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Gestational Diabetes

Gestational Diabetes

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Published by Sathish Kumar A

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Published by: Sathish Kumar A on Apr 19, 2011
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Gestational diabetes
From Wikipedia, the free encyclopedia
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Gestational diabetes
Classification and external resources
Universal blue circle symbol for diabetes.
Gestational diabetes
(or 
gestational diabetes mellitus
,
GDM
) is a condition in whichwomen without previously diagnoseddiabetesexhibithigh blood glucose levels during  pregnancy(especially during third trimester of pregnancy).Gestational diabetes generally has few symptomsand it is most commonly diagnosed by screeningduring pregnancy. Diagnostic tests detect inappropriately high levels of glucose  in blood samples. Gestational diabetes affects 3-10% of pregnancies, depending on the population studied.
 
Babies born to mothers with gestational diabetes are typically at increased risk of  problems such as beinglarge for gestational age(which may lead to deliverycomplications),low blood sugar , and jaundice. Gestational diabetes is a treatable condition and women who have adequatecontrol of glucose levelscan effectivelydecrease these risks.Women with gestational diabetes are at increased risk of developing type 2 diabetesmellitus(or, very rarely,latent autoimmune diabetesor Type 1) after pregnancy, as well as having a higher incidence of   pre-eclampsiaandCaesarean section;
their offspring are prone to developingchildhood obesity, withtype 2 diabeteslater in life. Most patients are treated only with diet modification and moderate exercise but some take anti-diabeticdrugs, includinginsulin.
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[edit] Classification
Gestational diabetes is formally defined as "any degree of  glucose intolerancewith onset or first recognition during pregnancy".
 This definition acknowledges the possibility that patients may have previously undiagnosed diabetes mellitus, or may have developeddiabetes coincidentally with pregnancy. Whether symptoms subside after pregnancy isalso irrelevant to the diagnosis.
 
The White classification, named after Priscilla White
 who pioneered in research on theeffect of diabetes types on perinatal outcome, is widely used to assess maternal and fetalrisk. It distinguishes between gestational diabetes (type A) and diabetes that existed prior to pregnancy (pregestational diabetes). These two groups are further subdividedaccording to their associated risks and management.
There are 2 subtypes of gestational diabetes (diabetes which began during pregnancy):
Type A1: abnormal oral glucose tolerance test (OGTT) but normal blood glucoselevels during fasting and 2 hours after meals; diet modification is sufficient tocontrol glucose levels
Type A2: abnormal OGTT compounded by abnormal glucose levels duringfasting and/or after meals; additional therapy with insulin or other medications isrequiredThe second group of diabetes which existed prior to pregnancy is also split up into several subtypes.
[edit] Risk Factors
Classical risk factors for developing gestational diabetes are the following:
a previous diagnosis of gestational diabetes or prediabetes,impaired glucosetolerance, or impaired fasting glycaemia
a family historyrevealing a first degree relative with type 2 diabetes
maternal age - a woman's risk factor increases as she gets older (especially for women over 35 years of age)
ethnic background (those with higher risk factors includeAfrican-Americans,Afro-Caribbeans, Native Americans, Hispanics,Pacific Islanders, and people originating fromSouth Asia
 
)
 beingoverweight,obeseor severely obese increases the risk by a factor 2.1, 3.6 and 8.6, respectively.
a previous pregnancy which resulted in a child with a high birth weight (>90thcentile, or >4000 g (8 lbs 12.8 oz))
 previous poor obstetric historyIn addition to this, statistics show a double risk of GDM insmokers.
 Polycystic ovarian syndromeis also a risk factor,
although relevant evidence remains controversial.
Some studies have looked at more controversial potential risk factors, such as shortstature.
About 40-60% of women with GDM have no demonstrable risk factor; for this reasonmany advocate to screen all women.
 Typically women with gestational diabetes exhibitno symptoms (another reason for universal screening), but some women may demonstrateincreasedthirst, increasedurination, fatigue,nauseaandvomiting,  bladder infection, yeast infectionsand blurred vision.

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