all about pregnancy induced hypertension

1. By :-
AGASYA RAJ

2.  GDM is defined as carbohydrate intolerance of
variable severity with onset or first recognition
during the present pregnancy.
 This usually presents late in second or during the
third trimester.
 It is evident that majority of these women(>50%)
with GDM ultimately develop overt diabetes by
next 15 - 20 years.

3.  Positive family history of diabetes.
 Having a previous birth of an overweight baby of 4kg or
more.
 Previous stillbirth with pancreatic islet hyperplasia
revealed on autopsy.
 Unexplained perinatal loss
 Presence of polyhydramnios or recurrent vaginal
candidiasis in present pregnancy.
 Present glycosuria
 Age over 30 years
 Obesity
 Ethnic groups

4.  Low risk : Absence of any risk factor. Blood
glucose test is not routinely required.
 Average risk : Some risk factors. Screening test is
done.
 High risk : Blood glucose test as soon as feasible
 Screening procedure: Done by using 50gm oral
glucose challenge test without regard to time of
day or last meal, between 24 weeks and 28
weeks of pregnancy.

5. Time Carpenter &
Coustan
NDDG
Fasting 95 105
1 hour 180 190
2 hours 155 165
3 hours 140 145
Criteria for diagnosis of GDM with 100gm oral glucose
(O’Sullivan and Mahan modified by Carpenter and
Coustan) and National Diabetes Data Group
GTT: Venous Plasma(mg/dL)
GDM is diagnosed when any two values are met or elevated.

6.  Increased perinatal loss is associated with fasting
hyperglycaemia. Fetal anomalies are not
increased due to absence of metabolic
disturbances during organogenesis.
 Increased incidence of macrosomia
 Polyhydramnios
 Birth trauma
 Recurrence of GDM in subsequent pregnancies is
about 50%

7.  Diet with 2000 - 3000 Kcal/day for normal weight women and
restriction to 1200 - 1800 Kcal/day for over weight woman.
 Carbohydrate should be 40-50% of total calories
 The patient needs more frequent antenatal supervision with
periodic check up of fasting plasma glucose level which should
be less than 90mg%
 Control of high blood glucose done by restriction of diet,
exercise with or without insulin.
 Human insulin should be started if fasting plasma glucose level
exceeds 90mg% and 2 hours postprandial value is greater than
120mg% even on diet control.

8.  Women with good glycemic control and who do
not require insulin may wait for spontaneous
onset of labor.
 However, elective delivery (induction or cesarean
section) is considered in patients requiring
insulin or with complication at around 38weeks.

9.  Nearly 50% of women with GDM would develop
overt diabetes over a follow up period of 5-20 years.
 Women with fasting hyperglycemia have got worse
prognosis to develop type-2 diabetes and
cardiovascular complications.
 Recurrence risk is more than 50%