Future of GDM Mothers
Future of GDM Mothers
It is clearly established that about 40% of persons with GDM may develop
clinical diabetes within seven years of delivery. Hence it is important
that all persons with GDM should have a GTT (75 g) done 3 months after
delivery and if this is normal, follow up at least once a year with
a post-lunch Blood Sugar & HBA1c testing to decide their status.
The Babies of Diabetic Pregnancies
(Infants of diabetic Mother (IDM))
These require expert attention during pregnancy, labour and at delivery.
They require special care in the neonatal period, varying from 3 to
7 days or more. Those high risk babies and preterm babies may require
intensive neonatal care during the immediate neonatal period.
The usual perinatal morbidity seen at our Centre are
(i) Macrosomia, Hypoglycemia, jittery baby
(iv) Respiratory distress syndrome (RDS)
(vi) Major or minor congenital anamolies of heart or other organs
In our experience we have not
had any significant difference in the co-morbidity in babies of GDM
mothers as compared to non-diabetic deliveries. In an earlier study
3 major cardiac anamolies occurred in Group I with one death. It is
relevant to note that all these cases presented to the Obst. Between
atleast 8-16 weeks after conception even though they were IDDM, attending
a Diabetes Centre regularly and most of the m had erratic control prior
to conception and at the time or reporting pregnancy.
GDM - Future
Prevention and Reversal of GDM: Myth or Reality
GDM is by all account an extension
of a chemical state of carbohydrate intolerance and as more than 40%
of these are likely to become future diabetics in 7 to 10 years time
it should indeed be possible to envisage a study where GDM in Para 1,
may, by close follow-up, motivation and pregnancy counselling go through
the next pregnancy without GDM. Indeed we have had a few cases recorded,
to authenticate this, but again there are equal if not more number of
cases of GDM Group IV P1 becoming GDM Group III in P2 (or) Group III
P1 becoming Group II P2.
Long-term Follow-up of GDM - A Necessity
It is essential for Obstetricians and Diabetologists to get together
for a simple epidemiological exercise which should be region-wise (Asian
Sub-continent, Far East, Asia Pacific Zone, etc.) and pool their findings
to achieve consensus.
i) For finding out the actual
incidence of GDM for that region and establish a Central Registry and
ii) To plan mandatory annual follow-up report of all these cases from
the members of the regional registry for a period of 10 years. This
would result in a tremendous input and form a valuable database for
future preventive and control programmes relating to GDM pregnancies.
Public Education - The Key
The demographic pattern in the next
millennium is predictably going to be determined by the literacy and
empowerment of women. This has indeed been largely achieved in the developed
countries where birthrates have been negative or zero. When these objectives
come within the sight of the developing countries, one should be fully
equipped to offer the same level of success in the outcome of diabetic
pregnancies as in non-diabetic pregnancies. For this to fructify, a
concerted massive effort in public education regarding diabetic pregnancies
and GDM is necessary.
Factors for GDM in Pregnant Women (Indications for doing Glucose Tolerance
DIABETES, PREGNANCY BIRTH STUDY (1994)
Dietary Plan and Nutrition Recommendations in
Pregnant Women with Diabetes
Physical Exercise in Type I (or) IDDM Pregnancy
Physical Exercise in Type II (or) NIDDM &