Gestational Diabetes Mellitus (GDM): an update based on evidence
Gestational Diabetes Mellitus (GDM) is generally defined as any degree of glucose intolerance with onset or first recognition during pregnancy (American Diabetes Association). Therefore, GDM does not include the situation of those women who previously suffer from diabetes before becoming pregnant.
GDM is usually highlighted from the equator and towards the end of the gestation period. Run with resistance to insulin, glucose intolerance and hyperglycemia. This situation of hyperglycemia also affects the development of the fetus in the uterus, being one of the consequences the birth of babies significantly greater and of greater weight than average. Known as macrosomia: birth weight greater than 4 kg, or above 90th percentile in height-for-age tables.
Some women are more likely than other to get GDM we shall consider the NICE (National Institute for Health and Care Excellence) risk factors, being at higher risk if any of the following apply :
- Previous gestational diabetes
- Previous macrosomia baby weighing 4.5 kg or above
- BMI above 30 kg/m2
- Family history of diabetes (first degree relative with diabetes)
- Maternal age (>35 years old are at greater risk)
Not forgetting the existence of new genetic test that can help us to know the genetic risk of GDM such Patia´s GDMpredict.
GDM no good outlook for the mother
Although the situation of hyperglycemia of GDM is often reversed at the end of pregnancy, health outlook for both, the mother and the baby, is not particularly flattering.
The consequences related to mother´s health affect both the course of pregnancy and her health after it. Women diagnosed with GDM have an increased risk of suffering from different pathologies associated with their situation. Among them, the most important is preeclampsia, a possible complication of pregnancy that is characterized by a set of symptoms, among which high blood pressure and maternal proteinuria (elevated proteins in the urine) with or without pathological edema.
GDM increases the risk for diabetes in the next pregnancy and alter in life. Thus, estimating the risk of GDM in further pregnancies provides a time frame for possible preventive measures. Recurrence of diet‐treated GDM was 47.2% in primiparous women with previous GDM and the recurrence was associated with weight gain between pregnancies.
Women with GDM are diagnosed with T2D and hypertension much earlier in life. This expands the current evidence that GDM is potentially an important indicator for preventive cardiovascular risk management. Of these women, 35% to 60% develop T2D within 10 years. The presence of both high maternal weight and GDM compounds the risk of developing diabetes. However, the association between overweight alone and GDM alone and hypertension and cardiovascular disease appears similar suggesting a need for effective interventions to manage both these conditions to improve the health of these patients. And happens with the so-called metabolic syndrome. The prevalence of this syndrome of women with GDM is three-fold higher than in general population.
GDM also bad outlook for the future of the baby
The baby affected by GDM during conception also assumes a series of risks, the mentioned macrosomia, complications in childbirth related to the need to practice cesarean section, shoulder dystocia, respiratory problems, fetal hypoglycemia and hyperbilirubinemia. But in addition, the baby in these circumstances also assumes a series of long-term risks that will accompany him throughout his development and life as a result of “genetic programming in the womb”, among which there is a greater risk of obesity, suffering metabolic syndrome and type 2 diabetes itself.
To confront the GDM from the nutritional point of view
An ounce on prevention is worth a pound of cure. Dietary recommendations are: index and low blood glucose charges, adequate fiber intake and close monitoring by a multidisciplinary team that includes periodic monitoring and the use of food journals. All of this, in general, is associated with Mediterranean dietary patterns or related to a diet known as DASH (in English, Dietary Approaches to Stop Hypertension) that in some way can be linked, without problems, to the guidelines already known by our preferred diet guide , that is, those of the Healthy Food Plate of the School of Public Health of the University of Harvard.
Another aspect of both prevention and treatment of DG is physical activity. It has been shown that aerobic exercise improves blood glucose levels in fasting. Also, after meals in women with gestational diabetes that exercise three to four times a week.
Juan Revenga, Dietician-nutritionist
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