How to Control and Manage Gestational Diabetes Mellitus (GDM)

Gestational diabetes mellitus (GDM) is a state of high glucose (sugar) levels detected for the first time during pregnancy.

This condition is more commonly seen in women who :

• Are obese
• Have sedentary lifestyle
• Are more than 25 years old
• Have family history of diabetes mellitus
• Have past history of gestational diabetes mellitus
• Have poly cystic ovarian syndrome (PCOS)

GDM can be diagnosed using different criteria, but management options remain same.

Following are the various approaches which are used for controlling GDM, usually in combination-

Diet control

Diet is a very important factor in controlling gestational diabetes.

• Women with GDM should cut down on their dietary caloric intake, depending upon their body weight.
• They should avoid/decrease intake of foods containing simple sugars (sweets, juices, soft drinks, jaggery etc) and calorie dense foods (fried food items, butter, nuts etc.).
• In place of these they are advised to increase intake of fresh vegetables, salads, raw fruits, pulses etc.
• They should avoid taking large meals at a time and should instead spread it throughout the day (small frequent meals).

Exercise

Women with GDM should exercise daily, unless they are advised against it by their treating doctor (based on their medical condition).

At least 30 minutes of aerobic exercise is advisable, which can be increased based on fitness level. They can also do yoga, stretching and strengthening (weight training) exercises under guidance.

Insulin

Is the first choice agent for treatment of GDM, because of its excellent safety profile and effective glucose (sugar) control. Its frequency depends on the glucose (sugar) levels.

Once started, it is usually continued till delivery with dose adjustments done on regular basis.

Oral medications

Metformin is available as tablet, for treatment of diabetes mellitus. It can be used in selected women with GDM, after discussing their associated medical conditions with the endocrinologist. It is usually given as once or twice daily.

The target levels to be achieved in GDM women are (as advised by American Diabetes Association  (ADA) –

[Ref –American Diabetes Association Diabetes Care 2020 Jan; 43(Supplement 1): S183-S192]

Women with GDM are at high risk of developing type 2 diabetes mellitus in future and hence are advised to continue healthy lifestyle post delivery.