In the short term, diabetes-related pregnancy complications continue to be a significant cause of maternal and fetal morbidity, and they act as antecedents and predictors of long-term risks of diabetes, obesity, and more widespread metabolic disease in both mother and fetus.
GDM (gestational diabetes mellitus) is characterized as glucose sensitivity of varying severity that develops or is first seen during pregnancy. Stuebe et al (diabetes journal) conclude that this disorder was linked to chronic metabolic dysfunction in women three years after birth, even though other clinical risk factors are linked to it.
Pathophysiology
Gestational Diabetes Mellitus (GDM) is characterised by hyperglycaemia first recognised in pregnancy. Its prevalence varies widely in the literature, but is thought to effect 4-7.5% of all pregnancies. (Medscape). Newborns of mothers who have type 2 diabetes have a two-fold increased risk of severe injury at birth, a three-fold increased risk of cesarean delivery, and a four-fold increased risk of admission to the neonatal intensive care unit (NICU).
In pregnancy, the placenta (the blood source for the baby) produces hormones that help the baby grow and develop. Some of these hormones block the action of the mother’s insulin which is called insulin resistance. During pregnancy, to keep the blood glucose levels normal, mothers need to make 2 to 3 times the normal amount of insulin due to this insulin resistance. If the body is unable to produce the extra insulin or becomes more resistant, gestational diabetes develops. When the baby is born and the insulin requirements fall, glucose levels return to normal and diabetes usually disappears.
Risk factors
A previous gestational Diabetes episode
Glucose in Urine (Glycosuria)
Obesity of high severity
A recent diagnosis of Polycystic ovarian syndrome (PCOS)
If Type 2 diabetes runs in the family.
Screening for Diabetes
Some of the manifestations of Gestational diabetes diabetes are similar to symptoms encountered during pregnancy – such as getting more sluggish or visiting the urinals more often. Many forms with gestational diabetes are diagnosed through screening method referred to as an OGTT (Oral Glucose Tolerance Test). it is done at 24-28 weeks.
The optimal strategy for detecting gestational diabetes is up for debate. In the United States, the two-step system is preferred. (eMedicine) A fifty-gram glucose challenge test (GCT) lasting 1 hour is accompanied by a hundred-gram Oral Glucose tolerance test (OGTT) lasting 3 hours.
SELF-MANAGEMENT
Dietary Therapy
Dietary treatment aims to reduce the number of big meals a day and diets high in basic carbs. To reduce the bursts of energy consumption introduced to the bloodstream at each point of time, a total of 6 meals/day are recommended, including 3 main meals and 3 snackings. Recommended meals should be high in carbs and cellulose. Examples include whole grain bread and legumes.
Insulin Therapy
Insulin treatment during pregnancy aims to maintain glucose levels that are close to those of expectant mothers who are not diabetic. Provided that stable pregnant women retain a comparatively small range of blood sugar excursions (70-120 mg/dL), replicating this profile demands diligent regular care both from the patient and the health professional.
Physiotherapy management
Aerobic or resistance exercise, performed at a moderate intensity at least three times per week, safely helps to control postprandial blood glucose levels and other measures of glycaemic control in women diagnosed with gestational diabetes mellitus.(NCBI)
The primary aim of GDM management is to optimise glucose control and improve pregnancy outcomes(Alwan)
Both ACSM and ESSA recommend that combined aerobic and resistance exercise are more effective if blood glucose management, body composition improvement and fitness outcomes[ACSM].Resistance training resulting in an increased muscle mass can increase blood glucose uptake independent of intrinsic insulin response as insulin does not have influence on musculature glucose uptake[Lopez, Cuff, Martin]. Activating both of these metabolic pathways may be more physiologically beneficial than utilising only one pathway or exercising using only resistance training or aerobic training[Collberg, Sigal].
When prescribing exercise it is important to take into consideration the woman’s previous physical activity history, cardiorespiratory fitness and strength[NCBI]. For women who were previously sedentary it may be more convenient for them to start an exercise program in the second trimester, after which most of the initial discomforts of morning sickness, nausea and fatigue have settled down[Marcus]
During pregnancy, the majority of guidelines indicate the use of moderate intensity, but even low intensity exercise such as Yoga and Tai-Chi has shown benefits on mood, balance, lower back pain and urinary incontinence[ncbi]. As cardiorespiratory fitness is vitally important in encouraging positive outcomes during pregnancy and post pregnancy, moderate aerobic exercise is highly recommended(Addison, Smith)
In regards to evidence specific to GDM treatment, exercise has been shown to be an effective tool in glucose control which may prevent, reduce or delay the need for insulin[Tuffnell]
“I’d really recommend newly diagnosed mums speak to other mums with, or who’ve had, gestational diabetes, if they can. The moral support really helps.”
diabetes.org.uk
– Vicky, a journalist from London
Table 1
Exercise guidelines for gestational diabetes mellitus
| Type of exercise | Intensity | Duration | Frequency |
| Aerobic (large muscle activities in a rhythmic manner) e.g., walking, running, swimming and cycling | Moderate 60%-90% of APHRM RPE 12-14 Previously sedentary Owt/Ob should begin training at 20%-30% of APVO2R RPE 12-14 Vigorous RPE 14-16 | ≤ 30 min continuously (up to 45 min if self-paced) | No more than two consecutive days without exercising |
| Resistance (multi joint exercises, large muscle groups) e.g., dumbbells, resistance band and pregnancy Pilates | Moderate 50% 1RM 5-10 exercises 8-15 repetitions 1-2 sets | 60 min | At least 2 but ideally 3 times a week |
APHRM: Age predicted heart rate maximum; RPE: Rate of perceived exertion; Owt: Overweight; Ob: Obese; APVO2R: Age predicted VO2 reserve; RM: Repetition maximum.
Links for further Reading
Download the gestational diabetes below pdf
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