Gestational diabetes mellitus.

Gestational diabetes mellitus.

Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance which begins or is first recognised during pregnancy. The definition applies whether insulin or only diet modification is used for treatment and whether or not the condition persists after pregnancy. It does not exclude the possibility that unrecognised glucose intolerance may have antedated or begun concomitantly with the pregnancy.
The importance of proper diagnosis can be appreciated as gestational diabetes mellitus is known to cause increased foetal loss (two to three times greater risk than general population) and congenital malformations like foetal macrosomy.
Further, females with GDM are at increased risk for the development of diabetes after pregnancy. 4 Offsprings of females with GDM are at increased risk of obesity and diabetes.
The diagnosis of gestational diabetes mellitus is based on a 100 g glucose tolerance test. A larger than usual glucose load (75 g) is advocated as there is an increased turnover of glucose in pregnant state. Hundred grams of glucose is dissolved in 300-400 mL of water and consumed over 5 minutes.
The first criteria for diagnosing gestational diabetes mellitus were given by O'Sullivan and were based on whole blood glucose levels. However, as the levels of glucose may vary in whole blood due to uptake by red blood cells, Carpenter and Coustan have given new values based on plasma glucose levels.

Management.

Oral hypoglycaemic chugs are contraindicated in gestational diabetes mellitus.
These pregnant diabetics should be managed meticulously with insulin.