INTRODUCTION

Gestational Diabetes Mellitus (GDM) is defined when a women has a glucose intolerance with
onset and first recognition between 24 to 28 weeks of gestation.

American Diabetes Association. Standards of medical care in diabetes—2014. Diabetes

Care. 2014; 37 (Supplement 1):S14–80.Return to ref 1 in article

Gestational Diabetes Mellitus (GDM) is defined as the glucose intolerance in women with onset
and first identification between 24 to 28 weeks of gestation.

Approximately 7% of all pregnancies are complicated by GDM, resulting in more than

200,000 cases annually. The prevalence may range from 1 to 14% of all pregnancies, depending
on the population studied and the diagnostic tests employed.

Report of the expert committee on the diagnosis and classification of diabetes mellitus.
Diabetes Care. 2003; 26: S5-20.

American Diabetes Association Diabetes Care 2004 Jan; 27: S88-S90.

It is estimated that 7% of all pregnancies are problematical by GDM expected to have more
than 200,000 cases yearly. The occurrence of GDM may vary from 1 to 14% depending on the
residents considered and the investigative tests used.

Gestational diabetes mellitus is one of the most common complications on pregnancies,

presently 3-5% up to 14% of the pregnant women are affected, dependent on the ethnical group
investigated. Actual estimations suggest that the prevalence of GDM will significantly increase
in the near future due to the rising rate of obesity and glucose intolerance in young women in
industrialized countries.

Lowdermilk, Perry, Bobak Maternity Nursing. 5th ed. St Louis: Mosby: 2005 601-618

Gestational diabetes mellitus is one of the serious problems in pregnancy, currently 5 - 14% of
antenatal mothers are impacted with GDM based on the community group examined. Definite
findings put forward that the incidence of GDM will radically rise in the near future due to the
increasing occurrence of obesity and glucose intolerance in adult women in developed countries.

Gestational diabetic mellitus is a public health priority in our country due to its high prevalence
as well as its immense potential for diabetes prevention. The realization that diabetes in
pregnancy is a significant contributor to the growing epidemic of type 2 diabetes mellitus
(T2DM) has also helped focus our attention on the pregnant women as a critical target for
diabetes prevention strategies.

Madhu, S.V. International Journal of Diabetes in Developing Countries 2018 Feb; 38: 1-3

Gestational diabetic mellitus is an important health problem in our country due to its high
incidence as well as its enormous possibility for diabetes prevention. The fact that the diabetes in
pregnancy is a major cause to the increasing outbreak of type 2 diabetes mellitus (T2DM) and it
has turn to concentrate its consideration for the antenatal mother as a vital goal for diabetes
avoidance strategies.

Gestational diabetes is caused by not enough insulin in the setting of insulin resistance. Risk
factors include being overweight, previously having gestational diabetes, a family history of type
2 diabetes, and having polycystic ovarian syndrome. Diagnosis is by blood tests. For those at
normal risk, screening is recommended between 24 and 28 weeks gestation. For those at high
risk, testing may occur at the first prenatal visit
National Institute of Diabetes and Digestive and Kidney Disease, September 2014.

Gestational diabetes is not only caused by the insufficient amount of insulin but also due to
the danger factors which comprise of overweight, history of diabetes in previous pregnancy,
family history of type 2 diabetes, and polycystic ovarian syndrome. Identification of GDM is
done by blood tests. For pregnant at normal risk, screening is suggested between 24 and 28
weeks gestation and for high risk testing may done at the first antenatal visit.

Although the increased incidence of GDM has caused serious concerns for the health
system around the world, there is strong evidence suggesting that a proper management can yield
better results for the mother and child. Hence, women should receive education on diabetes self-
care according to national standards after diagnosis and based on their requirements

Iran Journal of Public Health. 2018 Dec; 47(12): 1805–1815.

Even though the greater occurrence of GDM has caused severe impact for the health
organization around the world but there are supportive studies signifying that a appropriate
treatment results in better outcome for both mother and baby. Therefore the mother should be
provided with health education on diabetes self-care based on the national standards after
identification and according to their need.

Giving awareness helps the antenatal women to achieve and maintain pregnancy and give birth
to healthy infants. With the active participation of well motivated women in the treatment plan
and careful management from a multidisciplinary health care team, positive pregnancy outcomes
are often possible today.

Lowdermilk, Perry, Bobak Maternity Nursing. 5th ed. St Louis: Mosby: 2005 601-618

Providing proper health education helps the pregnant women to attain and continue healthy
pregnancy and give birth to healthy infants. With the active involvement of women in the
planning and cautious supervision from the health care team members helps in providing positive
outcomes in pregnancy today.

Prevention is by maintaining a healthy weight and exercising before pregnancy. Gestational

diabetes is treated with a diabetic diet, exercise, and possibly insulin injections.[2] Most women
are able to manage their blood sugar with diet and exercise. Blood sugar testing among those
who are affected is often recommended four times a day. Breastfeeding is recommended as soon
as possible after birth,

Donovan P J, Mclntyre HD ‘’Drugs for Gestational diabetes”2010, 33 (5): 141-144

Avoidance of GDM is done before pregnancy by conserving a healthy weight and exercise.
Gestational diabetes is managed with a proper healthy diet, exercise, and insulin injections if
indicated. All most all cases can be limited through lifestyle modifications like diet and physical
activity. Blood sugar testing is often suggested four times a day for affected women and breast
feeding should be initiated immediately after birth.

Currently there is no consensus regarding the best intervention for weight management and
GDM reduction during pregnancy. Available evidence appears to suggest that antenatal lifestyle
interventions, especially dietary interventions are associated with restricted gestational weight
gain (GWG) and could possibly reduce the risk of GDM in overweight or obese pregnant
women. However, most available trials that have been conducted in Western and Chinese
populations focused on the treatment of GDM and only few of them have tested the effectiveness
of lifestyle interventions using the prevention of GDM as the primary outcome.

Ruth Suk-Mei Chan et al , Randomized trial examining effectiveness of lifestyle

intervention in reducing gestational diabetes in high risk Chinese pregnant women in Hong
Kong- September 2018

Presently there is no availability of the best treatment modalities for the weight management
and glucose reduction in the pregnancy. Existing facts appears to recommend that lifestyle
interventions during pregnancy, particularly nutritional interventions are associated with reduced
gestational weight gain and could probably decrease the occurrence of GDM in obese pregnant
women. Still, most available studies performed in Asian populations focused on the treatment of
GDM and only few of them only conducted the effectiveness of lifestyle interventions as
prevention of GDM.

The use of mobile phones is increasing worldwide . It is estimated that in 2020, 90% of the
worldwide population will own a mobile phone . In 2015, about 94% of the population aged
between 25 and 45 years owned a smartphone with internet access offering opportunities for a
broad use of mobile apps including health apps . Carroll et al showed that main users of health
apps were healthy, young, higher-educated persons with a higher income. However, they also
showed that in general, determinants such as gender, age, and education were less suitable for
predicting the use of mobile and health apps, which is in contradiction with the profile of main
users of health app

Carroll JK, Moorhead A, Bond R, LeBlanc WG, Petrella RJ, Fiscella K. Who uses mobile
phone health apps and does use matter

The utilization of mobile phones is growing worldwide. It is expected that in 2020, 90% of the
worldwide population will possess own mobile phones. In 2015, about 94% of the population
aged between 25 and 45 years owned a smartphone with internet access offering opportunities
for a broad use of mobile apps including health apps. A study showed that users of health apps
were healthy, young, higher-educated persons with a higher income. However, they also showed
that in general, factors such as gender, age, and education were less suitable for predicting the
use of mobile and health apps, which is in contradiction with the profile of main users of health
app.

NEED FOR THE STUDY

Health of mother is affectionate and required component of total care and cannot be overlooked
because of the reality that if mother is healthy means child also will be healthy and it results in
nation’s health

Importance and components of primary health care 2018

Health of mother is tender and wanted component of total care and cannot be ignored because of
the fact that if mother is healthy; the children also will be healthy, which in turn affect nation’s
health

Gestational diabetes mellitus is a condition in which women without previously diagnosed

diabetes exhibit high blood glucose level during pregnancy .GDM affect 3 -10% of pregnancy.
Babies born to mothers with GDM are increased risk of problems such as being large for
gestational age, low blood sugar and jaundice. Women with gestational diabetes are at increased
risk of pre-eclampsia and caesarean section.GDM is a treatable condition and women who have
adequate control on glucose level can effectively decrease these risk.

Journal from American Diabetes Association-2019

Gestational diabetes mellitus is a state in which women who has not before diagnosed as
diabetes show signs of elevated blood glucose level during pregnancy .GDM influences 3 -10%
of pregnancy. The outcome of the baby delivered by the GDM mother have more incidence of
complications like large for gestational age, low blood sugar and jaundice. Women with
gestational diabetes are at greater risk of pre-eclampsia and caesarean section.GDM is a
manageable condition for women who can able to properly control their blood glucose levels.

Every year more than 200 million women become pregnant, and some 15% are likely to
develop complications that will require skilled obstetric care to prevent death or serious ill
health. All women whether their pregnancies are complicated or not need good quality maternal

health services during pregnancy.. The incidence of GDM in world is approximately 4% of

mothers. Among these women with GDM, 40% will go on to develop type II diabetes in future.
 United Nations Population Fund-2018

Every year about 200 million women become pregnant, and 15% of those pregnancies are
probable to result in complications and that should have the need of skilled obstetric care to
avoid death or serious ill health. All women whether their pregnancies are complex or not need
good quality maternal health services during pregnancy. The occurrence of GDM in world is
about 4% of mothers and among these women with GDM, 40% will have the chances to develop
type II diabetes .

Diabetes is a major public health problem in India with prevalence rates reported to be
between 4.6% and 14% in urban areas, and 1.7% and 13.2% in rural areas.[India has an estimated
62 million people with Type 2 diabetes mellitus (DM); this number is expected to go up to 79.4
million by 2025. Management of diabetes and its complications imposes a huge economic
burden on the society; hence effective strategies are urgently needed to control this epidemic.
Not surprisingly, in parallel with the increase in diabetes prevalence, there seems to be an
increasing prevalence of gestational DM (GDM), that is, diabetes diagnosed during pregnancy.
The prevalence of gestational diabetes has been reported to range from 3.8% in Kashmir, to 6.2%
in Mysore, 9.5% in Western India and 17.9% in Tamil Nadu. In more recent studies, using
different criteria, prevalence rates as high as 35% from Punjab and 41% from Lucknow have
been reported.The geographical differences in prevalence have been attributed to differences in
age and/or socioeconomic status of pregnant women in these regions. It is estimated that about 4
million women are affected by GDM in India, at any given time point.

Anjana RM, Pradeepa R, Deepa M, Datta M, Sudha V, Unnikrishnan R, et al. Prevalence

of diabetes and prediabetes (impaired fasting glucose and/or impaired glucose tolerance) in
urban and rural India: Phase I results of the Indian Council of Medical Research-INdia
DIABetes (ICMR-INDIAB) study. Diabetologia 2011;54:3022-7.
Arora GP, Thaman RG, Prasad RB, Almgren P, Brøns C, Groop LC, et al. Prevalence and
risk factors of gestational diabetes in Punjab, North India: Results from a population
screening program

In India context the occurrence rates reported to be between 4.6% and 14% in urban areas,
and 1.7% and 13.2% in rural areas. India is predictable to have 62 million people with Type 2
diabetes mellitus; this estimation is anticipated to rise up to 79.4 million by 2025. Prevention of
diabetes and its aftereffects consists of huge economic burden on the society; therefore efficient
strategies are immediately required to manage this epidemic. Not shockingly, in equal to the
increase in diabetes incidence, there is increase in the occurrence of gestational diabetic mellitus.
The occurrence of gestational diabetes has been estimated to range from 3.8% in Kashmir, to
6.2% in Mysore, 9.5% in Western India and 17.9% in Tamil Nadu. The environmental
differences in prevalence have been associated with differences in age or socioeconomic status
of antenatal mother in these regions. In India It is likely to have occurrence of 4 million women
with GDM at given time point.

Scientific evidence in management of GDM can result in less serious fetal complications and can
increase maternal quality of life. The development of macrosomia can be evaluated during
pregnancy by using Sonography. Most women manage their GDM with dietary changes and
exercise. Self monitoring of blood glucose levels can help therapy. Counseling before pregnancy
and multi-disciplinary management are important for good pregnancy outcome. GDM possess a
high risk to mother and the baby. The risks on the baby are growth abnormality and chemical
imbalances after birth. Neonates are also at risk of decreased blood glucose, jaundice, high red
cell mass. GDM also causes immature babies prone for respiratory distress syndrome due to
incomplete lung maturity and impaired surfactant synthesis.

World Journal of Diabetes-2013

Scientific data suggests that the proper treatment of GDM results in fewer incidence of fetal
complications and which in turn improves the maternal quality o life.. Most women deal with
their GDM by dietary changes and exercise. Self monitoring of blood glucose levels is also an
important part of the therapy. Proper preconception counseling is an important part of this to
achieve good pregnancy outcome. GDM owes high risk to mother and the baby. The risks on the
baby are growth abnormality and chemical imbalances after birth. Neonates are also at risk of
decreased blood glucose, jaundice, high red cell mass. GDM also results in immature babies
who are suspectable to get respiratory distress syndrome due to inadequate lung maturity and
reduced surfactant levels.

The key therapy in most patients is diet and exercise. Carbohydrate restriction has been
shown to improve glycemic control in diet to control GDM. The patients check their glucose
level 4 times daily.

Journal from American Diabetes Association - Clinical Diabetes 2013 Oct; 31(4): 179-188.

The effective therapy in most mothers is diet and exercise. Carbohydrate control has been
shown to improve glycemic control in diet to control GDM and encourage mothers to check
their glucose level 4 times daily.

A study suggests that physical activity reduce the risk of GDM. The management for women
with GDM consists of medical nutrition therapy with adjunctive exercise for at least 30 minutes
per day. Based on the study, exercise plays a vital role in preventing GDM. Studies have shown
that babies of mother with GDM are at a high risk of congenital malformation. The risk of pre
eclampsia was between 13 and 37% higher in case of GDM

Michelle, The role of exercise in the prevention and treatment of gestational diabetes
mellitus December 2007, Volume 6, Issue 6, pp 381–386

A study recommended that physical activity reduce the occurrence of GDM. The treatment
modality for women with GDM comprises of medical nutrition therapy with adjunctive exercise
for at least 30 minutes per day. Based on the study, exercise plays a important role in preventing
GDM.