Prevention
Ways that can lower the risk of getting Gestational Diabetes Mellitus (GDM) (Ratner et al., 2008):
• Losing extra weight: Pregnancy could lead to a little increase of body weight, which is something good for baby health, but gaining too much weight in a very quick manner may increase the risk of getting Gestational Diabetes Mellitus (GDM) (Ratner et al., 2008).
• Increasing physical activity level before pregnancy is effective for the prevention of Gestational Diabetes Mellitus (GDM) (Sanabria‐Martínez et al., 2015).
• Stop smoking also may lower the risk of getting Gestational Diabetes Mellitus (GDM).
• Monitoring blood glucose levels regularly.
• Follow a healthy eating plan. Eating more grains, fruits, and vegetables. Cutting down on fat and calories (Kim et al., 2007).
Healthy Eating Plan
An important factor of managing Gestational Diabetes Mellitus (GDM) is diet (Reader et al., 2006). Following a healthy eating regimen will help:
• controlling blood glucose levels to be within normal limits
• Providing adequate nutrition for mother and growing fetus
• Achieving the convenient necessary changes of weight during pregnancy (Kim et al., 2007).
Women with Gestational Diabetes Mellitus (GDM) are encouraged to (Reader et al., 2006):
• Eat small amounts and keep their weight healthy.
• Eat carbohydrate in every meal
• Eat foods that provide nutrients especially needed during pregnancy.
• Eat foods with high fiber content
• Avoid foods and drinks of large amounts of sugar or high glycemic index ex. Basmati rices.
Carbohydrates
Carbohydrate are metabolized into glucose which is then used to produce energy. To well control glucose levels, it is necessary to distribute carbohydrate over three small meals and snacks daily (Zhang et al., 2006a).
Foods containing carbohydrate:
• Milk and yogurt
• Cereals and Multigrain breads
• Legumes (red kidney and baked beans)
• Rice (Basmati), pasta and noodles
• Fruits
• Corn, Potato, sweet potato
N.B. sucrose (table sugar), fruit juices, soft drinks, cakes, and biscuits have low nutritional value (Zhang et al., 2006a).
Fat
Eating fats, especially saturated fat, should be limited. Healthy fats should be used example:
• Polyunsaturated oils and margarine
• Canola, olive oil
• Avocados and unsalted nuts.
To avoid or decrease the intake of saturated fat, you can select low-fat dairy foods, lean meats, and avoid processed and takeaway foods (Liang et al., 2010).
Protein
Protein should be served two times each day in a small amount, because of its importance for the growth of fetus and maintenance of mother health. It include lean meat, eggs, milk, low fat cheese and fish (Zhang et al., 2006b, Kim et al., 2007). These foods don't affect glucose levels of blood in a direct manner. (Zhang et al., 2006b).
Calcium & iron
They are increasingly required as pregnancy progresses. So should be served two times daily. (For calcium, one serve is equivalent to 200 g of yogurt, 250 ml milk, or 2 slices of cheese). The iron from red meat, chicken and fish are readily absorbed (Zhang et al., 2006b).
Other dietary considerations
Any of nutritious foods that don't cause increase of weight or cause glucose levels in blood can be eaten freely. Examples on these foods are fruits and vegetables (except corn, beans, potato, sweet potato, mentioned above) (Zhang et al., 2006b).
Drinks
Water is considered the best drink for the body – it is recommended with fresh lemon for difference. Sugar-free or diet drinks are preferred for people with diabetes (Gray-Donald et al., 2000).
However products containing caffeine and carbonated soft water can increase osteoporosis risk and alter the mood so should have just little of them (Gray-Donald et al., 2000).
Alternative sweeteners
Alternative sweeteners are more prefered than to natural sugars.
Physical activity
Moderate intensity physical activity is recommended for women with GDM as it can help to control glucose levels, however, it is more preferred to check that with physician prior to starting any activity during pregnancy (Sanabria‐Martínez et al., 2015).
Benefits of Physical activity
It helps to lower insulin resistance (Sanabria‐Martínez et al., 2015). Practicing exercise, like walking, regularly will help to increase fitness of mother and be prepared more for delivery of her baby. It also helps to maintain glucose levels of blood under control (Sanabria‐Martínez et al., 2015).
Walking as a regular exercise:
• Using a ‘pedometer’ (or a ‘step counter’).
• Standing and moving a lot in kitchen.
• Taking the stairs not the elevator
• Walking to the local shops instead of driving.
• Making a ‘walking group’ with family or friends at a regular time
• Garden.
How to decrease the risk of getting type 2 diabetes
Glucose levels of pregnant woman usually return to normal limits after delivery, but there is still an increased risk for her to develop type 2 diabetes later in her life (Retnakaran et al., 2007).
To decrease this risk or delay it, it is recommended to (Ross, 2006):
• Achieve a healthy weight and maintain it. By eating balanced food and practicing physical activities to reduce any extra weight.
• Eat only healthy and nutritious foods, as previously mentioned.
• Be physically active for at least 30 minutes on most days.
• keep checking glucose levels regularly at least every 1-2 years (Vijan, 2010).
Treatment & Management
The purpose of treatment is to reduce the risks of Gestational Diabetes Mellitus (GDM) for both mother and child. Controlling glucose levels can lower fetal complications (such as macrosomia) and increase maternal health (Artal et al., 2007).
If a healthy diet, physical exercise, and oral medication are not enough to maintain glucose levels within normal, then treatment with insulin would be necessary(Westermeier et al., 2015).
Lifestyle
Counseling before pregnancy is always a good way for a good lifestyle) (Artal et al., 2007).
Most women can manage their Gestational Diabetes Mellitus (GDM) by making healthy dietary changes and exercise activity, as mentioned above. Self-monitoring of glucose levels in blood is an important factor to guide therapy (Saudek et al., 2006). Some women need anti-diabetic drugs, whereas most commonly need insulin therapy (Artal et al., 2007).
Self-monitoring could be achieved using a device called "handheld capillary glucose dosage system" ( a device used for measuring blood Glucose levels) (Tang et al., 2000).
Medication
If monitoring indicates failure of maintain of glucose levels within normal limits using these ways, or if there are complications like macrosomia, then treatment with insulin would be necessary (Westermeier et al., 2015).
Fast-acting insulin is commonly used just before eating on an empty stomach. Take care to avoid lowering blood sugar levels (hypoglycemia) when injecting excess insulin (Westermeier et al., 2015).
Certain oral anti-diabetic drugs might be safe or less dangerous in pregnancy on the growing fetus than poorly controlled diabetes (i.e The lesser of two harms) (Zhu et al., 2016).
In oral drugs, Metformin is better than glyburide. If glucose levels cannot be controlled enough with a single drug, then metformin and insulin combination would be better than insulin alone (Ashoush et al., 2016).
Metformin is preferred as oral drug rather than insulin injections. Also, it helps with treatment of polycystic ovarian syndrome during pregnancy one of the risk factors of Gestational Diabetes Mellitus (GDM) (Song et al., 2016).
Metformin also lowers the need for insulin and help to gain less weight (Song et al., 2016).
Prognosis
Gestational Diabetes Mellitus (GDM) generally resolves once the baby is born. According to different studies, the potential of developing Gestational Diabetes Mellitus (GDM) in a second pregnancy, if first pregnancy developed Gestational Diabetes Mellitus (GDM), is between 30 and 84%, especially within one year of the previous pregnancy, depending on ethnic background (Nohira et al., 2006).
Women with Gestational Diabetes Mellitus (GDM) are subject to an increased risk rate of developing diabetes mellitus in the future, ( Type 2) (Nohira et al., 2006).
This risk is highest in case of:
• Women who needed treatment with insulin.
• Women who had antibodies related to diabetes ex. glutamate decarboxylase antibodies, islet cell antibodies and/or insulinoma antigen-2.
• Women who had more than two previous pregnancies
• Women who were obese.
Women who need insulin to treat GDM have a 50 percent risk of getting diabetes in the following 5 years (Lee et al., 2007).
Also, their children have an increased risk for obesity in childhood and adult phase as well as type 2 diabetes and glucose intolerance later in life (Lee et al., 2007).