Targeting Glycemic Level in Gestational Diabetes Mellitus to that of Normal Pregnancy would result in a better Maternal-Fetal Outcome

摘要

Women with a history of Gestational Diabetes Mellitus (GDM) are at increased riskof future diabetes and related Non-Communicable Diseases (NCD) as are theiroffspring. “Transgenerational transmission occurs”. Independent of genetic risk,offspring of hyperglycaemic pregnancies are at increased risk of early onset type2 diabetes mellitus (Type 2 DM) and obesity. Differences exist in offspring risk ofdiabetes and obesity based on time and type of diabetes exposure in utero. Thereis a risk gradient, wherein type 2 DM exposure confers greater risk and reducestime to development of type 2 DM in the offspring compared with exposure toGDM and no diabetes exposure. These data suggest, glucose dose dependencein risk transmission. Given that the age of onset of prediabetes and type 2 DMis declining many reproductive age women may have undiagnosed diabetesor dysglycaemia when they become pregnant. This has great public healthsignificance and it has become imperative that all pregnant women should bescreened for hyperglycemia even if they have no symptoms. Ministry of Health,Government of India has developed the national guidelines for testing, diagnosisand management of hyperglycemia in pregnancy. These guidelines recommendearly testing at booking, to be repeated again between 24-28 weeks if negative atfirst testing. The guideline also recommends that GDM can be diagnosed if the 2hr PG is ≥140mg/dl after 75 gm of oral glucose administration without regard tothe time of the last meal (i.e., fasting or non-fasting). This approach has also beenendorsed by International Diabetes Federation (IDF), World Health Organization(WHO) and International Federation of Gynaecology and Obstetrics (FIGO) forresource constrained settings.The aim should be to target new born baby’s birth weight, appropriate forgestational age (2.5 to 3.5 kg) to prevent the offspring developing NCD in thefuture. For this to happen early diagnosis and tight maternal glucose controlduring pregnancy similar to glycaemic level in the normal pregnancy, (FPGbetween 80 and 90 mg, 2 hr. post prandial between 110 and 120 mg) is necessary.