Introduction
Diabetes Mellitus (DM) is a chronic disease of poorly controlled blood sugar levels which can affect pregnancy in various forms. Due to the chronic and progressive nature of this disease, in the long term, it seriously affects the quality of life through the risk of various irreversible and difficult-to-control complications, such as kidney injury, ophthalmologic disease, and wound infections or limb amputations.
Due to physiological changes in pregnancy leading to higher insulin resistance in organs, expectant mothers suffering from pre-existing DM struggle with an increased risk of exacerbation. At the same time, those without any history of DM face an increased risk of developing Gestational DM (GDM). This affects 2-6% of pregnancies worldwide, leading to an increased risk of serious complications both in mothers and babies.
This post aims to review the risk factors for developing GDM, list the possible complications, and provide adequate information regarding risk modification and blood glucose monitoring recommendations.
Risk Factors
While some risk factors, such as age and ethnicity, cannot be modified, others, like the Body Mass Index (BMI), can be managed through gentle lifestyle adjustments. Additionally, identifying these factors could help individuals take educated and calculated measures under the supervision of their healthcare providers to monitor their blood sugar more efficiently, if necessary.
It is recommended that women with pre-existing DM achieve optimum glycemic control before the start of their pregnancy journey.
Risk factors of the development of GDM include:
- Age > 35 years old
- Obesity (BMI > 30 kg/m2)
- Higher risk among Indigenous, Hispanic, Asian, and African populations
- Family history of Diabetes Mellitus
- Previous history of GDM
- Previous child with birthweight > 4kg
- Polycystic Ovarian Syndrome (PCO)
- Current use of steroids
- Essential Hypertension or pregnancy-related Hypertension
What other screening tests are available in high-risk and GDM pregnancy?
When diagnosed with GDM (or pre-existing DM in pregnancy), some tests might be considered by your physician, in addition to closer blood sugar monitoring, to monitor the development of the fetus. These tests include monthly ultrasound monitoring of the baby’s well-being known as the Biophysical Profile (BPP), starting at 28 weeks gestational age. These tests might be ordered more frequently as the anticipated date of delivery approaches, at about 36 weeks gestational age.
The physician might advise the labor induction between weeks 38-40 gestational age considering the mother’s and the baby’s well-being, while closely monitoring maternal glucose levels during labor. Furthermore, postpartum serum glucose tests might be ordered up to 6 months post-partum to assess the glycemic control of the mother and evaluate whether or not GDM has progressed to long-lasting DM.
How often should I monitor my blood glucose levels?
To screen for GDM among low-risk pregnant people, routine blood glucose testing is carried out at 24-28 weeks of gestation by the healthcare professional. It is worth noting that this provides the most accurate and reliable results regarding the mother’s glycemic control state.
Nevertheless, more frequent and closer monitoring of blood sugar levels during pregnancy is advised for women with pre-existing type 1 and 2 DM, as well as women suffering from GDM and those at higher risk. This is due to the importance of blood sugar levels in the management of both DM and its complications during pregnancy. It could be accomplished by utilizing a variety of at-home blood glucose monitoring devices which are commercially available.
There is no simple answer to the question of “How often should I monitor my blood glucose levels”, as many elements, such as individual risk factors, socioeconomic status, underlying state of glycemic control, and long-term glycemic goals weigh in when making the decision. Your physician may advise you to monitor your fasting (usually after at least 8 hours), 1-hour, and 2-hour post-prandial blood glucose levels a few days per week at times, and to provide him with the charted results for a more specific preventive or treatment plan.
Your healthcare provider is the most reliable source of information regarding options for at-home blood glucose monitoring devices, glycemic control goals, and routine laboratory blood glucose tests. Make sure to keep your physician informed about any decisions regarding your prenatal care, and share any at-home blood glucose monitoring results with them for the most reliable feedback and any necessary adjustments.
