Gestational Diabetes Mellitus or GDM, is the first recognition or onset of Impaired Glucose Tolerance or IGT in pregnancy. GDM affects 3-10% of all pregnancies. In this condition, both mother and the baby are at health risk. However, this can be managed by using the strategies given below.
Self Monitoring Blood Glucose or SMBG is necessary at least 4 times a day. Glucose monitoring will help in modifying the diet plan and insulin dosage so as to maintain euglycemia. Urine ketones must be recorded regularly to prevent presence of starvation ketosis.
Rate of weight gain needs to be carefully monitored depending on pre pregnancy weight. An obese individual can gain up to 7 kg in pregnancy versus an underweight individual, who can gain weight up to 18 kg.
Diet during pregnancy should be nutritionally adequate, help to maintain normal blood sugar and promote required weight gain. Meals must be split into 3 main meals and 3 small meals including a bedtime snack to ensure even carbohydrate distribution and adequate calorie intake. Protein requirement increases due to increased production of blood and its components, rapid development of fetus, growth of mother’s reproductive organs, increased requirement of amino acids and reserves post delivery, maintenance and repair of body tissues.
Most vitamin and mineral requirement increases during pregnancy, especially that of iron, zinc, B complex vitamins and vitamin A. Fluids need to be taken in plenty to flush out toxins and to replace fluid losses.
Exercise in pregnancy will regulate blood glucose levels by improving insulin sensitivity. It must be noted that exercises and other physical activities must not be strenuous or cause any discomfort. Snacking before exercise will help prevent hypoglycemia and fluctuations in blood sugar if insulin dosage is varied.
Insulin administration should be matched to carbohydrate content in a meal and must meet blood glucose targets. There is no recommended insulin regimen during GDM. Generally oral glucose medications are not recommended during pregnancy due to safety considerations.
Pregnant women must be motivated to maintain normal physical activity, take a nutritionally adequate diet, monitor blood glucose and follow insulin regimens as per doctor’s advice. GDM women must not lose weight or fast during pregnancy. They must be educated about combating stress during labor and delivery. They must be advised to maintain normal lactation and implement successful strategies to prevent diabetes in future.