College Papers

Gestational diabetes mellitus

Gestational diabetes mellitus (GDM) is defined as “carbohydrate intolerance resulting in hyperglycaemia of variable severity with onset of first recognition during pregnancy” (WHO, 1999). According to International Diabetes Federation (IDF), GDM is a sub group of diabetes that occurs during the period of pregnancy and tends to occur from the 24th week of pregnancy (IDF, 2015).
Pathophysiology of GDM is similar to type two DM and characterized by peripheral insulin resistance associated with insulin secretory defects (Parretti et al., 2011). This resistance is developed because of reduction of insulin action by certain hormones and human placental lactogen produced during pregnancy (Parretti et al., 2011).
Advanced maternal age (>35 years), past history of miscarriages or still births, previous birth weight > 3,5Kg, family history of DM (in first degree relatives), past history of GDM or PIH (Pregnancy induced hypertension), previous features of polycystic ovary syndrome, long term use of steroids and anti-psychotic medication, and excessive weight gain during pregnancy are significant risk factors associated with GDM (Jayathilaka et al., 2011).
GDM can be symptomatic or asymptomatic: GDM in most pregnant women is asymptomatic and difficult to diagnose, while visual disorders, bulimia, polyuria, weight loss and confusion are symptoms of GDM (Bouzari et al., 2013).
Significant increase of GDM has been reported from Southeast countries during last two decades (Rodrigues et al., 2009). However, high prevalence of GDM has reported from India with urban (17.8%), semi urban (13.8%) and rural (9.9%) (Seshiah et al., 2008). In 2016, prevalence of GDM in Sri Lanka was reported as 13.9% in more rural setting and it was a 65.5% rise when compared with prevalence of GDM reported in 2004 (Sudasinghe, Ginige and Wijeyaratne, 2016).
Untreated GDM leads to spontaneous abortion, fetal anomalies, preeclampsia, fetal demise, macrosomia and hypoglycaemia and hyperbilirubinaemia in the neonate (Holmes et al., 2011). Risk of obesity and type two DM in the offspring are long term consequences of GDM (Dabelea et al., 2000). American Diabetes Association (ADA) for the first time, recommended that all pregnant women must undergone a 75g OGTT at 24- 28th weeks of gestation to prevent maternal and fetal complications associated with GDM (ADA, 2011).
Diet and life style modifications play a crucial role in controlling glucose intolerance in GDM (Luota et al., 2011), and when dieting or life style medications are unable to achieve the desired glucose level, insulin or oral anti-diabetic drugs are used (ADA, 2003).
All the pregnant women should pay their attention to solve this global health problem. For that, they should have adequate knowledge and awareness regarding GDM and its preventive measures to overcome its high prevalence in Sri Lanka. This study is aimed at evaluating current level of knowledge, awareness and attitudes regarding GDM, associated risk factors, available screening tests and treatments among pregnant women attending antenatal clinics in a selected population in Sri Lanka.