Health Tips

[Part 2] How to prevent gestational diabetes mellitus (GDM) ?

So, we have read the risk factors, the possible complications and what we need to do - SCREEN for GDM ! Today, we will talk moe on the treatment options and how to prevent it in the first place, even with the risks (modifiable ones only). 

Treatment

Treatment of gestational diabetes mellitus can reduce the risk of some pregnancy complications (eg, preeclampsia) and adverse neonatal outcomes (eg, macrosomia). Although, improvement in long-term outcomes in offspring is less clear. Treatment is often comprehensive encompassing nutritional therapy, glucose monitoring, pharmacology therapy and exercise.

Nutritional therapy 

The importance of nutritional therapy lies in the need to achieve normal glycemic level, prevent ketosis and provide adequate gestational weight gain based on maternal body mass index (BMI). Ketosis occurs when the body breaks down fat for energy, while this might sound like a good diet plan, it is not safe for pregnant mothers to be under this state. It is important to consult a dietitian and have meal plans in order to achieve the optimal nutrition that you need as nutritional therapy can decrease the risk of macrosomia. 

Glucose targets based on ADA and ACOG are:

• Fasting blood glucose concentration: <95 mg/dL (5.3 mmol/L)

• One-hour postprandial blood glucose concentration: <140 mg/dL (7.8 mmol/L)

• Two-hour postprandial glucose concentration: <120 mg/dL (6.7 mmol/L)

Pharmacologic therapy

Antihyperglycemic agents are only given when normoglycemia cannot be maintained by medical nutritional therapy based on the target above. There are basically 2 types of pharmacologic options namely insulin or oral antihyperglycemic agents. although insulin is said to be the preferred option, both has been approved to be used in GDM patients with their doctor's approval. 

Prevention

Although we can not change unmodifiable risk factors such as genetics, we can however modify other risk factors which could help decrease the likelihood of getting gestational diabetes. If you are overwight or obese, weight loss before pregnancy can reduce the risk of developing gestational diabetes mellitus. a good program of diet and exercise will help to achieve this during pregnancy and has proven to be effective. Exercise should start from a prepregnancy stage and continued until delivery for it to be effective. 

Below are some exercise recommendations:

Benefits of preventing GDM: 

• Prevent long term complications in the child (obesity, metabolic syndrome)

• Perinatal and neonatal complications

• Decrease fetal and maternal morbidity:

  • Macrosomia

  • Shoulder dystocia

  • Preeclampsia.

Prognosis 

Women with GDM usually have their glucose levels return to normal after delivery. However, they are at high risk for GDM, prediabetes and overt diabetes in the subsequent 5 years. 

In terms of long-term risk, a history of GDM increases one’s risk of developing type2 DM, type 1 DM, Metabolic syndrome and cardiovascular diseases, more so if a mother had GDM with gestational hypertension. 

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Reference :

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4653418/

2. https://www.uptodate.com/contents/diabetes-mellitus-in-pregnancy-screening-and-diagnosis?search=gestational-diabetes&source=search_result&selectedTitle=3~86&usage_type=default&display_rank=3

3. https://www.uptodate.com/contents/gestational-diabetes-mellitus-glycemic-control-and-maternal-prognosis?search=gestational-diabetes&source=search_result&selectedTitle=1~57&usage_type=default&display_rank=1#H2

Picture credit :

1. https://www.medicaldaily.com/moderate-exercise-during-pregnancy-reduces-risk-gestational-diabetes-excessive-weight-336938

2. https://healthunits.com/diabetes/gestational-diabetes-2/

3. https://www.semanticscholar.org/paper/Exercise-guidelines-for-gestational-diabetes-Padayachee-Coombes/20794fc65a896633a2adcbf5121235b6adff12f5

Written by

Dr. Jessamine Chong Sze Lynn