Gestational diabetes is a condition where women without pre-existing diabetes experience high blood sugar levels during pregnancy. It is diagnosed if glucose intolerance persists after 24-28 weeks of gestation. It can be classified as Type A1, managed with diet, or Type A2, requiring insulin or medications in addition to diet. Management involves explaining the implications of gestational diabetes to the mother, treating it with changes in diet, exercise, and possibly medicines, and teaching self-monitoring of blood glucose. Treatment depends on fasting plasma glucose levels and can involve diet and exercise alone for mild cases or immediate insulin with or without other measures for more severe cases.

1. GESTATIONAL
DIABETES
DR. HAMZA KHAWAJA
FAMILY MEDICINE
INDUS HOSPITAL , SABZAZAR

3. DEFINITION
Gestational diabetes is a condition in which a
woman without diabetes develops high blood
sugar levels during pregnancy.
A woman is diagnosed with gestational diabetes
when glucose intolerance continues beyond 24
to 28 weeks of gestation.

5. CLASSIFICATION
TYPE A1:
Abnormal oral glucose tolerance test (OGTT), but normal
blood glucose levels during fasting and two hours after
meals; diet modification is sufficient to control glucose
levels.
TYPE A2:
Abnormal OGTT compounded by abnormal glucose levels
during fasting and/or after meals; additional therapy with
insulin or other medications is required.

14. MANAGEMENT
Explain to women with gestational diabetes:
 The implications (both short and long term) of the diagnosis for
her and her baby that good blood glucose control throughout
pregnancy will reduce the risk of fetal macrosomia, trauma
during birth (for her and her baby), induction of labour and/or
caesarean section, neonatal hypoglycemia and perinatal death.
 Treatment includes changes in diet and exercise, and could
involve medicines.
 Teach women with gestational diabetes how to self-monitor
their blood glucose.

15. TREATMENT
1. For women with gestational diabetes who have a
fasting plasma glucose level below < 7 mmol/litre at
diagnosis, offer a trial of diet and exercise changes.
 If blood glucose targets are not met with diet and
exercise changes within 1 to 2 weeks, offer
metformin.
 If metformin is contraindicated or unacceptable to
the woman, offer insulin.
 If blood glucose targets are not met with diet and
exercise changes plus metformin, offer insulin as well.

16. 2. For women with gestational diabetes who have a
fasting plasma glucose level of between 6.0 and 6.9
mmol/litre and complications such as macrosomia or
hydroamnios, consider:
Immediate treatment with insulin, with or without
metformin and diet and exercise changes.

17. 3. For women with gestational diabetes who have a
fasting plasma glucose level of above >7.0 mmol/litre at
diagnosis, offer:
Immediate treatment with insulin, with or without
metformin and diet and exercise changes.