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About Gestational Diabetes

Classification

Gestational diabetes is formally defined as "any degree of glucose intolerance with onset or first recognition during pregnancy". This definition acknowledges the possibility that a woman 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. A woman is diagnosed with gestational diabetes when glucose intolerance continues beyond 24–28 weeks of gestation.


Risk factors
Classical risk factors for developing gestational diabetes are:

Polycystic Ovary Syndrome
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).
Minority groups (those with higher risk factors include African-Americans, Afro-Caribbeans, Native Americans, Hispanics, Pacific Islanders, and people originating from South Asia)

Pathophysiology

The precise mechanisms underlying gestational diabetes remain unknown. The hallmark of GDM is increased insulin resistance. Pregnancy hormones and other factors are thought to interfere with the action of insulin as it binds to the insulin receptor. The interference probably occurs at the level of the cell signaling pathway behind the insulin receptor. Since insulin promotes the entry of glucose into most cells, insulin resistance prevents glucose from entering the cells properly. As a result, glucose remains in the bloodstream, where glucose levels rise. More insulin is needed to overcome this resistance. about 1.5-2.5 times more insulin is produced than in a normal pregnancy.

Screening glucose challenge test

The screening glucose challenge test (sometimes called the O'Sullivan test) is performed between 24–28 weeks, and can be seen as a simplified version of the oral glucose tolerance test (OGTT). No previous fasting is required for this screening test,in contrast to the OGTT. The O'Sullivan test involves drinking a solution containing 50 grams of glucose, and measuring blood levels 1 hour later.

Medication

If monitoring reveals failing control of glucose levels with these measures, or if there is evidence of complications like excessive fetal growth, treatment with insulin might become necessary. The most common therapeutic regimen involves premeal fast-acting insulin to blunt sharp glucose rises after meals.Care needs to be taken to avoid low blood sugar levels (hypoglycemia) due to excessive insulin injections. Insulin therapy can be normal or very tight; more injections can result in better control but requires more effort, and there is no consensus that it has large benefits

Prognosis

Gestational diabetes generally resolves once the baby is born. Based on different studies, the chances of developing GDM in a second pregnancy, if you had GDM in your first pregnancy, are between 30 and 84%, depending on ethnic background. A second pregnancy within 1 year of the previous pregnancy has a high rate of recurrence.

Epidemiology

Gestational diabetes affects 3-10% of pregnancies, depending on the population studied

Gestational diabetes

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Gestational diabetes is high blood sugar (diabetes) that starts or is first diagnosed during pregnancy.

Causes

Pregnancy hormones can block insulin from doing its job. When this happens, glucose levels may increase in a pregnant woman's blood.

You are at greater risk for gestational diabetes if you:

Are older than 25 when you are pregnant
Have a family history of diabetes
Gave birth to a baby that weighed more than 9 pounds or had a birth defect
Have high blood pressure
Have too much amniotic fluid
Have had an unexplained miscarriage or stillbirth
Were overweight before your pregnancy

Prevention

Beginning prenatal care early and having regular prenatal visits helps improve your health and the health of your baby. Having prenatal screening at 24 - 28 weeks into the pregnancy will help detect gestational diabetes early.

If you are overweight, decreasing your body mass index (BMI) to a normal range before you get pregnant will decrease your risk of developing gestational diabetes.

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