Mumbai In the last three years, civic-run hospitals recorded a rise in cases of gestational diabetes (GDM) among pregnant women, data from the health department of Brihanmumbai Municipal Corporation (BMC) shows, which doctors attribute to an increase in lifestyle diseases and improved screening.
GDM is defined as glucose intolerance with recognition or onset during pregnancy, irrespective of treatment with diet or insulin.
Between April 2021 and Feb 2022, civic hospitals reported 2,785 GDM cases, out of which 53% of women were put on insulin to control blood sugar levels. While 48% of the 2001 pregnant women detected with GDM were put on insulin from April 2020-March 2021, 49% of the 2128 expectant mothers with GDM were started on insulin between April 2019 and March 2020.
Doctors said that one-third of women with GDM will develop type II diabetes after pregnancy and their children are at higher risk for obesity and diabetes at a young age.
Dr Komal Chavan, obstetrician and gynaecologist at BMC-run Dr VN Desai Hospital in Andheri, said that the rise in metabolic diseases because of lifestyle patterns is one of the reasons behind increasing incidences of GDM.
“Polycystic ovary syndrome (PCOS) or polycystic ovarian disease (PCOD), a hormonal disorder among women of reproductive age, is on a rise. Screening for GDM has also improved in pregnant women which led to a rise in the numbers. It is important to detect GDM as it has an impact on both the mother and the unborn child. It helps avoid adverse outcomes,” she said.
While 70% of the GDM positive pregnant women manage to control sugar levels with diet therapy and do not need medications, Dr Chavan said insulin is advised only when medication fails to control the sugar levels.
“If the blood sugar levels are not maintained with higher doses of medicines, we put such patients on insulin. It is the safest option in pregnancy,” she added.
As per an article published in the Indian Journal of Community Medicine in 2019, the prevalence of GDM reported from different parts of India stands at 3.8% to 17.9%.
Dr Sudeshna Ray, gynaecologist and obstetrician, Jaslok Hospital- Peddar Road, said that good counselling and explaining the risks and interventions is vital to make GDM women stick to the control routine through diet exercise and medications if needed.
“GDM is seen in increasing prevalence these days. The main reasons behind this are increased age at first pregnancy, PCOS, pregnancy through ART (assisted reproductive technology), family history of diabetes, obesity, increased weight gain during pregnancy, lack of exercise, and sedentary lifestyle with increased stress level,” she said.
Dr Ray added that screening for GDM during pregnancy should be universal and as per national and international guidelines at every level-primary, secondary and tertiary care. Pregnancy is a huge challenge to the glucose metabolism of the body and hence a good time to detect pre-diabetics and overt diabetes.
“GDM not only increases pregnancy complications such as high blood pressure, infections, miscarriages, preterm labours, operative deliveries, delivery and neonatal complications, it also increases the risk of the mother remaining diabetic and even the child being diabetic in adult life. Hence, detection and control have to be stringent during pregnancy,” she explained.
According to doctors, timely treatment of GDM not only protects the offspring from getting diabetes in future but also will help doctors in advising contraceptives. “If we know the patient had GDM, we suggest the right type of contraceptives that should be used. Taking the wrong contraceptives can only add to diabetes problems,” said Dr Ashwini Bhalerao Gandhi, consulting gynaecologist, PD Hinduja hospital.