This document discusses diabetes during pregnancy, including gestational diabetes mellitus (GDM) and pregestational diabetes. [1] GDM accounts for 80% of diabetes in pregnancy and is defined as glucose intolerance first recognized during pregnancy, while pregestational diabetes accounts for 20% and is detected before pregnancy. [2] Risk factors, complications, and approaches for managing both GDM and pregestational diabetes are covered. The goal of treatment is to control blood glucose levels and prevent fetal complications like macrosomia.
This document discusses diabetes during pregnancy, including gestational diabetes mellitus (GDM) and pregestational diabetes. [1] GDM accounts for 80% of diabetes in pregnancy and is defined as glucose intolerance first recognized during pregnancy, while pregestational diabetes accounts for 20% and is detected before pregnancy. [2] Risk factors, complications, and approaches for managing both GDM and pregestational diabetes are covered. The goal of treatment is to control blood glucose levels and prevent fetal complications like macrosomia.
This document discusses diabetes during pregnancy, including gestational diabetes mellitus (GDM) and pregestational diabetes. [1] GDM accounts for 80% of diabetes in pregnancy and is defined as glucose intolerance first recognized during pregnancy, while pregestational diabetes accounts for 20% and is detected before pregnancy. [2] Risk factors, complications, and approaches for managing both GDM and pregestational diabetes are covered. The goal of treatment is to control blood glucose levels and prevent fetal complications like macrosomia.
This document discusses diabetes during pregnancy, including gestational diabetes mellitus (GDM) and pregestational diabetes. [1] GDM accounts for 80% of diabetes in pregnancy and is defined as glucose intolerance first recognized during pregnancy, while pregestational diabetes accounts for 20% and is detected before pregnancy. [2] Risk factors, complications, and approaches for managing both GDM and pregestational diabetes are covered. The goal of treatment is to control blood glucose levels and prevent fetal complications like macrosomia.
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Pregnancy & diabetes mellitus
Contents Introduction Gestational diabetes mellitus Risk factors Complications Approch for GDM Pregestational DM Diagnostic criteria Approch for pregestational DM Introduction Diabetes mellitus is the most common medical complication of pregnancy Preexisting (type 1 or type 2) diabetes mellitus affects approximately 1–3 per 1000 pregnancies Types diabetes during pregnancy:
1 Gestational Diabetes Mellitus (GDM)
Diabetes diagnosed during pregnancy =>accountes for 80% of DM in pregnancy 2 Pre gestational DM Detected before pregnancy =>Accounts for 20% of DM in pregnancy Could be: type 1 or type 2 GESTATIONAL DIABETES
GDM is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. The risk of recurrence in future pregnancies is at least 60%. GDM complicates approximately 4% of pregnancies. Women with GDM have an approximately 50% risk of developing type 2 diabetes over the next 10 years Phatophysiology is similar to type 2 DM In the majority of GDM cases, glucose levels return to normal after delivery. Maternal Risk factors obesity (nonpregnant body mass index 30), prior history of GDM, heavy glycosuria (> 2+), Presence of polyhydraminos Having a previous birth of an overweight baby of 4kg or more unexplained stillbirth, prior infant with major malformation, and family history of diabetes in a first-degree relative.
Risk assessment for GDM is performed at the first prenatal visit in all women who do not already have diagnosed diabetes. women with low risk The low-risk group comprises women who fulfill all of the following criteria: age less than 25 years, normal body weight, no family history (first-degree relatives) of diabetes, no history of abnormal glucose metabolism or poor obstetric outcome, and not a member of an ethnic/racial group with a high prevalence of diabetes (eg, Hispanic American, Native American, Asian Complications
Diabetic ketoacidosis (DKA)
spontaneous abortion Fetal cx Elevated glucose levels are toxic to the developing fetus, miscarriages and major malformations leading to macrosomia and also to enlargement of internal organs. shoulder dystocia, and birth trauma.
They are preventable by preconceptional glucose control. Because malformations occur within the first 8 weeks of gestation. Infants --- increased risk of hypoglycemia, hypocalcemia, RDS, polycythemia,jaundice
Offspring of mothers with GDM appear to be at increased risk of obesity and impaired glucose tolerance later in life They might also have…
Cns- Neural tube defects, Anencephaly Renal - Hydronephrosis, Renal agenesis Gastrointestinal – Duodenal atresia Spinal- sacral agenesis Approch for GDM History- rull out all the risk factors Physical examination – BMI index
Universal vs Risk based screening
Early detection: Screening starts: as early as possible All women of ordinary or high risk should be screened between 24 and 28 weeks' gestation. If results of testing do not demonstrate diabetes, these women should be retested between 24 and 28 weeks' gestation. , NB: Risk based screening detects only 50% Universal screening at first ANC visit with OGTT for In those who meet the following criteria Maternal age > 35 yrs. Previous macrosomic infant ( ≥ 4000gm) Previous unexplained fetal death History of pregnancy with GDM Strong immediate family history of diabetes. Obesity ( > 90kg) Previous congenital abnormal fetus Glucosuria. determination 1 hour after the ingestion of a 50-g glucose load. If the blood glucose concentration exceeds 140 mg/dl, a 3-hour oral GTT has been recommended Diagnostic test: 100gm OGTT, it is done after overnight fasting, in the morning 1st take FBS sample, 100gm glucose taken PO then 1hr, 2hrs, 3hrs blood sugar is determined: GDM diagnosed, if 2 or more abnormal results are seen Normal results are:- FBS <95mg/dl 1hr BS<180mg/dl 2hr BS<155mg/dl 2 or more abnormal results are needed 3hr BS<140mg/dl Management & follow up
GDM once diagnosed: Main stay of management
Exercise Diet Dietary counseling: patients are prescribed diabetic diet. Initiate insulin IF FBS>95mg/dl or 2hrs post-prandal >120mg/dl : 0.5-u/kg in the first half pregnancy and increase to 0.7u/kg in the second half subcutaneously 2/3rd (NPH) in the morning and 1/3rd(regular Insuline) in the evening from total dose Medical mgt for complication
Oral hypoglycemic agents are contraindicated as they cause prolonged neonatal hypoglycemia and congenital anomalies because they cross the placenta. Obstetric Mgt.
Management of comlication Antepartum Fetal Surveilance: In excellent glycemic control achieved by diet alone, fetal follow up with BPP. and ultrasound assessment of fetal growth are advised. Planned delivery: anticipate intrapartum compln. induction vs c/s Intrapartum care Insulin infusion method Withhold the morning Regular insulin injection. Give ½ the usual insulin dose in AM. Begin & continue glucose infusion (5%DW) (RI 0.5 unit/hr )at 100ml/hr throughout labor. monitor glucose levels every 2 hours in early labor and every 1hours in active labor. Follow feto-maternal condition Mode of delivery induction vs c/s Timing of delivery b/n 38& 40wks Postpartum Care
GDM - No therapy required as is blood glucose monitoring.
All patients with GDM should have a 2-hour, 75-g OGTT approximately 6 weeks postpartum. Those with normal glucose tolerance should be reassessed every 3 years. For Pre-existing DM restart as protocol Recommended Contraception - Barrier methods are safe & without metabolic side effects - Permanent sterilization should be made available to women with diabetes who have completed childbearing
- preexisting diabetes, who do not have serious vascular disease
---- lowest dose combination or progestin only contraceptive --- Breast feeding Target glucose levels Pre-meal glucose 70-95mg/dl PP glucose <130mg/dl at 1hr. or <120mg/dl at 2hrs. No significant hypoglycemia Pregestational diabetes
Type 1 diabetes mellitus (T1DM)
results from beta cell destruction, usually leading to absolute insulin deficiency. Onset often occurs in the young T1DM may appear in older persons and may rarely present during pregnancy. Profound thirst, increased urination, and weight loss or even overt ketoacidosis are the usual symptoms prompting medical evaluation. TYPE 2 DIABETES (NONINSULIN DEPENDENT) is characterized by insufficient insulin receptors to effect proper glucose control after insulin is released (insulin resistance). Women with T2DM typically have a body habitus consisting of increased abdominal girth, often described as an "apple shape." T2DM is a multifactorial illness that is influenced by heredity, environment, and lifestyle choices Diagnostic Criteria for Diabetes Mellitus Prior to Pregnancy
However, if the fasting plasma glucose value is > 126 mg/dL and if confirmed on repeat test, there is no need to perform GTT as the woman is diabetic SEVERE HYPERGLYCEMIA & KETOACIDOSIS During pregnancy, severe hyperglycemia and ketoacidosis are treated exactly the same as in the nonpregnant state. Insulin therapy, careful monitoring of potassium level, and fluid replacement are crucial Thank you!
