Gestational diabetes is a condition in which an individual without diabetes develops high blood sugar levels during pregnancy. Gestational diabetes generally results in few symptoms. Obesity increases the rate of pre-eclampsia, cesarean sections, and embryo macrosomia, as well as gestational diabetes. Babies born to individuals with poorly treated gestational diabetes are at increased risk of macrosomia, of having hypoglycemia after birth, and of jaundice. If untreated, diabetes can also result in stillbirth. Long term, children are at higher risk of being overweight and of developing type 2 diabetes. Gestational diabetes can occur during pregnancy because of insulin resistance or reduced production of insulin. Risk factors include being overweight, previously having gestational diabetes, a family history of type 2 diabetes, and having polycystic ovarian syndrome. Diagnosis is by blood tests. For those at normal risk, screening is recommended between 24 and 28 weeks' gestation. For those at high risk, testing may occur at the first prenatal visit. Maintaining a healthy weight and exercising before pregnancy assists in prevention. Gestational diabetes is treated with a healthy eating plan, exercise, medication (such as metformin), and sometimes insulin injections. Most people manage blood sugar with diet and exercise. Blood sugar testing among those affected is often recommended four times daily. Breastfeeding is recommended as soon as possible after birth. Gestational diabetes affects 3–9% of pregnancies, depending on the population studied. It is especially common during the third trimester. It affects 1% of those under the age of 20 and 13% of those over the age of 44. Several ethnic groups including Asians, American Indians, Indigenous Australians, and Pacific Islanders are at higher risk. However, the variations in prevalence are also due to different screening strategies and diagnostic criteria. In 90% of cases, gestational diabetes resolves after the baby is born. Affected people, however, are at an increased risk of developing type 2 diabetes.
Classification Gestational diabetes is formally defined as "any degree of glucose intolerance with onset or first recognition during pregnancy". This definition acknowledges the possibility that a woman may have previously undiagnosed diabetes mellitus or may have developed diabetes coincidentally with pregnancy. Whether symptoms subside after pregnancy is also irrelevant to the diagnosis. A woman is diagnosed with gestational diabetes when glucose intolerance continues beyond 24 to 28 weeks of gestation. The White classification, named after Priscilla White, who pioneered research on the effect of diabetes types on perinatal outcome, is widely used to assess maternal and fetal risk. It distinguishes between gestational diabetes (type A) and pregestational diabetes (diabetes that existed before pregnancy). These two groups are further subdivided according to their associated risks and management. The two subtypes of gestational diabetes under this classification system are:
Type A1: abnormal oral glucose tolerance test (OGTT), but normal blood glucose levels during fasting and two hours after meals; diet modification is sufficient to control glucose levels Type A2: abnormal OGTT compounded by abnormal glucose levels during fasting or after meals; additional therapy with insulin or other medications is required Diabetes which existed before pregnancy is also split up into several subtypes under this system:
Type B: onset at age 20 or older and duration of less than 10 years. Type C: onset at age 10–19 or duration of 10–19 years. Type D: onset before age 10 or duration greater than 20 years. Type E: overt diabetes mellitus with calcified pelvic vessels. Type F: diabetic nephropathy. Type R: proliferative retinopathy. Type RF: retinopathy and nephropathy. Type H: ischemic heart disease. Type T: prior kidney transplant. An early age of onset or long-standing disease comes with greater risks, hence the first three subtypes. Two other sets of criteria are available to diagnose gestational diabetes, both based on blood-sugar levels. Criteria for diagnosis of gestational diabetes, using the 100-gram Glucose Tolerance Test, according to Carpenter and Coustan:
Fasting 95 mg/dl 1 hour 180 mg/dl 2 hours 155 mg/dl 3 hours 140 mg/dl Criteria for diagnosis of gestational diabetes according to National Diabetes Data Group:
Fasting 105 mg/dl 1 hour 190 mg/dl 2 hours 165 mg/dl 3 hours 145 mg/dl The third criterion used was endorsed by the Diabetes in Pregnancy Study Group India and approved by the National Health Mission in its Guidelines DIPSI(Diabetes in Pregnancy Study Group India Guidelines) OGTT is performed in pregnant women by measuring the plasma glucose after 2 hours of fasting or non-fasting after ingesting 75 grams of glucose (Monohydrate Dextrose Anhydrous). The Indian Guidelines (DIPSI Test) are simple for diagnosing gestational diabetes (GDM). They can be done quickly in low-resource settings, where many pregnant women visit for ANC check-ups in a Non-fasting state. A single value of ≥140 mg/dl is diagnostic for Gestational Diabetes Mellitus. Guidelines to screen glucose intolerance at appropriate Gestational weeks: Prediction of GDM can be done if the 2-hour PPBG is ≥110 mg/dl at the 10th week. At the 8th week itself, PPBG needs to be estimated because, in case PPBG is > 110 mg/dl at this week, a grace period of 2 weeks is available to bring it down to PPBG <110 mg/dl at the 10th week with metformin 250 mg twice a day, in addition to Medical Nutritional Therapy (MNT) and exercise.
Risk factors Classical risk factors for developing gestational diabetes are:
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