Gestational Diabetes
Gestational Diabetes
As if pregnancy wasn’t enough
Gestational diabetes mellitus (GDM), may be defined as any glucose intolerance first diagnosed or commencing during pregnancy, so that it includes previously undiagnosed diabetes and diabetes which develops during pregnancy. Depending on the study group and the methodology, gestational diabetes may present in up to 10 or even 15% of all pregnancies and may abate or even cease after the birth. With similar caveats about the studies, 20–50% of women affected by GDM develop Type II diabetes at some later date. The odds on gestational diabetes recurring in a subsequent pregnancy may be from 30 to more than 80%.
More US mothers have pre-existing diabetes when pregnant, the rate doubling in the last few years. Diabetes of any type increases the risk of complications in pregnancy, and makes more likely the prospect of a diabetic’s children themselves becoming diabetics in time.
GDM is like Type II diabetes in that it combines depressed insulin production and lessened responsiveness to the hormone. It is readily treated – close medical supervision during the term is indicated.
Notwithstanding that GDM may be transitory, if it is untreated the health of fetus and mother can be adversely affected. The baby may be at risk of high birth weight, cardiac issues, central nervous system problems, skeletal abnormalities, or respiratory distress. If circulation is impaired, placental exchange may be affected and stillbirth may be a possible outcome. If such problems are foreseen, delivery may be induced and caesarean intervention may be necessary.
Risk assessment
Priscilla White was a pioneering researcher into the effect of GDM on the babies of affected mothers. The White Classification she developed is used in assessing risks to mother and baby, and recognizes gestational diabetes (diabetes which began during pregnancy and labeled type A) and pregestational diabetes, with further sub-classification by risk and medical approach. Essentially, sub-type A1 is controllable by dietary modification while sub-type A2 may require insulin or other medications. Pregestational diabetes is also sub-classified.
Gestational diabetics are at increased risk of developing diabetes at some later date. There is considerable research into the risks in this area. It shows that those women who required insulin therapy are most at risk (one in two will exhibit diabetes in five years after treatment), along with obese women, women with diabetes-associated antibodies, and women with three or more previous pregnancies.
The risk of developing diabetes seems to peak in the first 5 years, and then flattens out. In one US study, half of the study group had diabetes after 6 years and nearly three-quarters affected after 28 years. Different studies produce different numbers – one found a 25% chance 15 years after GDM, other studies give higher odds.
The children of GDM mothers are more likely to be obese in childhood and beyond and at greater risk of Type II diabetes in later life. It is not clear how important genetic and environmental factors are in determining these risks, nor if the treatment of the gestational diabetes affects results.
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