It has become imperative that every pregnant woman be screened for high blood glucose even if no symptoms are exhibited, a recent paper published in the Journal of the Association of Physicians of India has posited.
Arguing that primordial prevention or, in this case, at the earliest stage of development of the foetus, is essential to prevent children from becoming predisposed to diabetes or other non-communicable diseases (NCD), the paper by V. Seshiah and his team from the Diabetes in Pregnancy Study Group India (DIPSI) makes a case for testing all pregnant women.
“The aim should be to target keeping the new born's birth weight appropriate for the gestational age (2.5-3.5 kg) to prevent the offspring developing NCD in the future,” the authors have stated. “It is essential to make an early diagnosis and ensure the mother maintains ideal blood sugar levels (fasting glucose under or 90 mg/dl, and post prandial under or 120 mg/dl),” explains Dr. Seshiah, lead author and patron, DIPSI.
Intra-uterine period
The paper states that while several reasons have been ascribed for the rising trend of NCD, the concept of intrauterine programming has not received adequate attention. Quoting David Barker’s ‘Fetal Origin of Adult Diseases’ theory, it says the body’s susceptibility to lifestyle diseases was programmed in the intra-uterine period.
Higher glucose transfer to the foetus, when the mother has high blood sugar, stimulates the foetal pancreatic cells to start secreting insulin earlier and in higher quantities. Once initiated, it becomes self perpetuating. In addition, when the maternal glucose reading is over 110 mg/dl, the amniotic fluid becomes glucose enriched, and after 20 weeks, when the foetus begins to swallow the amniotic fluid, which further stimulates production of insulin.
National guidelines
The Ministry of Health has developed national guidelines for testing, diagnosis and management of hyperglycaemia in pregnancy, and they recommend early testing at the time of contact (during the first trimester) and if the test is negative, yet another test should be done between 24-28 weeks. “Uttar Pradesh has implemented this programme extremely well. They are even using advanced testing equipment not seen in other parts of the country,” Dr. Seshiah says.
“Testing all pregnant women has become the norm across the world,” explains V. Balaji, secretary, DIPSI. “The common test is the single dose oral glucose, because it is simple and economical.” A single reading of blood sugar two hours after the ingestion of 75 gm oral glucose solution is taken. A value of 140 mg/dl or more indicates GDM.
