Gestational diabetes is condition in which normal women is recognized with diabetes during pregnancy for the first time. Since it is a complex condition and the mother and the child has to be protected from further complications proper management is necessary.
Treatment of GDM with dietary approaches and insulin therapy reduces risk of health problems in mother and child.
The first step in the management of gestational diabetes is dietary control, nutritional counselling and exercise.
Several studies proves that restricting the daily carbohydrate intake to less than 40% decreases glucose level and produces better outcomes in mother and fetus. It is also found that nutritional supplementation with micronutrients and bioactive substances like probiotics and myoinositol have shown promising better results.
Regular and moderate exercise have to be done along with dietary control.
If diabetes is not controlled other measures have to be taken. Oral tablets are not generally used, but in some cases metformin and glyburide is used and are safer during pregnancy.
When she fails to manage self – monitored glucose levels, insulin therapy is recommended to begin. Normal or very low insulin therapy is recommended. High doses does not always work in GDM.
Diabetes control during labor
During labor and delivery diabetes management is aimed at maintaining euglycemia in the mother to avoid hypoglycemia in the child. In certain cases the hyper insulinimic fetus after a continuous exposure to increased blood sugar level produces an insulin response to glucose challenge
If maternal glucose levels are increased in mother just before the time of labor, hypoglycemia may develop in the newborn as it is been suddenly cut off from the placental supply of glucose. This condition can result in seizures and other related problems. During labor capillary glucose levels should be maintained between 70 – 120 mg/dl.
Managing gestational diabetes after labor
- If the patient develop any sort of symptoms of hyperglycemia, they should seek medical attention immediately.
- Capillary level should be kept under proper monitoring for the next 6 months after labor.
- Breastfeeding is very much encouraged in women with gestational diabetes.
- Before subsequent pregnancy, proper counselling of family planning shold be done to educate on optimal glycemic regulation.
- Oral contraceptives containing low dose estrogen – progestin should be encouraged in women who have encountered gestational diabetes before.
- Children of mother with GDM should be closely monitored for obesity and if any symptoms of diabetes persist, ensure proper medical advice.