This document discusses gestational diabetes mellitus (GDM), including its definition, incidence rates, pathophysiology, diagnostic criteria, risks, management, and postnatal care. GDM is glucose intolerance that begins during pregnancy. It affects 3-15% of pregnancies and increases risks for both mother and baby. Babies are at higher risk of macrosomia, injury during birth, and hypoglycemia. Mothers face increased risks of preeclampsia, cesarean delivery, and developing diabetes after pregnancy. Treatment involves diet, exercise, blood glucose monitoring, and possibly antidiabetic medications. After delivery, women with a history of GDM require screening and lifestyle changes to prevent subsequent diabetes.
2. Gestational diabetes mellitus
(GDM)
It is defined as any degree of glucose
intolerance with onset or first recognition
during pregnancy, whether or not the
condition persisted after pregnancy, and
not excluding the possibility that
unrecognized glucose intolerance may
have antedated or begun concomitantly
with the pregnancy
3. Incidence
3 to 15% of all pregnancies are
complicated by diabetes
0.2% to 0.5% of all pregnancies occur in
women with pre-existing diagnosis of
type 1 DM
similar number has pre-existing type 2
DM
5. Increased lipolysis
Mother uses fat for her caloric needs
& serves glucose for fetal needs
Changes of gluconeogenesis
Fetus preferentially utilizes alanine
& other amino acids deprivng the mother
of major neoglucogenic source
6. White classification
Based on maternal and obstetric risk
factors, graded from A (best) to F (worst)
designed to predict pregnancy outcomes
7.
8. 1971 and further updated in 1980 to
incorporate ischemic heart disease and
renal transplantation
10. WHO recommended 75gm
OGTT criteria for GDM
Time point of OGTT Glucose values (mmol/L)
0 hour ≥ 6.1
02 hour ≥7.8
(Satisfying both or any of these
values)
11. GDM risk assessment:
ascertain at 1st ANC
Low risk
Age < 25 yrs
No known DM in 1st degree relative
Weight normal before pregnancy
Weight normal at birth
No hx. Of abnormal glucose metabolism
No history of poor obstetrics outcome
12. Average risk :
Perform blood glucose testing at 24-28
wks using:
One-step procedure: Diagnostic OGTT
on all subjects
13. High-risk:
Perform blood glucose testing as soon
as feasible :
Maternal age >35 yrs
BMI >30kg/m2
Strong FH. of type II DM
Previous Hx. Of : GDM, impaired
glucose metabolism, or glucosuria
14. If GDM is not Dx. repeated at 24-28 wks or
at any time a pt. has a symtoms or signs
suggestive of hyperglycemia
19. Related to fetus cont………
Shoulder dystocia or birth injury
Stillbirth
Perinatal mortality
Congenital malformation ( women with
fasting hyperglycemia )
Polycythemia (Hyperglycemia is a
stimulus for erythropoietin production)
20. Related to neonate
Hypoglycemia(maternal hyperglycemia
causing fetal hyperinsulinemia)-<1.7mmol/l
Hyperbilirubinemia- ≥20mg/dl
Hypocalcemia
Intensive neonatal care
RDS
Neonatal death
22. Related to mother
Preeclampsia(≥140mmhg SBP or ≥90
DBP + proteinuria- + or more or UTP-
≥300mg/dl)
Hypertension(related to insulin resistance)
Premature delivery
Ketoacidosis
Urinary and genital tract infections
24. Management of gestational
diabetes
Initial management is with diet and
exercise
women with GDM need to be taught to
SMBG and perform daily tests fasting and
1 - hour after meals
If glycemic targets are not met within 2
weeks antidiabetic therapy is required
27. Time of delivery
Duration of pregnancy
Control of diabetes
Presence of complications-
PIH,macrosomia
Past obstetrics history
Tests o fetal well being
28. Mode of delivery
Parity
Bishop’s score of cervix
Adequacy of pelvis
Estimated fetal wt or macrosomia
Associated maternal & fetal complication
30. Women with GDM are at increased risk
of developing diabetes
Risk factors:
• Family origin with high prevalence of
diabetes (e.g. South Asian, Afro-
Caribbean, Middle Eastern)
• Treatment with insulin in pregnancy;
• Maternal obesity
• Weight gain postpartum &
• Family h/o diabetes