Gestational Diabetes Mellitus (GDM)
- GDM is a form of diabetes first recognized during pregnancy.
- It significantly increases the risk of:
- Type 2 diabetes in mothers later in life.
- Metabolic disorders and obesity in children.
- In India, ~20% of pregnant women develop GDM, creating long-term health burdens.
Relevance : GS 2(Health)
Need for Early Screening
- GDM is traditionally diagnosed at 24–28 weeks, but by then the foetus is already affected.
- New research suggests:
- Glucose levels should be regulated as early as 8 weeks.
- Foetal hyperinsulinemia (excess insulin in foetus) occurs around 11 weeks.
- Early glucose exposure programs lifelong metabolic responses (Barker’s Hypothesis).
Primordial Prevention Approach
- Goal: Prevent GDM before it occurs, not just manage it later.
- Components:
- Screening by 8 weeks of pregnancy.
- Maintain postprandial glucose < 110 mg/dL.
- Introduce Medical Nutrition Therapy and low-dose metformin (250 mg BD) if needed.
Clinical and Scientific Backing
- Evidence shows early glucose control reduces third-trimester GDM incidence.
- Reduces the need for insulin therapy.
- Prevents future NCDs (Non-Communicable Diseases) in child and mother.
Indian Context & Challenges
- India has 77 million diabetics, making it a global hotspot.
- Indian women are genetically more prone to insulin resistance.
- Challenges:
- Delayed antenatal care (many women report only in second trimester).
- Low awareness among both women and healthcare providers.
- Outdated guidelines focused on second-trimester screening.
Policy and Practice Recommendations
- Update National Guidelines:
- Mandate screening at 8 weeks.
- Integrate glucose testing into early antenatal visits.
- Education & Training:
- Sensitise healthcare providers, especially in rural and remote areas.
- Public awareness on early antenatal care.
- Pre-conception Health:
- Risk modification through diet, exercise, and preventive medications even before conception.
- Accessibility & Affordability:
- Make early tests and treatment affordable and available across public health facilities
- Monitoring High-Risk Mothers:
- Continuous glucose monitoring in women with risk factors throughout pregnancy.
Scientific Theories Involved
- Barker’s Hypothesis:
- Foetal conditions impact adult health.
- Early exposure to high glucose → higher risk of obesity, diabetes, metabolic syndrome.
- Primordial Prevention:
- Prevention at the root (even before risk factors emerge).
- Applies to intergenerational control of diabetes.
World Health Day 2025 Relevance
- Theme: “Healthy Beginnings, Hopeful Futures”.
- Recognises the life-long impact of maternal health on child well-being.
- WHO’s choice reinforces the urgency to intervene early in GDM.
Conclusion: A Paradigm Shift Needed
- Preventing GDM must start in the first trimester or earlier.
- A new model of maternal care involving:
- Early screening.
- Policy change.
- Stakeholder involvement.
- Lifelong monitoring.
- Fighting diabetes in India means starting in the womb — not the hospital.
