For the past several years, Chennai-based senior diabetologist V. Seshiah has been advocating that women should be tested by the eighth week of pregnancy for blood glucose levels. If their HbA1C is over 5.3, it predicts gestational diabetes mellitus, Dr. Seshiah has maintained.
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A postprandial test result of over 110mg/dl should trigger an alarm, he said.
Foetal beta cells begin secreting insulin around 10-11 weeks (about two-and-a-half months). With foetal secretion, changes in maternal metabolism start. “This is why blood glucose must be brought to less than 110mg/dl,” he explained.
Such antenatal women should be given Metformin 250mg twice a day. The use of Metformin had been approved by the ethics committee of Madras Medical College, he informed. “If postprandial blood glucose is more than 110mg/dl in the 10th week of gestation there is not enough time to bring it down in the 11th week. “So foetal beta cell insulin secretion starts to rise. “If PPBG is less than 110mg/dl at the 10th week, then there is no increase in foetal beta cell insulin secretion at the 11th week of gestation,” he added.
“If a woman with PCOD (polycystic ovarian disease) can be given Metformin even before conception then why not in gestation,” he said, adding: “By the 8th week, the foetal organ development is over. That is why we allow them to use Metformin,” Dr. Seshiah said.
“The focus is on foetus for the future,” said Anjalakshi Chandrasekar, a retired obstetrician and gynaecologist from the Madras Medical College and currently associated with the Prof. Seshiah Academic Foundation for Metabolism. “Women who are on treatment for infertility are at greater risk as they are already on drugs to treat a condition,” she explained.
The experts say a mother’s stimuli or metabolic change or insult in the mother causes permanent changes in the foetus. “Hyperglycaemia (higher blood sugar levels) causes non-communicable diseases in later life. So gestational diabetes is the mother of NCDs,” Dr. Seshiah explained. “Transgenerational transmission of diabetes should be avoided,” he said.
“Exposure to hyperglycaemic environment in utero is associated with increased occurrence of impaired glucose intolerance and a defective insulin secretory response in adult offspring independent of genetic predisposition to type 2 DM,” Dr. Seshiah explained.
“Genetics loads the gun and environment triggers it off” and without genetic factors intrauterine environment can cause the condition, he said.
The foundation is also involved in a study with two maternity hospitals – the Institute of Obstetrics and Gynaecology and Kasturba Gandhi Hospital besides in urban primary health centres in the city.
