Perspectives on diagnosis and management of gestational diabetes

Gestational diabetes mellitus is an important complication affecting pregnancy with implications for both maternal and perinatal outcome. It is also associated with increased risk of overt diabetes in later life and possibility of metabolic syndrome.

The Asian population particularly Indians are at higher risk of developing gestational diabetes. This mandate universal screening of all pregnant women in India. It is also important for the screening test to be one which is easy to perform and does not require repeated visits of the pregnant woman. Keeping this in mind the one stop test proposed by the DIPSI (Diabetes in Pregnancy Study Group of India) has been widely adopted. It has the advantage of testing and diagnosing GDM at a single visit so that appropriate treatment maybe started at the same visit.

Management basically rests on lifestyle modifications with a very small group of women requiring insulin or oral hypoglycaemics. A good counseling of the pregnant woman and her family plays a pivotal role in ensuring a good outcome. Control of plasma glucose needs to be good to avoid complications of fetal macrosomia and sudden intrauterine death. Poor control during pregnancy also leads to neonatal problems after delivery in the form of respiratory distress syndrome and neonatal hypoglycaemia.

Maternal hyperglycaemia usually resolves rapidly after delivery. It is important to counsel these women regarding the long-term complications and the need for lifelong lifestyle modifications. Public awareness regarding this is required. A combined effort can go a long way in combatting the diabetic epidemic and ensuring a healthier future generation.

Author(s):

Agarwal Anjoo

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