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Gestational Diabetes.


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Published in: Health & Medicine

Gestational Diabetes.

  1. 1. DR. Maheen Asad. Regional Medical Officer, Apollo.
  2. 2. This diagnosis is given when a woman, who has never had diabetes before, gets diabetes or has high blood sugar, when she is pregnant.  Its medical name is gestational diabetes mellitus or GDM.  It is one of the most common health problems for pregnant women.  The word “gestational” actually refers to “during pregnancy.”  4 of 42 gdm
  3. 3. It occurs in about 5% of all pregnancies. If not treated, gestational diabetes can cause health problems for the mother and the fetus. kvr gdm
  4. 4. Risk Factors  maternal age >25  Family history  glucosuria  prior macrosomia  previous unexplained stillbirth  ethnic group: Hispanic, Black, Asians
  5. 5. For most women, the body’s extra insulin is enough to keep their blood sugar levels in the healthy range.  But, for about 5% of pregnant women, even the extra insulin is not enough to keep blood sugar levels normal.  These women end up with high blood sugar or gestational diabetes at around the 20th to 24th week of pregnancy.  10 gdm
  6. 6.  Screening ◦ 24-28 weeks routine ◦ no need to fast ◦ screen at 1st prenatal visit if hx of previous GDM ◦ screen earlier (12-24 weeks ) if risk factors
  7. 7. MATERNAL RISK       Birth trauma Preterm Labor PIH Operative delivery 50% lifetime risk in developing Type II DM Recurrence risk of GDM is 30-50%
  8. 8. Management Goal is to optimize BG levels to minimize risk of adverse perinatal outcomes  Diet Exercise Insulin therapy
  9. 9.  Although your glucose levels change during the day, there is a healthy range that is normal. If your glucose level is outside of the healthy target range, speak with your health care provider. Time of Blood Sugar Test Fasting glucose level Healthy Target Levels (in mg/dl) No higher than 95 One hour after eating No higher than 140 Two hours after eating No higher than 120 PBRC 2006 23 of 42
  10. 10. If persistent hyperglycemia after one week of diet control proceed to insulin  6-14 weeks 0.5u/kg/d  14-26 weeks 0.7u/kg/d  26-36 weeks 0.9u/kg/d  36-40weeks 1 u /kg/d
  11. 11. If fasting hyperglycemia start with NPHhs  initial dose 6-8 U  if only pc hyperglycemia use Humalog 2-4u ac the specific meal  adjust 2u/time ; 1 formula /time   BG target ac <5.3 (90mg.) 2 h pc <6.7 ( 120 mg)
  12. 12. Time Frame In the first trimester of pregnancy (the first 3 months) During the second and third trimester (the last 6 months) If you gained too much weight early in the pregnancy Expected Weight Gain Three to six pounds for the entire three months Between ½ and 1 pound each week Limit weight gain to ¾ of a pound each week (3 pounds each month) to help get your blood sugar level under control A weight gain of two pounds or more each week is considered high. gdm 26
  13. 13. Traditionally not recommended in pregnancy   Recent RCT of oral glyburide vs insulin for GDM 440 patients  BG measured 7x daily  Treatment started after 11 weeks gestation 
  14. 14. THE END