this PPT will help to nursing students and also mother to know about the gestational diabetic mellitus during pregnancy and its management

1. Presented by- Preeti Shukla
Lecture
RCN, Kanpur

2. Objectives-
At the end of the presentation student will able
to-
Define gestational diabetes mellitus
Enlist the causes of gestational diabetes mellitus.
Describe the investigation of gestational diabetes
mellitus.
List-down the effect of GDM in pregnancy and
fetus.
Explain the management of GDM.
Describe the prevention of GDM.

4. Gestational diabetes mellitus
• GDM is defined as carbohydrate intolerance or
glucose intolerence of variable severity with
onset of first recognition during present
pregnancy.
• Usually present late in second or during third
trimester.

5. • Gestational diabetes starts when the body is
unable to make all of the insulin it needs for
pregnancy.
• Low insulin levels, combined with hormonal
changes, can lead to insulin resistance. When
this happens, high levels of glucose build up in
the blood.

6. Causes-
• Positive family history of diabetes.
• Previous birth of overweight baby.
• Previous stillbirth with pancreatic islet
hyperplasia.
• Unexplained perinatal loss
• Presence of polyhydromnios
• Age over 30 year
• Obesity

7. Screening-
- Blood glucose test as soon as possible.
- Glucose tolerance test

8. GLUCOSE TOLERENCE TEST-
• A glucose screening test is a routine test during
pregnancy that checks a pregnant woman's blood
glucose (sugar) level.
• Gestational diabetes is high blood sugar
(diabetes) that starts or is found during
pregnancy.
• The person will have a fasting blood test, then
drink a glucose drink and have further blood tests
1, 2, and maybe 3 hours later.
• If blood sugar levels are high, and the person has
not had a diagnosis of diabetes before, the doctor
will probably diagnose gestational diabetes.

10. Effect of diabetes on pregnancy-

11. Maternal effect- (during pregnancy)-
• Abortion
• Preterm labour
• Infection (UTI, vulvo vaginitis)
• Increased incidence of preeclampsia.
• Polyhydramnios
• Maternal distress
• Diabetic retinopathy
• Diabetic nephropathy
• ketoacidosis

12. During labour-
• Prolongation of labour due to big baby.
• Shoulder dystocia
• Postpartum hemorrhage
• Operative interferences
During puerperium-
• Puerperal sepsis
• Lactation failure

13. Fetal and neonatal hazards:
• Fetal macrosomia
• Congenital malformation ( neural tube defects,
anencephaly, microcephaly, VSD, ASD,
coarctation of aorta, fallots tetrology, renal
agenesis, hydronephrosis, double ureter,
polycystic kidneys, duodenal atresia, anorectal
atresia, omphalocoele).

14. Management-
Principles-
• Careful antenatal supervision and glycemic
control, so as to maitain the glucose level near
to physiolgical level as possible.
• To find out the optimum time and method of
delivery.
• Arrangement for the care of the newborn.

15. • Pre conceptional counseling
• Antenatal care:-
Antenatal supervision should be at monthly
intervals up to 20 weeks and thereafter at 2
weeks intervals.
At times patient needs admission for
stabilization of blood glucose and for
monitoring the fetus.
 Diet- 30 kcal/kg for normal weight women,
24 kcal/kg for overweight women and 12
kcal/kg for morbidly obese women.

18. • Frequent blood sugar estimation is required as
the urine examination for sugar is not
informative.
• Monitoring of blood glucose by glucose meter
can give an accurate idea about the control.
• Examination of HbAIc level.
• Sonographic evaluation in pregnancy is
extremely helpful, not only to diagnose
varieties of congenital malformation of fetus
but also to detect fetal macrosomia or growth
restriction.

19. • Biophysical profile and NST should be
performed weekly.
• Insulin therapy- when diabetes is first detected
during pregnancy and cannot be controlled by
diet alone, it should be treated with insulin. A
post prandial plasma glucose level of 140
mg% even on diet control is an indication of
insulin therapy.
• during the stabilization process of the insulin
dose, frequent blood sugar estimation specially
at night (2am – 6am) may be necessary using
glucose meter.

21. • Induction of labour.
• Cesarean section
• Fetal monitoring during labour or after delivery-
during the labour process shoulder dystocia may
be a problem. The cord should be clamped
immediately after delivery to avoid hypervolemia.
• Examination of placenta and cord- placenta is
large, the cord is thick and there is increased
incidence of single umbilical artery.
• Puerperium care- antibiotics should be given,
insulin requirement falls dramatically following
delivery. breast feeding is encouraged . Women
who had breast feed should have additional
500kcal daily in diet. In lactating women insulin
dose is lower.

22. Prevention of GDM