This resistance to insulin may persist after pregnancy, increasing the chance of developing T2DM.

GDM can also damage the function of pancreatic beta cells, which develop insulin. If the beta cells aren't functioning properly, it might result in the onset of T2DM.

· Obesity & Sedentary Lifestyle: A lack of physical activity, and poor eating habits are common indicators of risk for T2DM in women with GDM. These variables, if not considered, can raise the chance of developing T2DM.

·  Genetic predisposition/ Family History: There is evidence that genetic factors have played an integral part in the development of both GDM and T2DM. Having a family history of T2DM raises the likelihood of having the illness.

    ·   Gestational History: Previous history of giving birth to a child weighing more than 9 pounds.

 

    ·   Age: Women over the age of 25 are more vulnerable to developing gestational diabetes. 

   · Ethnicity/Race: Females belonging to African American, Asian American, Hispanic, and Pacific Islander are at a higher risk. 

 

Symptoms of Gestational Diabetes Miletus:

Gestational diabetes generally doesn't produce any symptoms. Mostly the cases are detected only when elevated blood sugar levels are recorded during antenatal screening. Some women might experience symptoms due to hyperglycemia.

 

 

Detection of Gestational Diabetes Mellitus:

The American Diabetes Association recommends screening for un-diagnosed type 2 diabetes at the very first antenatal consultation of women with risk factors for developing diabetes. GDM evaluation should be done between 24 and 28 weeks of gestational age in women who are not suspected to have diabetes. The screening test is known as an oral glucose tolerance test (OGTT), and it takes approximately two hours.

Furthermore, women who went through GDM should be monitored for persistent diabetes 6 to 12 weeks postpartum delivery. They should also be screened for the onset of either diabetes or pre-diabetes at least on a three-yearly basis for the rest of their lives.

Pregnancy Challenges Due to Gestational Diabetes:

• An Extra-Large Baby: Diabetes that is not efficiently managed elevates the baby's blood sugar levels. The baby is "overfed" and grows to be enormous in size. Apart from causing discomfort in the final few weeks of pregnancy, an extra-large baby might cause complications during birth for both the mother and the infant. To deliver the baby, the mother may require a C-Section or induction of labor. 
  

•  Cesarean Section: A woman with diabetes that is not well-controlled is more likely to require a C-section for the birth of her baby, and the recovery time from cesarean delivery is said to be longer than women undergoing a normal mode of delivery.
  

•  Pre-Eclampsia: A woman experiencing elevated blood pressure levels; has protein in her urine and persistent swelling in her fingers and toes. It could cause the baby to be born prematurely, as well as seizures or a stroke in the mother during labor and delivery. 
  

• Hypoglycemia: Individuals with diabetes who use insulin or other diabetes treatments may experience low blood sugar levels. If not treated promptly, low blood sugar levels can be extremely dangerous, even fatal. Also, the baby can suffer from low blood sugar very rapidly after birth.

• Polyhydramnios: It is a condition in which there is an excessive amount of amniotic fluid in the womb, which can lead to premature labor or complications during delivery. 

• Pre- Mature Delivery: Also referred to as Pre-term birth; the birth of the fetus before the 37th week of pregnancy. Premature delivery can occur spontaneously or may be medically induced.

  How to manage Gestational Diabetes and avoid Diabetes Miletus?

       Women must follow healthy lifestyle behaviors to lower their chances of getting T2DM after GDM. Diabetes caused by gestation can be optimized throughout pregnancy by eating healthy meals, exercising, and, if needed, taking medication. Controlling the level of sugar in the blood will benefit both the mother and baby to stay healthy and avoid a traumatic delivery and its associated complications. In addition, women with a history of GDM should have regular check-ups and diabetes testing to keep an eye on their glucose levels and identify any warning signs of prediabetes or diabetes early.