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DIABETES IN
PREGNANCY
PRESENTED BY
SUJATA SAHU
MSC TUTOR
Introduction
DM is a chronic metabolic
disorder due to either insulin
deficiency or either peripheral
tissue resistance to the action of
insulin.
Cont….
Pathophysiology involved are:
• Decreased sensitivity of skeletal muscles &
liver to insulin
• Inadequate secretion of insulin
• This is associated with increased circulating
levels of C- reactive protein & interleukin-6.
• Both these factors enhance insulin resistance.
• The defect lies both in insulin secretion &
action.
Types of diabetes
1) Type-1 (IDDM)
2) Type-2 (NIDDM)
3) GDM
4) Other :
• Genetic,
• Drugs,
• Mody (maturity onset diabetes of the youth)
is due to BETA cell dysfunction
GESTATIONAL DIABETES MALLITUS
• Gestational diabetes is defined as
carbohydrate intolerance of variable severity
with onset or first recognition during the
present pregnancy.
• GDM is a condition in which a woman
without diabetes develops high blood
sugar levels during pregnancy
GESTATIONAL DIABETES MALLITUS
• A woman is diagnosed with gestational
diabetes when glucose intolerance continues
beyond 24 to 28 weeks of gestation
Risk factor
• Obesity
• Family history
• Have had GDM before
• Have high blood pressure or other medical
complications
• Have given birth to a large baby (weight >4 kg)
Risk factor
• Have given birth to a baby who was stillborn
or had certain birth defects
• Age > 30 years
• Ethnic group-Are African-American, Asian,
Hispanic, or Native American
Investigation
• If blood glucose level is higher than 140
mg/dL (7.8 mmol/L) after the one-hour test,
doctor will recommend the three-hour test.
• If blood glucose level is higher than 190
mg/dL (10.6 mmol/L) after the one-hour test,
it 'll be diagnosed with gestational diabetes.
Investigation
For the three-hour test:
• A normal fasting blood glucose level is lower
than 95 mg/dL (5.3 mmol/L).
• One hour after drinking the glucose solution, a
normal blood glucose level is lower than 180
mg/dL (10 mmol/L).
Investigation
• Two hours after drinking the glucose solution,
a normal blood glucose level is lower than 155
mg/dL (8.6 mmol/L).
• Three hours after drinking the glucose
solution, a normal blood glucose level is lower
than 140 mg/dL (7.8 mmol/L).
Investigation
• If one of the results is higher than normal, it 'll
likely need to test again in four weeks.
• If two or more of the results are higher than
normal, diagnosed with GDM.
Treatment
• Check blood sugar levels four or more times a
day
• Frequent antenatal supervision
• Periodic check up FBS should be > 90
• Maintain mean plasma glucose level 105mg/dl -
110mg/dl for good fetal outcome .
Treatment
• The control of high glucose is done by restriction
of diet, exercise with or without insulin.
• Insulin start if FBS>90 mg/dl & PPBS > 120mg/dl
even on diet control.
Treatment
Exercise
• Exercise is safe in
Pregnancy are as:
Aerobic exercise
Brisk exercise
Treatment
Diet
• Recommend 2000-2500kcal/day for normal weight woman
• Restriction to 1200-1800 kcal/day for over weight woman
• Carbohydrate should be 40 %-50% of total calories.
• Complex carbohydrate are preferred (peas, beans, whole
grains, and vegetables).
Obstetric management
Spontaneous labour.
• If good glycemic control & who don’t require
insulin.
Elective delivery (induction of labour or CS)
• If patient is taking insulin or with complication
(macrosomia) at 38 weeks.
Complications of Gestational Diabetes
Fetal Complications
• Excessive birth weight.
• Early (preterm) birth.
• Serious breathing difficulties
• Low blood sugar (hypoglycemia)
• Obesity and type 2 diabetes later in life
• Stillbirth.
• Serious breathing difficulties.
• Low blood sugar (hypoglycemia).
Maternal Complications
• High blood pressure and preeclampsia.
• Having a surgical delivery (C-section).
• Future diabetes.
• Take these simple steps to hold off gestational
diabetes:
Prevention of Gestational Diabetes
Eat healthy foods.
• Choose foods high in fiber and low in fat and
calories.
• Focus on fruits, vegetables and whole grains.
.
Prevention of Gestational Diabetes
Keep active.
• Exercising before and during pregnancy can
help protect you from developing gestational
diabetes.
• Aim for 30 minutes of moderate activity on
most days of the week.
• Take a brisk daily walk.
Prevention of Gestational Diabetes
Start pregnancy at a healthy weight.
• If some one are planning to get pregnant,
losing extra weight beforehand may help have
a healthier pregnancy.
• Focus on making lasting changes to eating
habits that can help through pregnancy, such
as eating more vegetables and fruits.
Prevention of Gestational Diabetes
Don't gain more weight than recommended.
• Gaining some weight during pregnancy is
normal and healthy.
• But gaining too much weight too quickly can
risk of gestational diabetes.
Diabetes in pregnancy
Diabetes in pregnancy

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Diabetes in pregnancy

  • 1.
  • 3. Introduction DM is a chronic metabolic disorder due to either insulin deficiency or either peripheral tissue resistance to the action of insulin.
  • 4. Cont…. Pathophysiology involved are: • Decreased sensitivity of skeletal muscles & liver to insulin • Inadequate secretion of insulin • This is associated with increased circulating levels of C- reactive protein & interleukin-6. • Both these factors enhance insulin resistance. • The defect lies both in insulin secretion & action.
  • 5. Types of diabetes 1) Type-1 (IDDM) 2) Type-2 (NIDDM) 3) GDM 4) Other : • Genetic, • Drugs, • Mody (maturity onset diabetes of the youth) is due to BETA cell dysfunction
  • 6. GESTATIONAL DIABETES MALLITUS • Gestational diabetes is defined as carbohydrate intolerance of variable severity with onset or first recognition during the present pregnancy. • GDM is a condition in which a woman without diabetes develops high blood sugar levels during pregnancy
  • 7. GESTATIONAL DIABETES MALLITUS • A woman is diagnosed with gestational diabetes when glucose intolerance continues beyond 24 to 28 weeks of gestation
  • 8. Risk factor • Obesity • Family history • Have had GDM before • Have high blood pressure or other medical complications • Have given birth to a large baby (weight >4 kg)
  • 9. Risk factor • Have given birth to a baby who was stillborn or had certain birth defects • Age > 30 years • Ethnic group-Are African-American, Asian, Hispanic, or Native American
  • 10. Investigation • If blood glucose level is higher than 140 mg/dL (7.8 mmol/L) after the one-hour test, doctor will recommend the three-hour test. • If blood glucose level is higher than 190 mg/dL (10.6 mmol/L) after the one-hour test, it 'll be diagnosed with gestational diabetes.
  • 11. Investigation For the three-hour test: • A normal fasting blood glucose level is lower than 95 mg/dL (5.3 mmol/L). • One hour after drinking the glucose solution, a normal blood glucose level is lower than 180 mg/dL (10 mmol/L).
  • 12. Investigation • Two hours after drinking the glucose solution, a normal blood glucose level is lower than 155 mg/dL (8.6 mmol/L). • Three hours after drinking the glucose solution, a normal blood glucose level is lower than 140 mg/dL (7.8 mmol/L).
  • 13. Investigation • If one of the results is higher than normal, it 'll likely need to test again in four weeks. • If two or more of the results are higher than normal, diagnosed with GDM.
  • 14. Treatment • Check blood sugar levels four or more times a day • Frequent antenatal supervision • Periodic check up FBS should be > 90 • Maintain mean plasma glucose level 105mg/dl - 110mg/dl for good fetal outcome .
  • 15. Treatment • The control of high glucose is done by restriction of diet, exercise with or without insulin. • Insulin start if FBS>90 mg/dl & PPBS > 120mg/dl even on diet control.
  • 16. Treatment Exercise • Exercise is safe in Pregnancy are as: Aerobic exercise Brisk exercise
  • 17. Treatment Diet • Recommend 2000-2500kcal/day for normal weight woman • Restriction to 1200-1800 kcal/day for over weight woman • Carbohydrate should be 40 %-50% of total calories. • Complex carbohydrate are preferred (peas, beans, whole grains, and vegetables).
  • 18. Obstetric management Spontaneous labour. • If good glycemic control & who don’t require insulin. Elective delivery (induction of labour or CS) • If patient is taking insulin or with complication (macrosomia) at 38 weeks.
  • 19. Complications of Gestational Diabetes Fetal Complications • Excessive birth weight. • Early (preterm) birth. • Serious breathing difficulties • Low blood sugar (hypoglycemia) • Obesity and type 2 diabetes later in life • Stillbirth. • Serious breathing difficulties. • Low blood sugar (hypoglycemia).
  • 20. Maternal Complications • High blood pressure and preeclampsia. • Having a surgical delivery (C-section). • Future diabetes. • Take these simple steps to hold off gestational diabetes:
  • 21. Prevention of Gestational Diabetes Eat healthy foods. • Choose foods high in fiber and low in fat and calories. • Focus on fruits, vegetables and whole grains. .
  • 22. Prevention of Gestational Diabetes Keep active. • Exercising before and during pregnancy can help protect you from developing gestational diabetes. • Aim for 30 minutes of moderate activity on most days of the week. • Take a brisk daily walk.
  • 23. Prevention of Gestational Diabetes Start pregnancy at a healthy weight. • If some one are planning to get pregnant, losing extra weight beforehand may help have a healthier pregnancy. • Focus on making lasting changes to eating habits that can help through pregnancy, such as eating more vegetables and fruits.
  • 24. Prevention of Gestational Diabetes Don't gain more weight than recommended. • Gaining some weight during pregnancy is normal and healthy. • But gaining too much weight too quickly can risk of gestational diabetes.