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New Delhi: Gestational diabetes mellitus, often known as gestational diabetes, develops during pregnancy in people who are at slightly increased risk. During pregnancy, due to the interplay of different hormones and if the mother puts on a little bit of weight, then it possesses a state of resistance to insulin in the mother’s body, due to which normal glucose metabolism is hindered and the condition becomes diabetogenic. In such cases, usually, the patients are not diabetic before pregnancy.
Speaking of this, Dr. Chandan Mukherjee, BSc, BHMS, Homeo Pharmacy, New Barrackpore shared, “It is a temporary derangement of health that occurs to only 4-5% of pregnant women. Unfortunately, most of the time it is diagnosed in the later stages of pregnancy.”
This condition affects a pregnant woman who is in her 3rd trimester or in the later phase of pregnancy usually after 20 weeks. The majority of the time, gestational diabetes goes away after birth, but women who have it are at a higher chance of subsequently getting type 2 diabetes.
Risk Factors Of Gestational Diabetes:
Talking about the risk factors, Dr. Kundan Chaurasia, Internal Medicine Specialist at Samaritan, Kolkata shared that “Being overweight or obese, having a family history of diabetes, being over the age of 25, having gestational diabetes in a previous pregnancy and being of certain ethnicities can lead to gestational diabetes.”
Other risk factors include “Recurrent urinary tract infections, vulvovaginitis, polyhydramnios, macrosomic babies, or any other deformed babies throughout pregnancy. It is more likely that a woman has gestational diabetes mellitus if there has previously been unexplained uterine foetal demise.”, added Dr. Nibedita Chattopadhyay, Gynaecologist and Obstetrician at Samaritan, Kolkata.
Diagnosis Of Gestational Diabetes:
According to the American Blood Sugar Association, diabetes mellitus is initially identified during pregnancy when the random blood sugar is greater than 200 mg/dl, the HbA1c is greater than 6%, or the fasting blood sugar is greater than 126 mg/dl. It is not recognised before the pre-gestational period.
In this regard, Dr. Dipankar Bhattacharya, Obstetrician, and Gynaecologist at Samaritan, Kolkata said, “The diagnosis of gestational diabetes now typically occurs between 24-26 weeks into the pregnancy, and it can cause a variety of issues. The patients experience extreme drowsiness, extreme thirst, and unusual itching in private areas. The majority of the time, individuals are asymptomatic and are diagnosed by a lab test called a glucose tolerance test, which can quickly identify gestational diabetes. If the results of the glucose tolerance test are greater than 190, the patient is likely to develop gestational diabetes.”
To this, Dr. Chandan Mukherjee added, “If the doctor can detect gestational diabetes at an early stage of pregnancy, then the risk of birth injuries or miscarriages can be reduced. Therefore, maintaining a healthy weight throughout the tenure of nine months is necessary by incorporating a well-balanced diet, light exercises etc.”
Maternal And Foetal Complications That May Result In The Case Of Gestational Diabetes:
Dr. Nibedita Chattopadhyay said, “Maternal problems, some foetal complications, and some neonatal issues are all associated with GDM. Maternal complications include spontaneous miscarriage or abortion, pre-term delivery, preeclampsia, polyhydramnios, puerperal sepsis and difficult labour, along with recurrent vulvovaginitis, recurrent urinary tract infection, and puerperium. Premature birth, macrosomic or deformed babies, and unexplained IUFD are examples of foetal complications.”
Prevention Of Gestational Diabetes:
Maintaining a healthy body weight, creating a regular exercise schedule, and encouraging pregnant women to choose light, moderate exercise while under trained supervision are all important components of preventing gestational diabetes.
In this regard, Dr. Dipankar Bhattacharya shared, “With the right diet, gestational diabetes can be identified. Unlike other diabetic patients who are not pregnant, this kind of diabetic patient’s diet cannot be regulated because doing so may hinder the development of the baby. As a result, one should avoid sugar, starch, and carbs in moderation and increase fibre consumption. One needs to consider the quality of the diet more than the quantity.”
Additionally, being cautious and regularly checking blood sugar levels can help prevent gestational diabetes, especially for people who have a family history of the disease or who already have diabetes.
“One must lose excess body weight, and undergo regular checkups if there are symptoms of polycystic ovary in order to prevent gestational diabetes.”, added Dr. Raktim Guha.
Diet To Be Followed In Case Of Gestational Diabetes:
During pregnancy there is increased nutritional demand, hence the diet should be adequate in all nutrients to fulfil the requirement of both mother and the growing foetus.
The Recommended Dietary Allowance as per ICMR(2020) is an additional intake of 350 KCal/day over the normal requirement. An additional intake of 7.6gm and 17.6gm of protein per day is recommended during the 2nd trimester and 3rd trimester respectively.
30 gm of visible fat along with 800mg of Calcium, 320 mg of Magnesium, 32mg of Iron, 12mg of Zinc, 180 mcg of Iodine, 480 mcg of Folate, 1.6mg of thiamine, 2.3mg of riboflavin, 1.9 mg of pyridoxine, 406 mcg of Vitamin A and 400 IU of Vitamin D per day is recommended. An additional intake of 2mg of niacin,10mg of Vitamin C and 0.2mcg of Vitamin B12 over the normal requirement is also recommended.
During gestational diabetes, there is an elevation in the blood sugar level, hence the diet should contain food with a low glycemic index.
In this regard, Trisha Sarkar, who is an assistant professor of nutrition at Mahishadal Girls’ College, Vidyasagar University, shared a list of food items that should be incorporated/avoided in the case.
- Simple and refined carbohydrates such as potatoes, glucose water, candies, soda, white bread, white rice etc. should be avoided.
- 60 to 65 % of the total energy requirement should be met by carbohydrates.
- Complex carbohydrates which have a low glycemic index and high fibre content should be incorporated into the diet.
- Whole grain cereals, multi-grain bread, green leafy vegetables etc should be eaten.
- Protein requirements can be fulfilled by consuming lean protein such as fish and poultry. Cooked beans, lentils, pulses, milk, and yoghurt can be included.
- Fat should be provided in the form of vegetable oils such as olive oil and peanut oil. Nuts, olives, and oilseeds can be added, while saturated fat should be avoided.
- Fat is also an essential macronutrient which plays many important physiological roles in our body hence it should not be completely cut from our diet.
- The diet should be rich in calcium and iron to prevent osteomalacia and anaemia respectively.
- Iron is also required for building up the iron stored in the body and calcium is required for the calcification of the bones and teeth of the foetus.
“Small and frequent meals at regular intervals should be provided rather than providing only 3 heavy meals. Large meals may also cause some problems due to overcrowding of the foetus in the abdomen cavity in the second part of pregnancy. The entire menu should be split into 6 to 7 small meals, this would reduce the glycemic load at once and the chance of blood sugar spike is reduced. Whole fruits instead of fruit juices should be preferred as that will increase the dietary fibre content in our diet.”, Prof. Trisha further added.
Treatment Of Gestational Diabetes:
“Treatment for gestational diabetes is more or less similar to diabetic treatment but the dosage is comparatively lesser for pregnant women. In some cases, external insulin is recommended to control gestational diabetes. To check the blood sugar level further, an hba1c test is performed; depending on the result, treatment is initiated.”, said Dr. Raktim Guha, Critical Care Specialist, Samaritan, Kolkata.
In addition to that, homoeopathy also prevents the development of gestational diabetes.
In this regard, Dr. Chandan Mukherjee suggested, “Taking homoeopathic medicines from a good prescriber following totality and symptoms can cure the mothers’ and babies’ health. Regular taking of homoeopathic medicines such as Uranium Nitricum 3x or Syzygium Zambolum can effectively consume a large amount of glucose from the bloodstream.”
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