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Gestational Diabetes Increases Risk of High Birth Weight and Childhood Obesity

India already has the ignominious reputation of being the world’s diabetes capital. Now there is also an increased incidence of gestational diabetes in the India. It is a common medical complication, involving a sudden spike in the blood sugar levels of the expectant mothers. Places like Lucknow and Punjab have recorded alarmingly high rates of gestational diabetes as high as 41 percent and 35 percent respectively. If left unchecked, the disorder has the potential to impact the health of the child as well as that of the mother, prompting the need to monitor the mother’s blood glucose levels at all phases of her pregnancy.
 

How does gestational diabetes take its course?

 
According to Dr Srinivasa Munigoti, Diabetologist & Endocrinologist at Fortis Hospitals, Bangalore, the problem starts when there is excess glucose in the mother’s blood. “The excessive maternal glucose due to gestational diabetes travels to the baby via the placenta. This leads to excessive insulin secretion in the baby, contributing to abnormal weight gain called foetal macrosomia. Birthing a child this big is difficult and can cause birth injuries to the mother.
 
“Excessive insulin and weight in the baby at the time of birth not only leads to difficulty during labour but also could cause very low sugars in the baby immediately after birth needing admission and care in a neonatal intensive unit for administration of intravenous glucose to protect it from low sugars,” says Dr Munigoti. Gestational diabetes raises the risk of these mothers developing diabetes during future pregnancy and are more likely to develop type 2 diabetes when they get older.
 

What triggers gestational diabetes in expectant mothers and what are the risk factors?

 
The exact mechanism of gestational diabetes is still not known, but there are plenty of risk factors. “Pregnant women who have never had diabetes before but who have high blood glucose (sugar) levels during pregnancy are said to have gestational diabetes,” says Dr Munigoti. According to a 2014 analysis the Centers for Disease Control and Prevention, the prevalence of gestational diabetes across the globe is as high as 9.2 percent. Indians are particularly vulnerable. “Prevalence in Indians is quoted to be even higher up to 20%. High maternal age, high body mass index (high maternal obesity or being overweight), family history of parents having diabetes increase the risk of developing gestational diabetes,” adds Dr Munigoti.
 
Other factors such as past history of gestational diabetes, belonging to an ethnic group with a high prevalence of type 2 diabetes, polycystic ovary syndrome, history of recurrent abortions and stillbirths, hypertension and pregnancy-related hypertension are all risk factors for gestational diabetes.1
 

What are the signs of gestational diabetes in expectant mothers and what can be done to reduce the chances of developing gestational diabetes?

 
The unfortunate fact is that there are no overt signs of gestational diabetes in pregnant mothers, according to Dr Munigoti. “This is the reason why their routine pregnancy care may include a blood test (screening glucose tolerance test) to check if they are at risk of developing gestational diabetes,” he adds.
 
As in any case, to reduce the chances of developing gestational diabetes in pregnant women, they should maintain a healthy lifestyle which includes a healthy diet and regular exercise. Monthly follow up with a doctor is mandatory for regular titration of medication and to have good control over the blood sugar levels,” says Dr Munigoti.
 

If diagnosed with gestational diabetes, how can the mother reduce the risk of foetal macrosomia (big baby)?

 
Dr Munigoti says, “The expectant mother should seek help from healthcare professionals which may include a physician, endocrinologist, obstetrician, dietician to reduce carbohydrate content in the food along with increased exercise appropriate to their pregnant status and if need be use additional medication such as insulin. They may also need to closely monitor their sugars at home as advised by their doctor and have regular follow up with doctors for ensuring good control.”
 

How will gestational diabetes affect the child in later life?

 
A 2016 study has positively tied gestational diabetes to childhood obesity although the researchers stressed on the fact that it was not fully independent of the mother’s BMI. More than 4700 children born to mothers who have gestational diabetes were studied and it was noted that these children, between the age groups 9-11, had higher chances of general obesity, high body fat and central obesity as compared to other children.

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