Question

A 29-year-old G4P2 Hispanic woman, with a history of gestational diabetes mellitus (GDM), presents to her OB/GYN office for a routine prenatal visit at 24 weeks’ gestation. Her physical examination is unremarkable, and her fetal well-being is reassuring. Because of her previous history of GDM, she is at high risk of developing GDM during this pregnancy and the doctor recommends a glucose challenge test, which is the most common method of screening for GDM. Test results reveal that her 1-hour glucose loading test (GLT) is 179 mg/dL (normal value <140 mg/dL). Because her GLT value is high, she then undergoes a 3-hour glucose tolerance test (GTT), which is used for a definitive diagnosis of GDM. The patient is positive for GDM when all of her plasma glucose values are elevated. Treatment recommenda- tions include beginning a diabetic diet, participating in moderate exercise sessions three times a week, daily home glucose monitoring, and weekly antepartum visits to monitor glycemic control. The doctor explained to the mother that GDM poses little risk to her at this time; however, it is associated with an increase in infant birth trauma and perinatal morbidity and mortality with the risk to her fetus directly related to its size. The goal of antepartum treatment of GDM is to prevent fetal macrosomia, which is defined as an estimated fetal weight of ⩾ 4500 grams, and its resultant complications by maintaining desirable maternal blood glucose levels throughout gestation. It was explained that if diet alone did not maintain blood glucose at desirable levels, then hypoglycemic therapy with insulin injections given several times a day may be required.

1. Who is at greatest risk when the mother has GDM?

Answer 1

Gestational Diabetes mellitus is the carbohydrate intolerance of variable severity which is first recognised during the present pregnancy. It usually presents late in second or during third trimester.

A person with a family history of diabetes mellitus, previous birth of an over weight baby, unexplained perinatal loss, presence of polyhydramnios age over 30 years, some ethnic groups, obesity are at increased risk for gestational diabetes mellitus.

Here the women is Hispanic, which increases the risk of diabetes mellitus. She also had history of diabetes mellitus during previous pregnancy which again increases the risk of getting diabetes mellitus during the present pregnancy.

Screening is usually done between 24 to 28 weeks of pregnancy. Oral glucose tolerance test is the screening test which helps to find out the diabetes mellitus.

When the mother have diabetes mellitus, the baby is at risk for problems. The following are the problems which can occur for the baby when the mother is diabetic.

• Macrosomia- big baby
• Hypoglycemia- decreases blood glucose level
• Hyperbilirubinemia- increase in bilirubin due to break down of RBC
• Low blood calcium level
• Increased level of RBC and thickened blood
• Birth defects like heart problems, brain and spinal defects, oral clefts, kidney and gastric intestinal tract defects and limb deficiencies.
• Premature birth
• Enlarged heart
• Breathing problem

The blood glucose level to be monitored closely. Based on the blood glucose level mother have to be advised on diet control,exercises, medications. Insulin to be advised when the fasting blood glucose level exceeds 90 mg/ dl or 2 hours post prandial value is greater than 120 mg/ dl even on diet control.

Diet with 2000-2500 k cal/ day for normal weight women and 1200-1800 k cal/ day for overweight women is recommended. Exercises like brisk walking aerobics are safe during pregnancy.

When a pregnant women is diabetic, the baby is at greater risk of developing some complications.