Gestational Diabetes is a kind of diabetes that only pregnant women get.If a woman get diabetes or high blood sugar when she is pregnant, but she never had it before, then she has gestational diabetes.

1. GESTATIONAL DIABETES
MELLITUS
GDM
Gestational means “During
pregnancy.”

2. Gestational Diabetes is a kind of diabetes that only pregnant women get.
If a woman get diabetes or high blood sugar when she is pregnant, but she never
had it before, then she has gestational diabetes.
Commonly called as “Gestational diabetes mellitus.” or GDM.
It is first recognized during pregnancy.
Gestational diabetes is usually diagnosed during late pregnancy. If you are
diagnosed with diabetes earlier in your pregnancy, you may have had diabetes
before you became pregnant.
It is usually goes away after baby is born.
GDM is a carbohydrate intolerance.
From 3 to 8% of pregnant women will develop gestational diabetes around the 24th
to 28th weeks of pregnancy ( in between 5th to 6th months of pregnancy).

3. Risk Factors
•Parity
• Dietary risk factors
• Vitamin D levels
• Maternal history of sub fertility
• Maternal height
• Socioeconomic status
• Maternal co morbidity (Hypothyroidism, Chronic hypertension and Candida
infection
• Genetics
• Maternal Age
• Maternal Overweight
• Waist circumference >80
• No daily consumption of fruits, vegetable, or berries.
• Previous shoulder dystocia
• Psychiatric illness
• History of smoking
• Sedentary lifestyle

4. Risk Factors
Pre- pregnancy Body mass index > 25 kg/m2
Physical inactivity
Early gestational weight gain.
First and second–degree relative with diabetes
High risk race/ ethnicity
Weight during pregnancy.
Women who delivered a baby weighing 4000g or who were diagnosed with
gestational diabetes
Hypertension
High density lipoprotein cholesterol level/ triglyceride level
Women with polycystic ovary syndrome
HbA1c > 5.7% impaired glucose tolerance, or impaired fasting glucose on previous
testing.
Severe obesity (Abdominal )
Acanthosis nigricans (Skin disease occurred, when you are suffering from
diabetes, or high blood sugar level).
History of cardiovascular disease.
Current glycosuria
Have prediabetes

5. Most commonly used diagnostic criteria for GDM
The most commonly used guidelines for the diagnosis of GDM recommend the
following diagnostic criteria:-
Organization Fasting Plasma
Glucose
Glucose
Challenge
1- h plasma
glucose
2-h plasma
glucose
3-h plasma
glucose
WHO 1993 >7.0 mmol/l 75g OGTT Not
required
> 7.8 Not
required
American
Congress of
Obstetricians and
Gynecologists
> 5.3 mmol/l 100g OGTT > 10.0 > 8.6 > 7.8
Canadian
Diabetes
Association
> 5.3 mmol/l 75g OGTT > 10.6 > 8.9 Not
required
IADPSG (
International
Association of
Diabetes and
Pregnancy Study
Groups)
>5.1 mmol/l 75g OGTT > 10.0 > 8.5 Not
required

6. Pathophysiology
1. Insulin resistance increases as
pregnancy progresses.
2. Increased insulin resistance due to
increased maternal adiposity and
effects of placental hormones.
3. Hormones produced by the
placenta : Human chorionic
somatomammotropin (HCS),
cortisol, estrogen, progesterone.
4. As pregnancy progresses and
placenta grows, production of
hormones increases: thus leading to
increased insulin- resistance.
5. GDM occurs when insulin
secretion is not sufficient to offset
the decrease in insulin sensitivity.

7. Before pregnancy
This is particularly important for women who currently have diabetes or
intermediate degrees of hyperglycaemia (impaired glucose tolerance – IGT, or
impaired fasting glucose- IFG), or have experienced GDM in a previous pregnancy.
Women with GDM in a previous pregnancy should have had their glycaemic status
clarified in the postpartum period.
If more than a year has passed since the postpartum assessment, then these women
should have an oral glucose tolerance test (OGTT) prior to conception or at least in
the first trimester.
If the glycaemic status is then normal, the OGTT should be repeated at around 26 to
28 weeks, or at an earlier time.
Women already known to have diabetes need to consider how the effects of their
pregnancy may impact on the diabetes, and on any of their diabetes – associated
problems.
Hypoglycemia is more likely to occur in pregnancy, especially in the first trimester,
as a greater effort is made to attain and maintain glycaemic control.

8. Management during pregnancy
• Monitoring glucose levels.
• Life style management
• Medical nutrition therapy
• Exercise
• Self monitoring of blood glucose level
• Weight management

9. Recommendations
At first prenatal visit

11. Monitoring

13. Maternal and fetal complications in pregnancies with carbohydrate intolerance
Maternal complications Fetal complications
Diabetes complications Perinatal complications
• Diabetes ketoacidosis Fetal distress/ fetal death
• Deterioration of diabetic retinopathy Congenital malformation
• Deterioration of diabetic nephropathy Macrosomia
•Hypoglycemia (when using insulin) Birth injury due to shoulder dystocia
Obstetric complications
• Spontaneous abortion Delayed fetal development
•Premature birth Neonatal hypoglycemia
•Pregnancy- induced hypertension Neonatal hyperbilirubinemia
•Hydramnios Neonatal hypocalcaemia
•Shoulder dystocia Neonatal polycythemia
Newborn respiratory distress syndrome
Hypertrophic cardiomyopathy
Offspring’s complications
Obesity/ diabetes, Mental retarded and born

14. “Thank you for viewing
this presentation.”
Prepared By
Dr. Sakshi Dubey
sakshikumaridubey@gmail.com