Gestational diabetes mellitus is any degree of glucose intolerance with the onset or first recognition during pregnancy. This is irrespective of the form of treatment or whether it continues after pregnancy. Its prevalence may range from 1-14 percent, depending on the population, age, comorbid factors, weight, and Body Mass Index. Almost 4 percent of all pregnancies have complications, due to gestational diabetes mellitus.
A lot of changes happen during pregnancy, major ones being hormonal fluctuations. The hormones cortisol and estrogen increase, as the pregnancy progresses, leading to insulin resistance and increase in sugar levels. The maximum effect of these hormones is seen from the 26th to 33rd weeks. Thus, the screening of gestational diabetes happens between the 24th and 28th weeks of gestation.
Regular monitoring of sugar levels can keep the baby and the mother away from complications.
The risk categories for gestational diabetes mellitus are:
- High risk: Marked obesity, glycosuria (presence of sugar in urine), diabetes in 1st relative
- Low risk: Age below 25, normal weight gain
- Average risk: Do not fit in any of the above categories, but should undergo screening tests between 24-28th weeks of gestation.
Diagnosis of gestational diabetes mellitus is carried out by doing a glucose tolerance test. In this test, 75 gm of glucose is given to the patient and the sugar levels are monitored after two hours. The cut-off value is >140 mg/dl, and anything above 120 mg/dl regular monitoring is required.
Physiotherapy management for gestational diabetes mellitus
Physiotherapy plays a vital role in this condition. Sedentary women are more prone to gestational diabetes as compared to women who have an active lifestyle. Both resistance and aerobic exercises must be included. According to the American College of Sports Medicine (ACSM) guidelines, exercises are recommended at least a minimum of three days a week.
It is recommended to walk 30-40 minutes, at least thrice a week, while resistance exercises are advised twice a week under supervision. A combination of both these exercises will gradually maintain/ reduce the sugar levels.
According to ACSM guidelines, FIIT principle is used for exercise
Frequency: 3-5 times a week
Intensity: Moderate to somewhat severe intensity, according to modified borg’s scale or 60-90 percent of HR max. These things are evaluated by your physiotherapist and an exercise plan is made for you.
Time: 30-40 minutes a day
Type: Combination of aerobic and resistance exercises of upper and lower limbs
Here’s what you MUST keep in mind about physiotheraphy for gestational diabetes:
- These exercises must be started only under the supervision of a qualified physiotherapist, after detailed evaluation of your reports and pregnancy scans, weight gain, sugar levels etc.
- It has also been observed that mothers with gestational diabetes mellitus are more prone to diabetes mellitus post-delivery, and face an increased risk of their infants developing glucose intolerance .
- Physiotherapy doesn’t just play a role during pregnancy, but is also important in the post-delivery period, since it helps in reducing weight and maintaining your blood sugar levels.
- Early diagnosis can always lead to less complications and a smoother pregnancy and delivery process.
So, now that we all are aware of the condition and physiotherapy, let’s spread the word!
