Chennai-based doctor advocates fundamental prevention of gestational diabetes

Pregnant woman checking blood sugar level. Image used for representative purposes | Photo credit: Getty Images/iStockphoto

Did you know that Angelina Jolie had gestational diabetes when she was pregnant with twins in 2008? It may not be talked about much, but gestational diabetes – Hyperglycemia during pregnancy – is probably more common than many people realize.

And while it can be controlled and managed, a new chapter in the book Labor and Childbirth from a Public Health Perspective by Chennai-based diabetologist V. Seshiah et al. It outlines how important this is. fundamental prevention: Preconception care and early pregnancy screening to break the cycle of intergenerational transmission. In other words, addressing risk factors before and during pregnancy can ensure a healthier future for both mother and child.

Why is this important?

Gestational diabetes mellitus (GDM) affects the health of the mother and fetus during pregnancy, as detailed in a chapter entitled “Hope and scope for a diabetes-free generation” accepted this month by global publisher Intec Open. It may not only affect the current situation, but also have a chain reaction effect in the future. health of both.

Women with GDM are three to seven times more likely to develop type 2 diabetes later in life. More than half of women with diabetes develop this chronic disease within years or at most decades after giving birth. Children of mothers with GDM are also not immune. They are more prone to obesity, glucose intolerance, and type 2 diabetes in childhood and adulthood, locking in cycles of metabolic disorders over many generations, and this “intergenerational transmission” of metabolic disorders. It will be done. The paper notes that there are public health concerns.

Why does this happen?

This chapter states that the cause of GDM is multifactorial and influenced by hormonal changes and the synergistic effects of insulin. Throughout pregnancy, insulin sensitivity improves in the first trimester, but hormonal changes increase insulin resistance in the second and third trimesters. This physiological adaptation is important to ensure an adequate nutritional supply to the developing fetus. However, in women with GDM, this insulin resistance is further amplified, leading to glucose intolerance and hyperglycemia.

What will happen to the fetus?

The fuel-mediated teratogenicity hypothesis may hold the answer. When a fetus is exposed to too many nutrients, it can alter or disrupt normal development, which can lead to health problems later in life. The chapter states that in GDM, the fetus becomes hyperglycemic due to increased glucose transport across the placenta. In response, the fetal pancreas increases insulin synthesis, causing fetal hyperinsulinemia. Insulin mimics growth factors and stimulates excessive growth and obesity in the fetus. Newborns are often large for gestational age, and most of these babies are predisposed to long-term metabolic disorders that ultimately lead to severe glucose intolerance and insulin sensitivity in adulthood. .

What can you do?

This chapter details a number of measures, the most important of which is postprandial blood glucose (PPBG) testing during the first trimester. The chapter also states that prevention and management strategies to normalize maternal blood glucose levels by 11 weeks of pregnancy are also important to prevent stimulation of excessive insulin production in the fetus. Early intervention should include medical nutritional therapy, exercise, dietary counseling, and education aimed at optimizing glycemic control while ensuring adequate nutrition for both mother and developing fetus. And finally, the chapter states that pharmacological intervention may be necessary in some cases and states that metformin is being considered. Safe and effective for treating GBM.

This chapter states that it is essential to move from an intervention paradigm to a radical prevention paradigm to protect future populations from metabolic disorders, including diabetes.