=She arrived at my clinic at 28 weeks, worried because her glucose test was “borderline” and her mother had diabetes. She was already imagining a C‑section, insulin injections, and a newborn whisked off to the NICU. After a careful history, examination and a few targeted tests, we made a plan that calmed her fears—and kept both mother and baby safe.
=She arrived at my clinic at 28 weeks, worried because her glucose test was “borderline” and her mother had diabetes. She was already imagining a C‑section, insulin injections, and a newborn whisked off to the NICU. After a careful history, examination and a few targeted tests, we made a plan that calmed her fears—and kept both mother and baby safe.
Introduction
Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy in urban India. Rapid lifestyle changes, delayed childbearing, and diets rich in refined carbohydrates have made GDM an everyday concern in my practice. If detected early and managed properly, GDM rarely threatens the pregnancy—but left unchecked it can cause significant problems for mother and baby. This article explains what GDM is, how we diagnose and manage it, and practical steps you can take if you are pregnant or planning pregnancy.
Medical explanation (in simple, evidence‑based terms)
GDM means your blood sugar is higher than normal for the first time during pregnancy. Pregnancy hormones—especially from the placenta—make your body less responsive to insulin. For most women, the pancreas compensates by producing more insulin. If it cannot keep up, glucose rises in the mother’s blood and crosses the placenta, exposing the fetus to high sugar levels. The baby responds by producing more insulin, which increases fat deposition and growth (macrosomia). After birth, the newborn can have low blood sugar and breathing problems. For the mother, uncontrolled sugar increases risk of high blood pressure, infections, and future type 2 diabetes.
Risk factors in the Indian context
– Family history of diabetes (very common in India)
– Overweight or obesity, central fat distribution
– Polycystic ovarian syndrome (PCOS)
– Previous pregnancy with GDM or a large baby (>3.5–4 kg)
– Maternal age >30 years (increasing with delayed pregnancies)
– Sedentary lifestyle and urban dietary patterns (refined flour, white rice, sweets)
– History of unexplained miscarriage or stillbirth
Warning signs women must never ignore
– Excessive thirst, frequent urination, unexplained fatigue
– Recurrent urinary tract infections or vaginal thrush
– Rapid and excessive weight gain in later pregnancy
– Reduced fetal movements (after 28 weeks)
– Blurred vision or slow healing infections
When to see a gynecologist immediately
If you have any of the warning signs, or if home glucose readings are repeatedly above target (fasting >95 mg/dL or 2‑hour post‑meal >120–140 mg/dL depending on protocol), seek urgent review. Also come immediately if you notice decreased fetal movements, abdominal pain, vaginal bleeding, contractions before term, or fever with high sugars—these can be red flags requiring urgent care.
Doctor‑recommended management
My approach follows national and international recommendations—practical, individualized and family‑friendly.
Diet advice
– Focus on portion control rather than deprivation. Traditional foods like chapati, dal, vegetables and controlled portions of rice are fine.
– Prefer complex carbohydrates and low glycemic index choices (whole grains, millets, lentils, legumes).
– Eat three balanced meals with two light snacks to avoid blood sugar spikes. Combine carbs with protein or fibre (e.g., chapati + vegetable + dal).
– Limit sweets, fruit juices, packaged snacks and late‑night meals.
– Keep carbohydrate portions consistent and avoid sudden large meals.
Lifestyle changes
– Gentle exercise: brisk walking for 30 minutes after meals is very effective. Yoga and pregnancy‑appropriate aerobic activity help too.
– Avoid tobacco and alcohol.
– Adequate sleep and stress control—stress raises blood sugar.
Tests required
– Screening at first visit if high risk; otherwise universal screening at 24–28 weeks. In India, FOGSI and WHO accept the 75 g oral glucose tolerance test (OGTT) widely used (DIPSI protocol is commonly applied in India). ACOG supports either the two‑step or one‑step strategy; we choose the test that fits each patient.
– Baseline fasting glucose, HbA1c when needed, renal and liver function if medication is considered.
– Regular self‑monitoring of blood glucose at home (fasting and 1–2 hours post‑meal) as advised.
– Ultrasound growth scans in the third trimester to monitor fetal size; non‑stress testing if indicated.
Treatment approach
– First line: medical nutrition therapy and exercise, with close monitoring for 1–2 weeks.
– If targets are not met, medication is indicated. Insulin remains the gold standard in pregnancy for precise control and safety. Many centers use metformin in addition to lifestyle measures; it is effective and increasingly used, but it crosses the placenta—decisions are individualized.
– Frequent follow‑up and dose adjustments; collaboration with a diabetologist if required.
– After delivery: glucose testing at 6–12 weeks postpartum to detect persistent diabetes and regular screening thereafter because women with GDM have higher lifetime risk of type 2 diabetes. Breastfeeding reduces that risk and should be encouraged.
Normal delivery vs C‑section clarity
GDM itself is not an automatic indication for caesarean delivery. Many women with well‑controlled GDM deliver vaginally. The decision depends on fetal size, obstetric indications, and labour progress. If ultrasound suggests a very large baby (macrosomia) with risk of shoulder dystocia, we may recommend caesarean. The goal is a safe delivery for mother and baby—mode of delivery is individualized.
Guideline references
In my practice I follow a mix of evidence and national protocols—ACOG’s guidance on diagnosis and management, WHO’s recommendations on OGTT and maternal care, and FOGSI’s guidelines adapted for India (including practical screening approaches used in our clinics). These international and Indian guidelines help shape a safe, context‑sensitive plan for every woman.
Practical doctor tips from clinical experience
– Keep a simple glucose diary and share it with your doctor; patterns matter more than a single reading.
– Small frequent meals and a post‑meal walk work wonders.
– Involve your partner—meal planning and evening walks make adherence easier.
– Carry healthy snacks when travelling to avoid hypoglycaemic or hyperglycaemic swings.
– Plan for postpartum screening and long‑term lifestyle changes—GDM is a warning sign, not a life sentence.
Conclusion (reassuring)
GDM is common but manageable. With timely screening, sensible diet and activity changes, regular monitoring and, when needed, medication, most women with GDM deliver healthy babies and recover fully after birth. If you are planning pregnancy or presently pregnant, early discussion and screening can make the difference between worry and a calm, confident pregnancy journey.
Frequently asked questions
1. How soon should I be tested for gestational diabetes?
If you have risk factors, test at the first antenatal visit; otherwise universal screening at 24–28 weeks is standard.
2. Will I need insulin if I have GDM?
Not always. Many women control GDM with diet and exercise. If blood sugars remain above targets, we may add medication—insulin is preferred when tight control is needed.
3. Can I eat rice and chapati with GDM?
Yes, in controlled portions. Choose whole grains, limit white rice, pair with protein and vegetables, and avoid large portions.
4. Does GDM affect the baby long term?
Uncontrolled GDM can increase risks at birth and may predispose the child to obesity and metabolic issues later. Good control during pregnancy reduces these risks.
5. Will I develop type 2 diabetes after GDM?
Women with GDM have higher lifetime risk. Postpartum testing at 6–12 weeks and regular checks thereafter are important. Healthy lifestyle and breastfeeding help reduce risk.
Dr Uma Mishra
MD, Obstetrics & Gynecology
High Risk Pregnancy Care Expert | Normal Delivery Specialist
Leading Gynecologist in Noida
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Website: https://www.drumamishra.com
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