pregnant women are at high risk of developing gestational diabetes
- In women, GD increases the risk of spontaneous abortion, prolonged labor and
hypertension while in the fetus GD increases risk of stillbirth and congenital
- There are a few factors that will accurately help
in predicting the risk of GD facilitating timely intervention.
Identifying obese women who are at increased risk of developing gestational diabetes
(GD) early in their pregnancies will help in
providing timely and targeted intervention to those women.
Maternal obesity poses a threat to
both the mother and fetus. In the UK, in 2014 around 7 million were classified
as obese. By 2025, obesity is predicted to affect 1 in 5
‘Clinical application of diabetes tests would help in accurate targeting and prompt intervention of obese pregnant women at highest risk of developing gestational diabetes.’
Obesity during pregnancy increases
the likelihood of developing infections, gestational diabetes
mellitus, preeclampsia (high blood pressure during pregnancy), and
risk of cesarean delivery among mothers.
Obesity increases the likelihood of GD by three to five
fold. All obese pregnant women are
categorized as being at high risk of gestational diabetes, but
only around 25% will develop the disorder.
Excess weight gain during pregnancy
and after childbirth are future risk factors for obesity in women.
In the growing fetus, it increases
the risk of stillbirth and developing congenital anomalies.
Women with higher levels of blood
glucose during pregnancy are said to have gestational diabetes. The prevalence
of gestation diabetes is as high as 9.2%, according to a 2014 analysis by
Center for Disease Control and Prevention.
During pregnancy, metabolic changes
occur within the mother's body to meet the demand of increasing energy
requirements of the developing fetus.
During the initial stages of
pregnancy, the level of estrogen and placental hormone progesterone increases.
These hormones bring about an increase in the size of the pancreatic beta cells
and facilitate the production of adequate levels of insulin to lower the blood
There is an increase in peripheral
glucose utilization and glycogen storage with a simultaneous decrease in
glucose production in the liver. This results in low levels of fasting glucose
in the pregnant women.
Gestational diabetes usually begins
during 20-24 weeks of pregnancy.
During later stages of pregnancy,
increased levels of human chorionic sommatomammotropin (hCS), prolactin,
progesterone, cortisol, and estrogen create insulin resistance in the
There is also increased production of enzymes such as insulinase by the placenta
that causes degradation of insulin.
When insulin decreases, the level of
glucose in the blood increases and subsequently results in gestational
Few Factors that Facilitate Early
Detection of GD
Impact of GD on Mother
Impact of GD on Fetus
Frequent urinary tract infection
Fetal macrosomia-In this condition, the baby is considerably larger than normal. When the blood sugar levels are high in pregnant women, the extra blood glucose goes through the placenta into the fetus. This results in high blood glucose levels in the growing baby which in turn stimulates the baby's pancreas to increase production of insulin. As a result, the baby receives more energy, which is stored as fat. This results in a large-sized baby with increased muscle mass.
Risk of type 2 diabetes later in
In the study, funded by the National
Institute for Health Research (NIHR), 1303 women were
many factors and those which accurately
predicted gestational diabetes are:
- Older age of
- Gestational diabetes during
- High blood pressure
anthropometric measures such as skin thicknesses, waist and
- Blood tests including Hemoglobin A1c or
HbA1c- It is a blood test that provides information about the average level of
blood sugar over the past three months.
Out of the 1303 women in the study,
337 were affected by gestational diabetes.
Lead author, Dr Sara White from
King's College London said: "There is currently no accepted strategy to
identify obese women at high risk of gestational diabetes, early in pregnancy.
Today, all those classified as obese are considered high risk. With escalating
rates of obesity worldwide, a more accurate way of defining risk is necessary
in this group."
In this large and
comprehensive study, researchers have used an
extensive range of different measures to develop prediction tools.
A few clinical
factors and biomarkers are already available in
clinical practice and they are cost-effective.
"In addition, we
have identified a model that does not require blood sampling, which could be
developed for low and middle income countries where the prevalence of
gestational diabetes and obesity is rapidly increasing."Dr
The researchers are continuing their
study into gestational diabetes with the support of Diabetes
Management of Gestational Diabetes
Women diagnosed with GD
require intensive antenatal care to control blood glucose and to identify the
risk of developing common complications.
- Healthy diet including lots of fruits and vegetables with high
fiber content is beneficial. It is advisable to avoid food items with high
Physical Activity -
Mild and regular exercise
will increase the utilization of glucose for energy and will help in lowering
blood glucose levels.
- If the blood glucose level
is not controlled by the
above measures, insulin injections will be prescribed by doctors.
- Gestational Diabetes - (http://www.medindia.net/patients/patientinfo/causes-Gestational-diabetes.htm)
- What is Gestational Diabetes? - (http://www.diabetes.org/diabetes-basics/gestational/what-is-gestational-diabetes.html?referrer=https:www.google.co.in/)
- The Impact of Maternal Obesity on Maternal and
Fetal Health - (https:www.ncbi.nlm.nih.gov/pmc/articles/PMC2621047/)