1. Gestational diabetes mellitus (GDM) occurs when a woman with no history of diabetes develops high blood sugar levels during pregnancy. GDM usually develops between 24 to 28 weeks of gestation when the fetus is bigger and there are more demands on the maternal body.
2. One of the causes of GDM is pregnancy itself, as the hormones produced make the mother more prone to diabetes. Age of the mother, being overweight and a family history of diabetes are also contributing factors.
3. The risk of GDM includes:
- Having GDM has a negative impact on the developing fetus if the sugar levels are poorly controlled. This leads to the fetus being more prone to being overweight or macrosomic (larger-than-average). With a larger baby, there is a higher risk to mother and child resulting from a traumatic birth.
- Among the risks are greater vaginal tears, anal injuries leading to urinary or bowel dysfunctions for the mother, and even the need for an emergency Caesarean section because the baby proves to be too large for a normal vaginal delivery.
- The fetus could be in grave danger of severe oxygen deprivation as the baby is unable to breathe if the chest is stuck in the pelvis and only the head is out. Such a fetus also tends to suffer from neonatal jaundice and occasionally, very low blood sugar at birth and even delayed maturation of the lungs. Severe GDM also increases the risk of stillbirth due to metabolic death (excessive production of acid).
- An increased chance of developing Type II diabetes mellitus (DM) in the future. The risk of developing Type II DM is up to 10 to 50% depending on various factors. The good news is that less than 25% of GDM patients develop DM if they return to their ideal body weight after delivery.
4. The symptoms of GDM range from no symptoms to the full range of symptoms attributable to DM. Symptoms may include:
- The mother could suffer from recurrent urinary or vaginal infections, particularly candidiasis, which is a form of yeast infection.
- During pregnancy, the mother may develop excessive amounts of amniotic fluid. This is due to excessive fetal urination caused by the high sugar levels. With the excessive fluid, the mother has a higher risk of pre-term labour and an increased risk of developing high blood pressure or pre-eclampsia.
5. The standard test for diagnosis is the 75g Oral Glucose Tolerance Test, which measures the body’s ability to use glucose. The mainstay of GDM treatment revolves around having the correct diet to maintain sugar levels within the healthy range. Moderate exercise can also help increase usage of the glucose by the body’s cells, thus lowering blood glucose level. If control by a combination of diet and exercise cannot be adequately achieved, then insulin injections will need to be introduced.
