Dr .YASMIN AKTARMD Phase-B ResidentDepartment of EndocrinologyBSMMU
Gestational diabetes mellitus(GDM)It is defined as any degree of glucoseintolerance with onset or first recognitionduring ...
Incidence 3 to 15% of all pregnancies arecomplicated by diabetes 0.2% to 0.5% of all pregnancies occur inwomen with pre-...
Pathophygiology Insulin resistanceProduction of placental SomatomamotropinIncreased production of cortisol, estriol,proge...
 Increased lipolysisMother uses fat for her caloric needs& serves glucose for fetal needs Changes of gluconeogenesisFetu...
White classification Based on maternal and obstetric riskfactors, graded from A (best) to F (worst)designed to predict pr...
 1971 and further updated in 1980 toincorporate ischemic heart disease andrenal transplantation
Criteria for GDM(ADA)Test 75 gm OGTT MeasurementPlasma glucose Fasting ≥ 5.1mmol/L 1h ≥ 10.0 mmol/L 2h ≥ 8.5 mmol/L
WHO recommended 75gmOGTT criteria for GDMTime point of OGTT Glucose values (mmol/L)0 hour ≥ 6.102 hour ≥7.8(Satisfying bot...
GDM risk assessment:ascertain at 1st ANCLow riskAge < 25 yrsNo known DM in 1st degree relativeWeight normal before pregnan...
Average risk : Perform blood glucose testing at 24-28wks using: One-step procedure: Diagnostic OGTTon all subjects
High-risk: Perform blood glucose testing as soonas feasible :Maternal age >35 yrsBMI >30kg/m2Strong FH. of type II DMPrev...
 If GDM is not Dx. repeated at 24-28 wks orat any time a pt. has a symtoms or signssuggestive of hyperglycemia
Adverse outcome
Newborn baby
Related to fetus Macrosomia (> 4kg, 20–30% of infantswhose mothers have GDM)FBS > 105 mg/ dlMaternal hyperglycemiaFetal h...
Macrosomic baby Normal baby
Related to fetus cont……… Shoulder dystocia or birth injury Stillbirth Perinatal mortality Congenital malformation ( wo...
Related to neonate Hypoglycemia(maternal hyperglycemiacausing fetal hyperinsulinemia)-<1.7mmol/l Hyperbilirubinemia- ≥20...
 Long-term complicationsIncreased risk of glucose intoleranceDiabetesObesity
Related to mother Preeclampsia(≥140mmhg SBP or ≥90DBP + proteinuria- + or more or UTP-≥300mg/dl) Hypertension(related to...
 Polyhydramnios Increased risk ofcesarean delivery Increased risk ofdevelopingdiabetes afterpregnancy
Management of gestationaldiabetes Initial management is with diet andexercise women with GDM need to be taught toSMBG an...
Maternal assessment BP Wt A/E-for hydromnios, fetal growth Urine for glucose,protein & pus cell
Fetal assessment USGmacrosomiapolyhydromnios Fetal monitoringFetal kick countNSTBPL
Time of delivery Duration of pregnancy Control of diabetes Presence of complications-PIH,macrosomia Past obstetrics hi...
Mode of delivery Parity Bishop’s score of cervix Adequacy of pelvis Estimated fetal wt or macrosomia Associated mater...
Postnatal management BreastfeedingPrevent hypoglycemiaReduce insulin requrement by 25% Diabetes following GDM screening ...
Women with GDM are at increased riskof developing diabetes Risk factors:• Family origin with high prevalence ofdiabetes (...
Acknowledgement
Adverse pregnancy outcome in Gestational Diabetes Mellitus (GDM)
Adverse pregnancy outcome in Gestational Diabetes Mellitus (GDM)
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Adverse pregnancy outcome in Gestational Diabetes Mellitus (GDM)

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Presented by Dr. Yasmin Aktar (Phase B Resident, Department of Endocrinology, BSMMU) in morning session on 3rd June, 2013

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Adverse pregnancy outcome in Gestational Diabetes Mellitus (GDM)

  1. 1. Dr .YASMIN AKTARMD Phase-B ResidentDepartment of EndocrinologyBSMMU
  2. 2. Gestational diabetes mellitus(GDM)It is defined as any degree of glucoseintolerance with onset or first recognitionduring pregnancy, whether or not thecondition persisted after pregnancy, andnot excluding the possibility thatunrecognized glucose intolerance mayhave antedated or begun concomitantlywith the pregnancy
  3. 3. Incidence 3 to 15% of all pregnancies arecomplicated by diabetes 0.2% to 0.5% of all pregnancies occur inwomen with pre-existing diagnosis oftype 1 DM similar number has pre-existing type 2DM
  4. 4. Pathophygiology Insulin resistanceProduction of placental SomatomamotropinIncreased production of cortisol, estriol,progesteroneIncreased insulin destruction by kidney &placenta
  5. 5.  Increased lipolysisMother uses fat for her caloric needs& serves glucose for fetal needs Changes of gluconeogenesisFetus preferentially utilizes alanine& other amino acids deprivng the motherof major neoglucogenic source
  6. 6. White classification Based on maternal and obstetric riskfactors, graded from A (best) to F (worst)designed to predict pregnancy outcomes
  7. 7.  1971 and further updated in 1980 toincorporate ischemic heart disease andrenal transplantation
  8. 8. Criteria for GDM(ADA)Test 75 gm OGTT MeasurementPlasma glucose Fasting ≥ 5.1mmol/L 1h ≥ 10.0 mmol/L 2h ≥ 8.5 mmol/L
  9. 9. WHO recommended 75gmOGTT criteria for GDMTime point of OGTT Glucose values (mmol/L)0 hour ≥ 6.102 hour ≥7.8(Satisfying both or any of thesevalues)
  10. 10. GDM risk assessment:ascertain at 1st ANCLow riskAge < 25 yrsNo known DM in 1st degree relativeWeight normal before pregnancyWeight normal at birthNo hx. Of abnormal glucose metabolismNo history of poor obstetrics outcome
  11. 11. Average risk : Perform blood glucose testing at 24-28wks using: One-step procedure: Diagnostic OGTTon all subjects
  12. 12. High-risk: Perform blood glucose testing as soonas feasible :Maternal age >35 yrsBMI >30kg/m2Strong FH. of type II DMPrevious Hx. Of : GDM, impairedglucose metabolism, or glucosuria
  13. 13.  If GDM is not Dx. repeated at 24-28 wks orat any time a pt. has a symtoms or signssuggestive of hyperglycemia
  14. 14. Adverse outcome
  15. 15. Newborn baby
  16. 16. Related to fetus Macrosomia (> 4kg, 20–30% of infantswhose mothers have GDM)FBS > 105 mg/ dlMaternal hyperglycemiaFetal hyperglycemiaFetal hyperinsulinemiaExcessive Fetal growth & adiposity
  17. 17. Macrosomic baby Normal baby
  18. 18. Related to fetus cont……… Shoulder dystocia or birth injury Stillbirth Perinatal mortality Congenital malformation ( women withfasting hyperglycemia ) Polycythemia (Hyperglycemia is astimulus for erythropoietin production)
  19. 19. Related to neonate Hypoglycemia(maternal hyperglycemiacausing fetal hyperinsulinemia)-<1.7mmol/l Hyperbilirubinemia- ≥20mg/dl Hypocalcemia Intensive neonatal care RDS Neonatal death
  20. 20.  Long-term complicationsIncreased risk of glucose intoleranceDiabetesObesity
  21. 21. Related to mother Preeclampsia(≥140mmhg SBP or ≥90DBP + proteinuria- + or more or UTP-≥300mg/dl) Hypertension(related to insulin resistance) Premature delivery Ketoacidosis Urinary and genital tract infections
  22. 22.  Polyhydramnios Increased risk ofcesarean delivery Increased risk ofdevelopingdiabetes afterpregnancy
  23. 23. Management of gestationaldiabetes Initial management is with diet andexercise women with GDM need to be taught toSMBG and perform daily tests fasting and1 - hour after meals If glycemic targets are not met within 2weeks antidiabetic therapy is required
  24. 24. Maternal assessment BP Wt A/E-for hydromnios, fetal growth Urine for glucose,protein & pus cell
  25. 25. Fetal assessment USGmacrosomiapolyhydromnios Fetal monitoringFetal kick countNSTBPL
  26. 26. Time of delivery Duration of pregnancy Control of diabetes Presence of complications-PIH,macrosomia Past obstetrics history Tests o fetal well being
  27. 27. Mode of delivery Parity Bishop’s score of cervix Adequacy of pelvis Estimated fetal wt or macrosomia Associated maternal & fetal complication
  28. 28. Postnatal management BreastfeedingPrevent hypoglycemiaReduce insulin requrement by 25% Diabetes following GDM screening &Prevention
  29. 29. Women with GDM are at increased riskof developing diabetes Risk factors:• Family origin with high prevalence ofdiabetes (e.g. South Asian, Afro-Caribbean, Middle Eastern)• Treatment with insulin in pregnancy;• Maternal obesity• Weight gain postpartum &• Family h/o diabetes
  30. 30. Acknowledgement

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