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A recent paper published in the Journal of the
Association of Physicians of India has highlighted the need to screen every
pregnant woman for gestational diabetes even if no symptoms are exhibited.
Gestational Diabetes Mellitus (GDM) is defined
as Impaired Glucose Tolerance (IGT) with onset or first recognition during
pregnancy.
Undiagnosed or inadequately treated GDM can lead
to significant maternal & fetal complications. Maternal risks of GDM
include polyhydramnios, prolonged labour, obstructed labour, caesarean section,
uterine atony, postpartum haemorrhage, infection and progression of
retinopathy. These are the leading global causes of maternal morbidity and
mortality.
Fetal risks include spontaneous abortion,
intra-uterine death, stillbirth, congenital malformation, shoulder dystocia,
birth injuries, and infant respiratory distress syndrome.
Further, women with GDM and their off springs
are at increased risk of developing type 2 diabetes and other non-communicable
diseases later in life. Type 2 diabetes is characterised by high blood sugar,
insulin resistance, and relative lack of insulin.
To prevent and minimize maternal and fetal
morbidity associated with GDM, Ministry of Health and Family Welfare in India
had released a national guideline for provision of universal screening and
management of GDM as part of the essential antenatal package.
The guidelines recommend early testing during
the first trimester i.e. Week 1 to 12. If the test is negative, the guidelines
recommend to repeat the test between 24-28 weeks.
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