Gestational Diabetes

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Gestational diabetes
Gestational diabetes (or gestational diabetes mellitus, GDM) is a condition in which women without previously diagnosed diabetes exhibit high blood glucose levels during pregnancy. Gestational diabetes generally has few symptoms and it is most commonly diagnosed byscreening during pregnancy. Diagnostic tests detect inappropriately high levels of glucose in blood samples. Gestational diabetes affects 3-10% of pregnancies, depending on the population studied.[2] No specific cause has been identified, but it is believed that the hormones produced during pregnancy increase a woman's resistance to insulin, resulting in impaired glucose tolerance. Babies born to mothers with gestational diabetes are typically at increased risk of problems such as being large for gestational age (which may lead to delivery complications), low blood sugar, and jaundice. Gestational diabetes is a treatable condition and women who have adequate control of glucose levels can effectively decrease these risks. Women with gestational diabetes are at increased risk of developing type 2 diabetes mellitus(or, very rarely, latent autoimmune diabetes or Type 1) after pregnancy, as well as having a higher incidence of pre-eclampsia and Caesarean section[3] ; their offspring are prone to developing childhood obesity, with type 2 diabetes later in life. Most patients are treated only with diet modification and moderate exercise but some take anti-diabetic drugs, including insulin

Gestational diabetes is formally defined as "any degree of glucose intolerance with onset or first recognition during pregnancy".[4] This definition acknowledges the possibility that patients may have previously undiagnosed diabetes mellitus, or may have developed diabetes coincidentally with pregnancy. Whether symptoms subside after pregnancy is also irrelevant to the diagnosis.[5] The White classification, named after Priscilla White[6] who pioneered in research on the effect of diabetes types on perinatal outcome, is widely used to assess maternal and fetal risk. It distinguishes between gestational diabetes (type A) and diabetes that existed prior to pregnancy (pregestational diabetes). These two groups are further subdivided according to their associated risks and management.[7] There are 2 subtypes of gestational diabetes (diabetes which began during pregnancy): * Type A1: abnormal oral glucose tolerance test (OGTT) but normal blood glucose levels during fasting and 2 hours after meals; diet modification is sufficient to control glucose levels * Type A2: abnormal OGTT compounded by abnormal glucose levels during fasting and/or after meals; additional therapy with insulin or other medications is required The second group of diabetes which existed prior to pregnancy is also split up into several subtypes.

Risk Factors
Classical risk factors for developing gestational diabetes are the following:[8] * a previous diagnosis of gestational diabetes or prediabetes, impaired glucose tolerance, or impaired fasting glycaemia * a family history revealing a first degree relative with type 2 diabetes * maternal age - a woman's risk factor increases as she gets older (especially for women over 35 years of age) * ethnic background (those with higher risk factors include African-Americans, Afro-Caribbeans, Native Americans, Hispanics, Pacific Islanders, and people originating from South Asia) * being overweight, obese or severely obese increases the risk by a factor 2.1, 3.6 and 8.6, respectively.[9] * a previous pregnancy which resulted in a child with a high birth weight (>90th centile, or >4000 g (8 lbs 12.8 oz)) * previous poor obstetric history

In addition to this, statistics show a double risk of GDM in smokers.[10] Polycystic ovarian syndrome is also a risk factor,[8] although relevant evidence remains...
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