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Mrs. Awatef Al Swelem Diabetes Education Coordinator Security Forces Hospital Program GESTATIONAL DIABETESEducational Program
Gestational Diabetes is a state of carbohydrate intolerance with onset or first recognition during the current pregnancy.
The prevalence ranges from as low as 3% in caucasion women to as high as 12% in black, oriental and hispanic women.
Because of its hormonal milieu, pregnancy is considered to be a diabetogenic state. Estrogen, progesterone, and placental lactogen are secreted in increasing amounts and they all have counter-regulatory effects and anti-insulin actions.
All pregnant women should be screened for gestational diabetes except for lean, caucasian, young women who are at very low risk. Some authorities believe that all pregnant woman to be screened for gestational diabetes regardless of the details.
Screening for Gestational Diabetes is usually carried out between 24-28 weeks of gestation and is usually repeated between 32-34 weeks if normal initially. Screening should be carried out in the first anti-natal visit in the high-risk group.
High risk group includes the following women: Age over 35 years Overweight or obese Family history of type 2 diabetes Past history of GDM History of delivering a big baby.
There are different screening methods and diagnostic criteria for Gestational diabetes and there is no universal agreement as each center has its own diagnostic tests. Modified Glucose Tolerance Test (MGTT) is used at SFH for the diagnosis of GDM.
According to our MGTT: FBS after an overnight fast 2hr Post 75g glucose load.
Undiagnosed or inadequately treated GDM can be associated with potential risks to the mother and to the fetus.
Risk to the mother Polyhydramnious risk of caesarian section and traumatic delivery. risk of preeclampsia and toxemia of pregnancy.
Risk to the fetus Early pregnancy loss Still birth Respiratory distress syndrome Macrosomia (Fetal wt. > 90% of GA) Hypoglycemia, hyperbilirubinemia, hypocalcemia and thrombocytopenia.
Glycemic Targets for GDM Fasting and preprandial sugars < 5.3 mmoL/l 2_hr post prandial sugars < 6.7 mmoL/l
Management of GDM Diet can result in control of GDM in over 75% of cases. When diet alone is insufficient to meet the glycemic targets, insulin is initiated.
Educational Services provided to GDM pts at SFH include: Insulin Use and Storage Hypoglycemia Glucagon Injection Self Blood Glucose Monitoring Supplying Glucometers Telephone call service Weekly group teaching Educational Materials In Services
Conclusion GDM usually resolves after delivery All GDM pts are checked for type 2 DM using 75g OGTT 6-8 weeks post partum. Advice about healthy diet, lifestyle, and wt. loss in order to prevent development of type 2 DM. The risk of developing type 2 DM is about 50% after 15 years if no intervention.