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Business Standard

Understanding gestational diabetes: Why early detection, awareness matter

Gestational diabetes mellitus (GDM) is a condition that develops during pregnancy. In this condition, the body of the pregnant woman becomes less sensitive to insulin made by the pancreas, especially in the second and third trimesters. It causes elevated blood sugar levels, which, if unchecked, can lead to complications for both mother and baby. How common is GDM and what do the latest data show? Survey data from the International Institute of Population Sciences (IIPS), Mumbai shows developing countries—like India—are seeing sharper rises in diabetes than developed nations. The study analysed the individual data from the National Family Health Survey (NFHS) surveyed in 2015–2016 (4th round) and 2019–2021 (5th round). The number of diabetic women is projected to reach 313.3 million by 2040 globally. In 2015 alone, around 5 million Indian women had GDM—16.2 per cent of live births, with 85.1 per cent attributed specifically to GDM. Regional studies show varied prevalence: - 17.8 per cent in urban areas - 13.8 per cent in semi-urban areas - 9.9 per cent in rural areas The study highlights the key risk factors as: High BMI High-glycaemic index (GI) food Lack of exercise/physical inactivity Long-term contraceptive use Multimorbidity Hyperthyroidism Why is GDM often missed or diagnosed too late? Despite regional differences, delayed or missed GDM detection remains widespread. Universal screening at 24–28 weeks, and earlier for high-risk women, is essential. Dr Kalyan Kumar Gangopadhyay, Endocrinologist – CMRI, Kolkata told Business Standard: 'One of the studies revealed that GDM cases were missed among 57 per cent of mothers, chiefly because the condition can remain asymptomatic until sugar levels become dangerously high.' Dr Abhinaya Alluri, Senior Gynaecologist & Obstetrician, CARE Hospitals, Hyderabad added: 'In clinical practice, missed or late diagnoses of gestational diabetes mellitus (GDM) are unfortunately not uncommon, especially in resource-limited settings or among women with limited antenatal care access. GDM often presents without obvious symptoms, so without proactive screening, it can go undetected until later stages of pregnancy.' What are the risks of untreated gestational diabetes? The consequences of gestational diabetes can be serious if not diagnosed and managed early. For the mother, GDM increases the risk of: Preeclampsia (a dangerous pregnancy complication involving high blood pressure) Development of type 2 diabetes later in life Caesarean delivery For the baby, late-diagnosed or untreated GDM can lead to: Macrosomia (excessive birth weight), increasing the risk of birth trauma Shoulder dystocia, a delivery complication where the baby's shoulders get stuck behind the mother's pelvic bone Neonatal hypoglycaemia (low blood sugar in new-borns) Higher lifetime risk of obesity and glucose intolerance Can gestational diabetes lead to long-term health problems for the child? Recent research published in The Lancet Diabetes & Endocrinology, summarised by Business Standard, shows that maternal diabetes—whether gestational or pre-existing—is linked to increased risk of neurodevelopmental disorders in children. A globally pooled meta-analysis of 56 million pregnancies in over 200 studies found: 25 per cent higher risk of autism spectrum disorder (ASD) 30 per cent higher risk of ADHD 32 per cent higher risk of intellectual disability 28 per cent higher overall risk of any neurodevelopmental condition How is gestational diabetes diagnosed during pregnancy? Diagnosis of gestational diabetes is typically done through simple, non-invasive blood tests. The most common tests include: Oral Glucose Tolerance Test (OGTT): Conducted between 24–28 weeks of pregnancy. The patient drinks a glucose solution, and blood sugar levels are tested at regular intervals. Cost: ₹300–₹800 (private labs), free or subsidised in government hospitals Fasting Blood Sugar (FBS) and Postprandial Blood Sugar (PPBS): Sometimes used as preliminary screening tools, especially during early pregnancy. Cost: ₹100–₹300 Random Blood Sugar Test and HbA1c (glycated haemoglobin): May also be used in some cases. Cost: ₹500–₹800 What treatment options are available for GDM? Once diagnosed, GDM can usually be managed with lifestyle changes. Treatment includes: Medical Nutrition Therapy (MNT): A customised diet plan focused on low glycaemic index foods, adequate protein and fibre. Cost: ₹500–₹1,500 per session Self-Monitoring of Blood Glucose (SMBG): Regular glucose checks using home glucometers. Cost: ₹700–₹2,500 Medication: If blood sugar levels are not controlled through diet and exercise alone, doctors may prescribe: Insulin therapy (safe during pregnancy) Occasionally, oral anti-diabetic drugs like metformin (depending on clinical judgement) Cost: ₹1,000–₹3,000 per month Costs vary depending on location (urban vs rural), hospital (private vs public), and the frequency of monitoring or medication needed. Many government maternity clinics offer free GDM screening and management under the national health scheme. How do diet and lifestyle changes support early intervention? Controlling GDM often begins with diet and exercise. Balanced meals, fewer high-GI foods, and regular physical activity—even gentle exercise like prenatal walking—can regulate blood sugar effectively. 'In my practice, as soon as a woman is identified as high-risk, due to BMI, family history, or previous GDM, we begin counselling on balanced nutrition, physical activity, and healthy weight gain goals. A structured dietary plan focusing on complex carbohydrates, lean proteins, and fibre, along with portion control, can significantly help in maintaining glycaemic control. The key is personalisation—each woman's cultural background, food preferences, and lifestyle need to be considered,' said Dr Alluri. Adding to the discourse, Dr Kumar said, 'Women who are overweight or obese prior to conception are at significantly higher risk, and for that, pre-pregnancy weight management through healthy eating and exercising is highly recommended. I encourage patients to treat GDM as a condition they can manage, supported by structured meal plans and lifestyle coaching as needed.' Why early awareness and public education on GDM are essential The stakes are high: GDM not only affects immediate pregnancy outcomes but can also influence a child's lifelong cognitive and behavioural development. Highlighting the importance of awareness, Dr Alluri said, 'Public health campaigns, community outreach, and integrating GDM education into routine prenatal visits can significantly improve awareness. Social media, mobile health platforms, and maternal health apps also offer powerful channels for dissemination. Collaborations between obstetricians, diabetologists, and public health experts can ensure messaging is consistent and accessible. Ultimately, improving awareness is the first step toward early screening, timely diagnosis, and effective management of GDM.'