Gestational Diabetes Mellitus ( Gdm )

Along with all the worries and complications a woman might face while pregnant, one of the more serious conditions is gestational diabetes. Gestational diabetes occurs in 4% of all pregnancies (Seibel, 2009). Many women are not informed about the disease, some may not know that they need to be tested, and others may have heard about it, but want more information on what may cause it and/or how to prevent and treat it. Either way this disease needs to be taken seriously by every pregnant woman or woman planning to get pregnant to protect not only herself but the unborn child.

Gestational diabetes, affecting approximately 3-10% of pregnancies, is diagnosed by hyperglycemia during pregnancy in women without a history of diabetes. The underlying cause of gestational diabetes remains unknown, although the interference of pregnancy hormones, such as human placental lactogen, with susceptible insulin receptors, has been considered. The patients usually have few symptoms, and they are often diagnosed by screening during routine pregnancy check-up. For the mother, glucose intolerance typically disappears after the baby is born. However, gestational diabetes often places the body at risk. Babies born to mothers with poor hyperglycemia control are often at increased risk of series problems including macrosomia, which associates with a high chance of C-section, shoulder dystocia, hypoglycemia after birth, polycythemia as well as multiple chemical disorders.

There is an unresolved debate on whether routine HbA1c’s are not cost effective and the model should remain as women receiving a polycose test at 24-28 weeks. An HbA1c is a blood test that requires no consumption of concentrated glucose drinks or fasting. It measures the amount of blood glucose over the prior 120 days (Sevket, Sevket, Ozel, Dansuk & Kelekci, 2014). It has however been concluded that HbA1c’s are not an alternative for diagnosis of GDM and are not useful in reduces the need for further diagnostic testing (Sevket, Sevket, Ozel, Dansuk & Kelekci, 2014). Therefore not all guidelines are updated to follow these recommendations supported by the MOH (2014) REFERENCE and REFERENCE. The algothrithm for ADHB (2013) and WDHB (2012) follow the ‘risk screening’ approach where only women with risk factors are offered an HbA1c, all other women are offered the routine polycose at 24-28 weeks. Victorias midwife followed these guidelines. The screening and diagnosis of GDM also detects unrecognised type two diabetes and rarely type one (Pairman et al., 2015) because the pathophysiology of type 2 diabetes mellitus includes insulin resistance, similar to GDM. Thus pregnancy provides a window of opportunity to identify women at risk of developing type 2 diabetes or who may be in the prediabetic state (Lacroix et al, 2013; Chasam-Taber, 2015). Prehaps if Victoria was offered an HbA1c at booking her GDM might have been recognised earlier.

RESEARCH ARTICLE: Rowan J., Gao W., Battin M., & Moore M. (2008). Metformin Vs. Insulin for the Treatment of Gestational Diabetes. The New England Journal of Medicine. 358(19):2003-2015.

Diabetes has been established to be more precarious for women, as it can augment pregnancy complications such as macrosomia, miscarriage, and birth defects. Women with diabetes also have a higher prevalence of secondary cardiovascular disease. Among those women who continue in the spiral of diabetes complications, ischemic heart disease is an even greater complication which will reduce survival and quality of life (Beckles and Thompson-Reid, 2011). Pregnant women diagnosed with gestational diabetes mellitus (GDM) have a higher risk of developing type 2 diabetes later in their lifetime. It has been proven that an average of 25 percent of pregnant women with GDM will be diagnosed with type 2 diabetes within an average of seven years (Sokup, Ruszkowska-Ciatec, Walentowicz, Grabiec & Rose, 2014). In such women, blood glucose and triglyceride levels must be monitored closely, and appropriate action and referrals are given if needed for proper disease management.

This is a condition where the mother develops diabetes (mainly seen as high blood sugar) during pregnancy.She may not have been diabetic before pregnancy and the condition usually abates during pregnancy. According to the Center for disease Control and Prevention (CDC), gestational diabetes affects up to 1 out of 10 pregnant women in the US. In a recent review, up to 13.9% of Pregnant Nigerian women in Urban places were found to have diabetes. Most of them had risk factors which accounted for the high prevalence.

Insulin is the only hormone in the body that lowers blood glucose levels, as it targets cells and provides for glucose storage as glycogen (Mattson Porth, 2002). Insulin prevents fat and glycogen breakdown and inhibits glycogenesis and increases portent synthesis (Mattson Porth, 2002). The placenta secretes hormones and adipokines, these include tumor necrosis factor (TNF)-α, human placental lactogen, and human placental growth hormone (Alfadhli, 2015). Furthermore, increased oestrogen, progesterone and cortisol during pregnancy add to the disruption of the balance of glucose and insulin levels within the body (Alfadhli, 2015). The body tries to compensate for the insulin resistance by increasing the amount of insulin that is secreted, however women with gestational diabetes can not secrete enough insulin to keep up with the metabolic stress of the insulin resistance causing hyperglycaemia in the bloodstream (Alfadhli, 2015).

Type­2 Diabetes is an epidemic, increasingly affecting the lives of people almost of all ages as it becomes more known among youth and is even affecting our unborn. Diabetes in New Zealand as stated by the ‘Ministry of Health New Zealand’ has been recorded in December, 2013 that over 240,000 people have been diagnosed with mostly Type­2 Diabetes and it is said that around 100,000 more may have not been diagnosed yet. This is becoming a crisis because around 5.4% of the population has it, with it increasing 0.3% per annum. Gestational diabetes is when you’ve developed or have diabetes whilst being pregnant, which may have risks towards the mother and foetus.

Normally, the amount of glucose in the blood is controlled by insulin hormone. However, some women during pregnancy develop higher than normal levels of glucose in their blood, which insulin can't bring under control.

The hormonal changes that occur during pregnancy lead to hyperinsulinemia and insulin resistance, which causes some women to develop diabetes when their pancreatic function is not sufficient. Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset of pregnancy. The prevalence of gestational diabetes in the United States is between 1.5% to 15%. GDM tends to occur more frequently inAfrican American and Hispanic women . GDM is the most common co-morbidity during pregnancy and its prevalence is on the rise likely due to a parallel increase in obesity. Women diagnosed with GDM are at increased risk for obstetric complications, and higher higher rates of fetal morbidity and mortality.

Gestational diabetes mellitus (GDM) is an intolerance of glucose documented for the first time during pregnancy. It is usually a short-term type of diabetes and the most common health problem with pregnant women. GBM is caused by the way the hormones in pregnancy affect the mother. GDM accounts for 5-7% of all pregnancies (American Diabetes Association, 2010). During pregnancy the placenta develops and becomes the main bond between the mother and the baby. It is used to make sure the baby has and gets enough nutrients. The placenta makes several hormones which make it hard for insulin to control blood glucose and block the action of the mother’s insulin in her body (American Diabetes Association, 2010). Hormonal changes during the

Gestational diabetes happens during pregnancy. If an individual is diagnosed with this condition it usually disappears when the baby is born, although a history of gestational diabetes may increase a woman’s chances of developing Type II diabetes later in life. Diabetes can be managed through use of medication, insulin, and monitoring blood sugar levels. Gestational diabetes may occur around the 24th week of pregnancy. It doesn’t necessarily mean that the patient has or may develop diabetes. Studies have shown that it is estimated that gestational diabetes affects 18% of pregnancies. Gestational diabetes begins when your body is incapable of producing and using insulin necessary for pregnancy. Glucose cannot leave the blood and be changed to energy without enough insulin.

Starting in the beginning of pregnancy, you should go see a doctor. The doctor will evaluate your risk for gestational diabetes. If you are diagnosed with gestational diabetes, there may be extra check-up visits to the doctor than someone who does not have gestational diabetes, because of possible complications.

As nutrients are supplied by the mother’s body; the placenta senses this action, and triggers placenta transport. Through the duration of the pregnancy increased glucose and placental transporters; are associated with diabetic women; who have experience increased growth of the fetus. Hormones such as insulin; play a significant role in the regulation of the placental transporters. This issue (insulin resistance) occurs when an increase of gestational hormones hinder the actions of insulin. The majority of pregnant women are evaluated around 24-28 weeks for the risk of Gestation Diabetes Mellitus; although that these women should be screened at the first visit (Escott-Stump, 2012, p. 552).

It is estimated that 1-14% of pregnant women will develop gestational diabetes mellitus(GDM) (Hieronymus, Combs, Coleman, Ashford, & Wiggins, 2016). GDM is carbohydrate intolerance developed during pregnancy and is the most common metabolic complication of pregnancy (Wilson, Dyer, Latendresse, Wong, & Baksh, 2015). Gestational diabetes has been known to have serious complications for both the mother and the infant (Gilbert, 2011). Management of GDM includes diet, exercise, education, and possibly insulin therapy (Kopec, Ogonowski, Rahman, & Miazgowski, 2015).