Ground breaking concept for prediction and prevention of gestational diabetes mellitus and its sequelae

Abstract

The global prevalence of diabetes is increasing, prompting a shift in focus towards the primordial prevention of diabetes. Gestational diabetes mellitus (GDM) presents an ideal opportunity for this prevention. First time NIH study in 2018 suggested HbA1c 5.3 (2hr PPBS>110mg/dl) in the 10^th week of gestation predicts GDM, hence for prevention Blood sugar has to be brought to <110mg/dl, at 10^th week, as fetal beta cells start secreting insulin around 11^thweek. Therefore, at 8^th week itself post prandial blood sugar (PPBS) has to be estimated because in case PPBS is >110 mg at 8^th week, the grace period of 2 weeks is available to attain 2hr PPBS < 110mg at the 10^th week. The objectives of this study were: 1. To determine the risk for GDM in the first trimester at 8 Weeks; 2. To manage the risk for GDM (BG between 110 to 119) at 8-10 weeks of gestation by MNT and metformin; and 3. To compare the maternal-fetal outcomes in both groups. At 8 weeks of gestation, pregnant women were recruited and divided into 2 groups. Group A included those with 2-hour PPBS of < 110 mg/dL, they received no intervention (82 participants). Group B ((69 Participants) included women with 2-hour PPBS of 110-119 mg/dL and they received Medical Nutrition Therapy (MNT) and Metformin intervention. The prediction of GDM is based on a 2-hour PPBS ≥110 mg/dL at 10weeks. Therefore, at the 8th week, the 2-hour PPBS need to be estimated. In group A, one (1.2%) of the subjects got GDM in the third trimester due to being grand multipara, while in group B, one (1.4%) developed GDM in the third trimester due to non- adherence to management measures. In conclusion, screening for early gestational glucose intolerance (EGGI) at 8 weeks of pregnancy and intervention will benefit in preventing GDM and its sequelae.