Diabetes, a perpetual liver condition with its undeveloped cure until the Present day. A very common disease with a continuing threat of its proliferation among the commons. Especially within the environments of the developing and underdeveloped communities, where commons lack the sufficient awareness of the severe consequences of Diabetes and the general knowledge of preventing Diabetes, which in most cases, results from undergoing any irregularity in their daily living and diet for an ample time.
The very common phenomenon behind the increasing Diabetic condition in women would be their unregulated and least monitored condition of Gestational Diabetes Mellitus (GDM), which in simpler meaning refers to the Temporary Glucose Intolerance observed in women during their Pregnancy interim. A woman is diagnosed with Gestational Diabetes when Glucose Intolerance continues beyond 24-28 weeks of gestation. Any degree of glucose intolerance with onset or first recognition during pregnancy recognizes the possibility that the Patient may have previously had undiagnosed Diabetes Mellitus, or, may have developed Diabetes coincidentally along with pregnancy. Gestational Diabetes, often termed as a condition of "Temporary Glucose Intolerance", which usually resolves after the birth of the child. But when not monitored regularly and treated as needed, it might give rise to endangering complications to the health of both the mother and the fetus. Also, the lack of well monitoring of the blood glucose level periodically may enhance the longevity of the emerging insulin resistance caused by the interference of the actions of Pregnancy Hormones and other factors. Prevention is always said to be better than Cure, so before planning to conceive, it is very important to have a counseling with a Specialist or Gynecologist about the preventive supplements (e.g.: Folic Acid) and multidisciplinary management for better pregnancy outcomes. It is always advised to conduct moderate physical exercise during pregnancy, as in the latest review released in 2015 proved that moderate free-hand exercise done during pregnancy helps in regulating the flow of blood and enhances the metabolism which then effectively prevents Gestational Diabetes from occurring up to a certain extent.
Risk of developing Diabetes Mellitus in future is certainly greater if one already undergoes through the Gestational Diabetes in the interim while of her Pregnancy. A second pregnancy within about 1 year from the previous pregnancy carries very high risks of the Gestational Diabetes to reoccur and less promising chances of not resulting into Diabetes Mellitus which in further stabilizes in its permanent and incurable form in the patient's metabolism. GDM needs to strict regulation and proper medication to be in control to avoid its risk factors from effecting both the mother and the child.
Some risk factors must be taken into consideration before getting Pregnant which tend to develop GDM, these factors should always be the Primary concern that needs attention and care even before conceiving:
# Previously diagnosed GDM, Impaired Glucose Tolerance or Impaired Fasting Glycaemia.
# A decent amount of medial intervention from one pregnancy to the other, at least a minimum of 1 Year.
# Maternal Age span (up to 35 years) explains the strong immunity of a woman to endure the physical complications during Gestation and conduct a healthy Pregnancy successfully.
The risk factor increases as she gets older, especially more than 35 years of age.
# Having Polycystic Ovary Syndrome is itself a threat to develop GDM.
# A first-degree relative (e.g. Father, Mother, Siblings etc) with
Type-2 Diabetes in the family History.
# Untreated Genetic Disorder related to poor Obstetric background.
# Being Overweight or severe Obesity increases the risk of having developed GDM along with the chances of further risks of progressing into developing Diabetes Type-2 due to weak immunity and feeble metabolism.
Diagnosing GDM requires a universal screening as many women do not face the severity of the symptoms of Diabetes. But some women might experience symptoms like Bladder Infection, Yeast Infection, Fatigue, Vomiting, Sudden Blurred Vision, Abnormal proliferation in urination and Irritation in the cervix.
A wide range of diagnostic tests and various screening methods have been in use to perceive the presence of high level of Glucose found in Plasma and Serum in defined circumstances. Although it is not at all advised to Forgo routine checkups due to absence of risk factors, because a mass number of healthy women often develop GDM despite having no risk factors but due to the Pregnancy Hormones that tend to interfere with the action of Insulin and binds the Insulin Receptor. The phenomenon of Insulin resistance is a very normal condition of Pregnancy that tend to emerge in abound the second trimester of Pregnancy.
Tests for confirming Gestational-Diabetes
* Non-Challenge Blood Glucose Test : A simpler and Inexpensive Blood Test that measures the level of Glucose present in Plasma. The result is confirmed to be affirmative when the given Blood Glucose Level is observed through this test on two subsequent days:
* If found higher than 126 mg/dl (7.0 mmol/l) after Fasting
&
* over 200 mg/dl (11.1 mmol/l) on any occasion.
* Screening Glucose Challenge Test : This simplified version of Oral Glucose Tolerance Test is generally performed between 24-28 weeks of Gestation. It involves drinking 50 grams of Glucose Solution and measuring the blood Glucose level after 1 hour. No Prior fasting is required. Though this result detects the GDM successfully, there might be some women who may get subjected to a consequent Oral Glucose Tolerance Test unnecessarily. The cut-off value mentioned below clarifies the test result value to ensure the confirmation of GDM according to any particular test result value:
* If the cut-off value is set at 140 mg/dl (7.8 mmol/l), 80% of women with GDM will be detected.
* If this threshold for further testing is lowered to 130 mg/dl, 90% of GDM cases will be detected.
* Oral Glucose Tolerance Test (OGTT) : A type of Blood Test that is similar to Screening Glucose Challenge Test which also involves drinking a Glucose solution of 75-100 grams; but requires an overnight of fasting. The results are taken periodically over a set timer starting from the Fasting sugar level, then its repeated over certain intervals.
* Urinary Glucose Testing : Gestational Diabetes results in higher Glucose consistency in the urine produced (Glucosuria). The increased GFR of the urinary system during pregnancy causes positive results on the Dipstick for about half the women taking the test. It is quite hard to predict GDM through the urinary testing, as it requires a certain degree of Glucosuria's sensitivity for GDM which is too very low during the first two trimesters of Pregnancy and the Positive Predictive value is about 20% in an average if using Dipsticks.
Untreated GDM may give arise to life threatening circumstances for both the mother and the child. Uncontrolled Glucose level in blood may cause further abnormalities in the child which may need to be taken care of in the NICU unit. Neonates born from a GDM condition are also consistently in the risk of Hypoglycemia, Jaundice, Polycythemia, Hypomagnesaemia and also Hypocalcaemia.
In some children it causes chemical imbalance in their immune system causing interference with their maturation which makes them prone to Respiratory Distress Syndrome resulting from incomplete maturation of Lungs and Impaired Surfactant Synthesis.
An OGTT should must be done 6 weeks after the delivery of the child to ensure that the GDM disappeared. Strict maintenance of a proper nutritious diet consisting 2500 kCal per day excluding general carbohydrates, helps controlling sugar. Moderate physical Exercise as per stamina everyday helps preventing the risk of developing GDM. Patients are generally treated with safe oral Medications to regulate the insulin level, but Metformin group of insulin enhancers are safer than the Glyburide group of drugs. But it is very necessary to monitor the blood glucose level to prevent Hypoglycemia from occurring due to excessive dose of insulin received. But in many cases, use of Metformin and Insulin showed better result than the use of only insulin.
Prevention can always be successfully acquired if precautions are given alliance in the right hour. It is yet not too late for you to save your little ones from every little thing that might hurt it. This is not only about a female's health; it’s also about the health of a new life that is yet to arrive. Raise Awareness to prevent GDM to gift our future a beautiful society. In Bangladesh, according to the recent survey released by DMC in 2014, it showed that due to the lack of knowledge and proper health regulation, 72 out of 100 pregnant women tend to develop Diabetes Type-2 from GDM after pregnancy and has to live with it till eternity.
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