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Everything you need to know about Diabetes and pregnancy Part 2

What are the treatment options for GDM?

The cornerstone of GDM management is glycemic control. Once diagnosed with GDM, you should begin your treatment under the close control of an expert and experienced physician. The initial steps include lifestyle modifications, such as nutrition therapy and daily exercise. Furthermore, your physician may consider adding insulin or other medications, such as metformin, to complement the effects of lifestyle modifications. It is important to keep in mind not to rely solely on medications, as medications without adequate lifestyle modifications provide inadequate and often ineffective results in glycemic control for DM.

It is recommended to aim for Fasting Blood Glucose levels lower than 95 mg/dL (<5.3 mmol/L), 1-hour post-prandial levels of less than 140 mg/dL (<7.8 mmol/L), and 2-hours post-prandial levels less than 120 mg/dL (<6.7 mmol/L).

What are the common GDM complications?

The consequences of exacerbation of poorly controlled DM or the emergence of GDM in pregnancy have been extensively studied. This condition puts both the mother and the baby at increased risk of acute and chronic complications.

On the one hand, GDM puts the mother at a higher risk of developing prenatal complications such as hypertension, preeclampsia (a potentially life-threatening condition with hypertension and kidney disease), polyhydramnios (excessive amniotic fluid), as well as a higher risk of diabetic emergency conditions such as hyperglycemia (increased blood sugar), hypoglycemia (low blood sugar), Diabetic Ketoacidosis (DKA, a potentially life-threatening complication of DM), and Diabetic coma.

In the long term, GDM is typically resolved within 6 months after labor. However, mothers with a history of GDM face a higher risk of suffering from Type 2 DM for many years after, as well as a higher risk of suffering from GDM in the consequent pregnancies. This signifies the importance of proper post-partum follow-up as well as closer monitoring of glycemic control before pregnancy in mothers with a previous history of GDM.

On the other hand, the baby faces the impact of poor glycemic control before birth. Growth abnormalities, such as macrosomia (accelerated and bigger-than-expected organ growth), and Intra-Uterine Growth Restriction (IUGR, smaller than expected intra-uterine growth) occur more frequently in pregnancies complicated with GDM.

Delayed organ maturity, premature birth, increased risk of stillbirth, labor difficulties, trauma (due to macrosomia), neonatal hypoglycemia (low blood sugar), neonatal jaundice, and higher risk of development of DM are among other fetal complications of poorly controlled DM or GDM in pregnancy.

Hypoglycemia

Individuals suffering from DM are exposed to a higher risk of hypoglycemia than others. Some of the most common causes of hypoglycemia which should be avoided in pregnancy are listed below:

  • Skipping meals or not eating enough
  • Exercising more than usual
  • Taking too much insulin or diabetes medications in a day

As one of the most serious complications of DM, it is important that expecting families dealing with GDM educate themselves about signs and symptoms suggestive of hypoglycemia, and prepare to promptly monitor maternal blood glucose levels when facing any of these signs.

When suffering from hypoglycemia, the patient may feel:

  • Anxious
  • Confused
  • Dizzy
  • Drowsy
  • Headache
  • Heart pounding
  • Hungry
  • Irritable
  • Nauseous
  • Numbness or tingling
  • Shaky
  • Sweating
  • Vision changes
  • Weakness

How to deal with Hypoglycemia

A timely response could effectively mitigate serious complications due to hypoglycemia in both the mother and the baby. This further emphasizes the importance of individual preparedness, and being equipped with proper tools in the face of complications such as GDM.

When detecting low blood sugar levels in the face of hypoglycemic symptoms, a small sweet snack could significantly mitigate the risks. However, in case of any suspicion regarding hypoglycemia, or any other GDM complications, it is vital to immediately contact the healthcare professionals and quickly make your way to the Emergency Department for a professional assessment and treatment of the condition.

Please make sure to consult your healthcare provider for more information regarding GDM, hypoglycemia, and pregnancy-related complications and ways to manage them effectively.

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