Risk and Prevention of Gestational Diabetes Mellitus (GDM)

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Themes: Diabetes mellitus and Pregnancy

Title: Risk and Prevention of Gestational Diabetes Mellitus (GDM)

Today, there are 346 million people worldwide have diabetes. (WHO, 2011a). In 2004, WHO estimated 3.4 million people died from consequences of high blood sugar. More than 80% of diabetes deaths occur in low-and middle-income countries, include Indonesia.

Diabetes mellitus is a chronic disease that occurs either when pancreas does not produce enough insulin or when the body cannot effectively use the insulin that it produces. Diabetes is caused by hyperglycemia or raised blood sugar. (WHO, 2011a)

There are three main types of diabetes mellitus, that is type 1 diabetes, type 2 diabetes, and gestational diabetes mellitus. Type 1 diabetes is caused by absolute deficiency of the insulin hormone produced by the pancreas. Type 2 diabetes is caused by body ineffective uses insulin. Gestational diabetes mellitus (GDM) is caused by hyperglycemia during pregnancy. There is no exact causative factor of GDM. But hormones of pregnancy appear to interfere with insulin action. (WHO, 2011b) The symptoms of GDM are similar to type 2 diabetes, and also increased thirst (polydipsia) and increased urination (polynuria). (WHO, 2011a)

GDM can damage the fetus and the mother. GDM risks to the pregnancy itself include congenital malformations, increased birth weight and elevated risk of perinatal mortality. GDM also increased risk of woman to develop type 2 diabetes later in life. (WHO, 2011b) The baby can be born very large (macrosomia) with extra fat, this can make delivery difficult and more dangerous for the baby; low glucose right after birth; and also breathing problems. (NCDI, 2006) Gestational pregnancy affects approximately 7% of pregnant women and is associated with an increase risk for macrosomia, neonatal hypoglycemia, and birth trauma. (King, 2009)

King (2009) states that risk factors of GDM are maternal ages over 25 years, member of ethnic group at increase risk of type 2 DM, overweight with Body Mass Index (BMI) > 25, history of abnormal glucose tolerance, history of adverse outcomes associated with GDM (e.g. macrosomia and unexplained stillbirth), history of GDM in prior pregnancy, and first-degree relative with diabetes.

A number of screening and diagnostic tests have been used to look for high levels of glucose. Three of them are fasting blood glucose or random blood glucose test, screening glucose challenge test, and oral glucose tolerance test. By fasting blood glucose diagnostic or random blood glucose, the patient do fasting before the test. Patient may not eat or drink anything except drink water. By screening glucose challenge test, the patient will drink sugary beverage and have blood glucose level checked an hour later. And the last, using oral glucose tolerance test, the patient should eat normally three days before the test. But eight hours before the test, the patient should do fasting. (NDIC, 2006) Diagnosis of GDM is commonly based on the results of oral glucose tolerance tests. (Horvath, 2010)

There are several treatments for GDM patient. Insulin can be used for treating patient with GDM. Insulin is calculated based on the woman’s weight, total daily insulin is based on 0.5 to 0.7 units/kg of mother’s weight. Insulin is not harmful for the baby. (King, 2009)

Patient with GDM also can be treated by dietary therapy. GDM requires careful nutritional management. Patient is recommended to limit sweets, eat three small meals and one to three snacks every day, be careful when and how much consuming carbohydrate-rich food, plan the meal, and include fiber in meal in the form of fruits, vegetables, and whole-grain crackers, cereals, and bread. (NDIC, 2006)

Besides, patient can do self-monitoring of blood glucose. It appears to be superior to less frequent glucose monitoring in the clinic for detection of glucose concentrations. (Reece, 2004) Patient can check their own blood glucose. Blood glucose targets for women with GDM is <95 on awakening, <140 one hour after a meal, and <120 two hours after a meal. (NDCI, 2006)

Some physical treatments also can be done such as walking, swimming, and targeted exercise for women with GDM are keys to control blood glucose levels. (King, 2009)

Women who received specific treatment for GDM also had fewer macrosomic babies or babies with a birth weight at or above the 90^th centile (Horvath, 2010)

Crowther (2006) indicates that treatment of GDM in the form of dietary advice, blood glucose monitoring, and insulin therapy as required for glycemic control can reduce the rate of serious perinatal complications, without increasing the rate of cesarean delivery.

It can be concluded that gestational diabetes mellitus (GDM) supported by many factors is risky in pregnant women and the baby. Therefore, there are some treatments produced to minimize or prevent the effects of GDM.

Refrences

Crowther, Caroline A. Hiller, Janet E., Moss, John R., Andrew J., Jeffries William S., Robinson Jeffrey S. (2006). “Effect of Treatment of Gestational Diabetes Mellitus on Pregnancy Outcomes”. [Internet] NEJM, 16 June 2005, 352:2477-2486. Available from: <http://www.nejm.org/doi/full/10.1056/NEJMoa042973#t=article>

Horvath, K., Koch, K., Jeitler, K., Matyas, E., Bender, R., Bastian, H., Siebenhofer., A. (2010). “Effects of treatment in women with gestational diabetes mellitus: systematic review and meta-analysis”. [Internet] BMJ, April 2010, 340: c1395. Available from: <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2848718/>

King, Tekoa L. & Brucker, Mary C. (2009). “Pharmacology on Women’s Health”. [Internet] Canada: Jones & Barlett Learning. Available from: <http://books.google.co.id/books?id=u1wq63x4VsYC&printsec=frontcover#v=snippet&q=gestational%20diabetes&f=false> (accessed October 24, 2011)

NDIC (National Diabetes Information Clearinghouse). (2006). “What I need to know about Gestational Diabetes” [Internet] available from: < http://diabetes.niddk.nih.gov/dm/pubs/gestational/index.aspx>

Reece, E Albert., Coustan, R Donald., Gabbe, Steven G. (2004). “Diabetes in women: adolescence, pregnancy, and menopause”. [Internet] Philadelphia: Lippincott Williams & Wilkins. Available from: <http://books.google.co.id/books?id=cuyLlLAY14YC&pg=PA18&dq=gestasional+dm&hl=id#v=onepage&q&f=false>

WHO (World Health Organization). (2011a). “Diabetes”. [Internet] Available from: <http://www.who.int/mediacentre/factsheets/fs312/en/>

WHO (World Health Organization). (2011b). “About Diabetes”. [Internet] Available from: <http://www.who.int/diabetes/action_online/basics/en/index1.html>