GESTATIONAL DIABETES

2. Any disorder that causes dysfunction
of the metabolic action of the body,
resulting in loss of homeostasis.

3. 1.Diabetes Mellitus
2. Hypothyroidism
3. Hyperthyroidism
4. Phenylketonuria

4.  Diabetes mellitus (DM) is a
group of diseases characterized
by high levels of blood glucose
resulting from defects in
insulin production, insulin
action, or both.

6. DEFINITION
Gestational diabetes is a
carbohydrate intolerance of variable
severity that starts or is first
recognized during pregnancy or the
inability of the tissues to absorb
glucose from the bloodstream during
pregnancy due to a lack of the
hormone insulin.

7. A patient with symptoms of diabetes
mellitus & causal plasma glucose
concentration 200mg/dl or more

8. RISKS FACTORS
1. Older maternal age.
2.Family history of Type-2
diabetes.
3. Obesity in the women.
4. Poor obstetric history.
5.The presence of a birth
defect in previous
pregnancy.

9. Contd
6.Gestational diabetes in previous pregnancy.
7. A previous delivery of a large baby.
8. Wrong eating habits during pregnancy.
9. Previous still-birth or spontaneous
miscarriage.
10.A history of pregnancy induced UTI,HTN
etc.

11. SCREENING and DIAGNOSTIC TESTS
1. Non-challenge blood glucose
tests
2. Fasting glucose test
3. 2-hour postprandial (after a
meal) glucose test
4. Oral glucose tolerance test
(OGTT)

12. Non-challenge blood glucose tests
Non-challenge blood glucose
tests involve measuring
glucose levels in blood
samples without challenging
the subject with glucose
solutions.

13. Border line indicates
glucose tolerance test.
125-200 mg/dl.100-125 mg/dl
Diabetic>200 mg/ dl.>125 mg/ dl
Not diabetic< 145mg/ dl.<100 mg/dl
Result2h postprandialFasting

14. 50g oral glucose challenge test: A value
of 140mg/dl(7.8mmol/l)or higher will
identify 80% of all women with
gestational diabetes
The test involves drinking a solution
containing a certain amount of
glucose, and drawing blood to measure
glucose levels at the start and on set
time intervals thereafter.

15. Timing of
Measurem
ent
Plasma Glucose
National diabetes Data
Group(1979)
Carpenter and
Coustan(1982)
Fasting 105mg/dl(5.6mmol/l) 95
1hour 190mg/dl(10.5mmol/l) 180
2hour 165mg/dl(9.2mmol/l) 155
3hour 145mg/dl(8.0mmol/l) 140

16. COMPLICATIONS
For Mother: During pregnancy
1) Hypertension: High blood glucose
levels can cause high blood pressure.
2)Pre- eclampsia: If high blood pressure
becomes severe, pre- eclampsia may
develop.
3) Increased chances for developing
Type-2 diabetes.

17. DURING LABOUR
Prolongation of labour due to big baby
Shoulder dystocia
Perineal injuries
Operative interference
DURING PUERPERIUM
Puerperal sepsis
Lactation failure
COMPLICATIONS

18. Contd.
For Baby:
1) Macrosomia
2) Jaundice
3) Still-birth
4)Die in infancy

19. Contd…
5) Respiratory Distress
Syndrome
6) Neonatal
Hypoglycemia
7) Low blood Calcium
8) Shoulder dystocia

20. Pre-conception counseling-
To achieve tight control of
diabetes during pregnancy

21. Antenatal Care -Diet Therapy
Diet therapy is critical to
successful regulation of maternal
diabetes. A program consisting of
three meals and several snacks is
used for most patients. Dietary
composition should be :
 50 to 60 percent carbohydrate,
 20 percent protein,
 25 to 30 percent fat with less than
10 percent saturated fats, up to
10 percent polyunsaturated fatty
acids.

22. (I)First trimester
i. Careful monitoring of glucose control
is essential to management
ii. Diet:Total caloric intake of 30-
35kcal/kg of ideal body weight

23. (II)Second trimester
i.Maternal serum AFP
ii.Ultrasonoscan(at 18-20w) to detect
neural-tube defects and other anomalies
(III)Third trimester
i.Weekly visits to monitor glucose control
and to evaluate for preeclampsia
ii.Serial ultrasonography to evaluate fetal
growth and amnionic fluid volume
iii.Other fetal surveillance tests
iv.Accept hospitalization from 34w until
delivery

24. Insulin therapy is recommended when medical
nutrition therapy fails to maintain self-
monitored glucose at the following levels:
Fasting whole blood glucose <95 mg/dL
Fasting plasma glucose <105 mg/dL
1-hour postprandial whole blood glucose <140
mg/dL
1-hour postprandial plasma glucose <155 mg/dL
2-hour postprandial whole blood glucose <120
mg/dL
2-hour postprandial plasma glucose <135 mg/dL
Insulin therapy

25. The total first dose of insulin is calculated according
to the patient’s weight as follow:

26. Twice daily (before breakfast and
before dinner) injections of a
combination of short and intermediate
acting insulin's are usually sufficient to
control most patients otherwise a
subcutaneous insulin pump is used.

28. There is very little evidence to support
either elective delivery or expectant
management at term in pregnant
women with insulin-requiring diabetes.
Limited data from a single randomized
controlled trial suggest that induction
of labour in women with gestational
diabetes treated with insulin reduces
the risk of macrosomia.
From The Cochrane Library, Issue 4,
2003

29. (I)Timing of delivery
i.Women with gestational diabetes
who do not require insulin
ii.Women with gestational diabetes
who require insulin
iii.Overt diabetes women
iv.Others

30. (II)Mode of delivery
i. In general, women with GDM(who does not
require insulin), the way of delivery is
spontaneous labor
ii. Women with sonographic diagnosis of fetal
macrosomia, elective induction of labor or
cesarean section to prevent shouder dystocia
iii. In the overtly diabetic, cesarean delivery
has commonly been used to avoid traumatic
birth of a large infant, or to avoid maternal or
fetal complication due to more advanced
diabetes. Especially for those with vascular
diseases

31. • Usual dose of intermediate-acting insulin is given
at bedtime.
• Morning dose of insulin is withheld.
• Intravenous infusion of normal saline is begun.
• Once active labor begins or glucose levels fall
below 70 mg/dl, the infusion is changed from
saline to 5% dextrose and delivered at a rate of
2.5 mg/kg/min.
• Glucose levels are checked hourly using a
portable meter allowing for adjustment in the
infusion rate.
• Regular (short-acting) insulin in administered by
intravenous infusion if glucose levels exceed 140
mg/dl.
Insulin Management during Labor and
Delivery

32. Neonatal care
i.detecting of blood glucose, plasma calcium,
plasma bilirubin
ii.Be care for a preterm neonatal
iii.To find respiratory distress and treatment
iv.Prevention of postpartun hemorrhge

33. REFERENCES
1)http://nutrihealth.in/2009/08/gestational
diabetes-in-moms-to-be/
2)
http://www.dlife.com/diabetes/information
3)http://diabetes.niddk.nih.gov/dm/pubs/gest
ational/
4) http://www.ehow.com
5) http://www.womenfitness.net
6)http://www.marchofdimes.com