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Ana Parvulescu is a pharmacist and she joined us in our efforts to make a change. We continue with diabetes, but this time she talks about a particular form: gestational diabetes. Many women develop gestational diabetes during pregnancy, even though they never suffered from diabetes and they won’t have the diasease after pregnancy. It is important to follow the advice of the healthcare professionals so that the mother and the baby stay healthy.
Gestational diabetes mellitus (GDM) is defined as the glucose intollerance with onset during the 24th-28th weeks of pregnancy. The physiopathological changes that occur during GDM are simmilar to the ones defining type 2 diabetes mellitus: insulin resistence and incapacity of counterbalance with increassed insulin secretion. Insulin resistence appears due to increased fat tissue of the pregnant woman and due to hormons that are part of the placenta (estrogen, progesterone, human chorionic somatotropin, cortisol).
- family history of obesity or diabetes mellitus
- mother’s age > 35
- overwight or obesity (BMI>30 kg/m2)
- race (Hispanic, Native American, Afro American, South Asian, American, Asian American, Pacific Ocean islands inhabitants)
- GDM in previous pregnancies
- polycystic ovary syndrome
- sedentary lifestyle
For the women that present risk factors, it is important to make a screening right from the beginning of the pregnancy. As for the pregnant women that don’t have any risk factor, the screening is recommended during the 24th-28th weeks of pregnancy. The recommended (by professional associations) screening method is glucose tolerance test.
If GDM is inefficiently managed, there are complications that may affect the mother and/or the baby.
For the mother:
- hypertension (gestational hypertension, chronic hypertension, pre-eclampsia, eclampsia)
- pre-term birth
- cezarian section birth
For the baby:
- macrosomia (large for the gestational age)
- shoulder dystocia
- neonatal hyperbilirubinemia
- still birth
Pharmacoterapy of GDM
Once the diagnostic of GDM is certain, the first step that has to be done is lifestyle changing for reaching the normal glycemic level.
The diet plays an important role in controlling the glycemic level. It is highly recommended that the mother should have 3 meals and 3 snacks a day and a balanced ingestion of carbohydrates (40%), proteins (20%) and fats (40%).
Casual or moderate physical activity is as important as the diet. It is recommended that this should be done 3 to 7 times per week, during 30 minutes, if there is no contraindication for the mother.
If the glycemic level is still high when having this kind of lifestyle, the pharmacological treatment is recommended. The first line treatment is insulin, while the second line treatment could be oral antidiabetic medication, such as metformin (biguanides), or glibenclamide (sulphonamides).
The women that were affected by GDM during their pregnancy should be screened (glucose tolerance test) after 6 to 12 weeks after giving birth and every 3 years during the whole life, because of the risk of developing type 2 diabetes.
As for the preventing methods, besides the diet and the physical activity, studies show that there is a link between vitamin D low levels, obesity, decreased insulin sensibility, decreased insulin secretion, therefore high risk of GDM.
From the pharmacoeconomic perspective, GDM has a high impact because of:
- medical emergencies
- C-section birth giving
- medical interventions in neo-natal units