BENGALURU: With approximately one lakh pregnant women in the state being diabetic, the state health authorities are planning to put them on metformin tablets to manage the condition.
Dr Rajkumar N, Maternal Health programme officer said, “With insulin injections, there is a risk of hypoglycemia (low blood sugar, the body’s main source of energy). There is also the problem of preservation and technique of administering it that the healthcare provider has to be trained in. So, administering metformin tablets is easier.”
Henceforth, when any pregnant woman in the state comes for her first ante-natal check-up, she will be given oral glucose tolerance test where she is given 75 gm of glucose and her blood sugar levels will be tested two hours after that. If it is greater than 140 mg/dL, she will be given medical nutrition therapy for 15 days and if the blood sugar levels are still not back to normal, she will be given metformin tablets.
Medical nutrition therapy involves a carbohydrate-controlled balanced meal plan which promotes adequate energy for appropriate gestational weight gain.
The Union health ministry, on February 28, came out with revised technical and operational guidelines on diagnosis and management of gestational diabetes mellitus (GDM) under which pregnant women will be mandatorily screened for diabetes and given metformin tablet instead of insulin injections.
Guidelines advocate that if the first test is negative, second test should be done at 24-28 weeks of gestation. In the post-partum period, oral glucose tolerance test should be repeated at six weeks after delivery, if blood sugar is less than 140 mg/dL, then women are referred to non-communicable disease clinic for blood sugar testing annually.
“It is important to ensure second test as many pregnant women develop blood sugar tolerance during 24-28 weeks period. Only one-third of gestational diabetes mellitus-positive women are detected during first trimester,” Rajkumar said.
Maternal risks of GDM include polyhydramnios, pre-eclampsia, prolonged labour, obstructed labour, cesarean section, uterine atony, post-partum hemorrhage, infection and progression of retinopathy which are the leading global causes of maternal morbidity and mortality.
Fetal risks include spontaneous abortion, intra-uterine death, stillbirth, congenital malformation, shoulder dystocia, birth injuries and infant respiratory distress syndrome.