Pathogenesis and Complications of Gestational Diabetes Mellitus

1. Pathogenesis and Complications of
Gestational Diabetes Mellitus (GDM)
Brajesh Lahri
Final Professional MBBS
All India Institute of Medical Sciences
(AIIMS),Bhopal

2. Gestational Diabetes Mellitus (GDM)…
Why and How ?
Definition
Gestational Diabetes Mellitus (GDM) refers to cases with abnormal carbohydrate
tolerance which have onset or are first detected to have abnormal glucose
tolerance during the pregnancy.

3. Risk Factors for GDM
Positive family history of Diabetes (Parents or Sibling)
Having a previous birth of an overweight baby of 4kg or more
Persistent Glycosuria
Age over 30 years
Obesity
History of Unexplained perinatal loss
Presence of polyhydramnios or vaginal candidiasis in present pregnancy

4. Pathogenesis of GDM

5. Why to detect early and
treat GDM ?

6. An Overview of effects of Diabetes on Pregnancy
Effects of
Diabetes on
Pregnancy
Maternal
During
Pregnancy
During Labour
During
Puerperium
Foetal
Congenital
Malformations
Neonatal
Complications

7. Effects on Mother
During Pregnancy :
Abortion
Pre term Labour (May be secondary to infection or polyhydramnios)
Increased risk of Infections (specially Urinary Tract Infections)
Maternal Distress (Due to oversized foetus and polyhydramnios)
Diabetic Retinopathy
Diabetic Nephropathy
Ketoacidosis

8. During Labour :
Prolongation of Labour (Due to big baby)
Perineal Injuries (Due to big baby)
Shoulder Dystocia (Due to disproportionate growth)
Post Partum Hemorrhage
During Puerperium :
 Puerperal Sepsis
Lactation Failure

9. Effects on Foetus
Foetal Macrosomia : Most common foetal hazard (30-40% are affected)

10. Congenital Malformations
Usually not related to Gestational Diabetes mellitus as it presents in second and third trimester.
These teratogenic effects are related to severity of Diabetes affecting organogenesis ,in the first
trimester.

11. CNS Defects : Neural tube defects, Anencephaly, Microcephaly, Sacral agenesis
Cardiac Defects : VSD, ASD, Coarctation of aorta, Transposition of great vessels,
Cardiomegaly
Renal Defects : Renal agenesis, Hydronephrosis, Ureteral duplication
Gastrointestinal : Duodenal Atresia, Anorectal Atresia

12. Neonatal Complications
Hypoglycemia
Respiratory Distress Syndrome
Hyperbilirubinaemia
Polycythemia
Hypocalcemia
Hypomagnesaemia
Cardiomyopathy
The Overall Perinatal mortality rate is increased 2-3 times. The
neonatal deaths are principally due to hypoglycemia, respiratory
distress syndrome, polycythemia and jaundice.

13. Thank You !!!