विवरण
Gestational Diabetes Mellitus (GDM) is a condition characterized by elevated blood sugar levels during pregnancy, typically developing in the second or third trimester. It arises when the body cannot produce enough insulin to meet the increased demands of pregnancy, leading to insulin resistance. GDM poses risks to both the mother and the baby, including preeclampsia, preterm birth, and higher birth weight, which can complicate delivery. Mothers with GDM are also at increased risk for developing type 2 diabetes later in life. Management includes lifestyle modifications, such as diet and exercise, and, in some cases, medication to maintain blood glucose levels within a target range.
सारांश
- Gestational diabetes mellitus (GDM) is a condition where placental hormones block insulin's effectiveness, leading to high blood glucose. This isn't due to insulin deficiency but rather insulin resistance caused by hormones like estrogen, cortisol, and placental lactogen, typically starting around 20-24 weeks of pregnancy. While symptoms usually disappear post-delivery, GDM can affect up to 25% of pregnancies worldwide.
- Risk factors for GDM include heart disease, high blood pressure, inactivity, obesity, family history of diabetes, polycystic ovary syndrome, previous large babies, age over 25, certain ethnicities, and pre-diabetes. Dr. Lambi discovered it in 1926. Diagnosis is done through a 75g glucose tolerance test, where fasting blood glucose exceeds 92, 1-hour exceeds 180, and 2-hour exceeds 153 mg/dL.
- Maternal complications of GDM include preterm delivery, C-section, excessive fetal development, and newborn hyperinsulinemia and hypoglycemia. GDM increases the risk of type 2 diabetes, pre-eclampsia, and macrosomia (large baby). It can also lead to pregnancy-induced hypertension and increased incidence of C-sections.
- Fetal macrosomia occurs when high maternal blood glucose leads to fetal hyperglycemia. This stimulates the fetal pancreas to secrete insulin, causing excessive glucose uptake and growth. Fetal complications also include increased birth rate, breathing problems, hypoglycemia, seizures, obesity, premature birth, and later development of type 2 diabetes.
- The target range for blood glucose management involves achieving a fasting capillary blood glucose less than 5.5, 1-hour postprandial less than 8, and 2-hour postprandial less than 6.7. Management strategies include diet and lifestyle modifications, metformin, insulin, and sometimes vitamin D supplementation. Long-term cardiovascular risk for women with a history of GDM includes hypertension and obesity.
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