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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
(ii) Hypocalcaemia
(iii) Infections
(iv) Respiratory distress syndrome (RDS)
(v) Jaundice
(vi) Major or minor congenital anamolies of heart or other organs
(vii) Others

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 Perspectives
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.

Public Education
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.

Risk Factors for GDM in Pregnant Women (Indications for doing Glucose Tolerance Test GTT)
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 & GDM Pregnancies

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