Risk Factors for GDM

Risk factors for GDM in Pregnant Women (Indications for doing Glucose Tolerance Test GTT) :

1. Positive family history for diabetes
2. Previously bad obstetric history
3. Hydramnios (excessive Amniotic fluid) complicating pregnancy
4. Pre-Eclaptic Toxaemia of Pregnancy
5. Pregnancy induced Hypertension (PIH)
6. Elderly persons conceiving for the first time (usually 30 years & above is termed under this category).
7. Previous intra uterine fetal demise (IUFD) or still birth
8. Obesity associated with pregnancy
9. Multiparity / Twin gestation / Multiple Gestation
10. Pervious delivery of a "Big Baby" (weighing ³ 4 Kgs).
11. Post-prandial or Random Blood Glucose value ³ 120 mgm/dl, during Antenatal check up.
12. Positive sugar in the urine (Glycosuria) detected during antenatal check-up.
13. Previous h/o delivering babies with congenital defects.
14. Recurrent urinary tract infections during pregnancy/ Pyelitis / Pyclonephritis

When and How should GTT be done for diagnosing GDM?
The GTT test for the diagnosis of GDM is usually carried out between the 24th to 28th week of Pregnancy, unless indicated earlier because of the risk factors mentioned above.

It is both sensible, and logical to use 75 G glucose load for the GTT test during pregnancy as the same is used in the non-pregnant state as well for the comparison and also since the cut off levels for diagnosis have been redefined for the diagnosis of GDM state.

Pre Pregnancy Counselling
The role of pre-pregnancy counselling of persons with diabetes who are planning for conception, including pre-pregnancy nutrition, physical exercise during pregnancy, Drug therapy for diabetes prior to conception, all these play important part in successful outcome of Diabetic pregnancy.

a) Those who have type 1 diabetes (IDDM) should optimise their diabetic control prior to conception and need detailed counselling
b) Those who have type 2 diabetes (NIDDM) and are on OHA (oral drugs) should stop these tablets and should be advised to control their diabetes with diet/exercise only (or) take insulin if required.
c) Those who are on diet / exercise only for their diabetes, prior to pregnancy may continue the same and optimize their control as per the diabetologists advice.

Who requires Insulin during Pregnancy? / Role of vitamin B6 (Pyridoxine) in GDM
In our experience in Gestational diabetes (Groups III & IV of Diabetic Pregnancy) do not require Insulin for successful outcome of Pregnancy & deliver of a healthy baby. We managed these persons with diet and supplements of Pyridoxine (Vitamin B6) 80 mgm daily throughout their Pregnancy. There was no increase in any of the Perinatal or neonatal complications in the babies delivered in this group as compared with the non-diabetic deliveries.

DIABETES, PREGNANCY BIRTH STUDY (1994)
Dietary Plan and Nutrition Recommendations in Pregnant Women with Diabetes
Physical Exercise in Type I (or) IDDM Pregnancy
Physical Exercise in Type II (or) NIDDM & GDM Pregnancies
Future of GDM Mothers