This document discusses gestational diabetes, including its causes, risk factors, diagnosis, treatment, complications, and prevention. Gestational diabetes is a form of diabetes that develops during pregnancy. It occurs when pregnancy hormones interfere with the body's ability to produce and use insulin, resulting in high blood sugar levels. Risk factors include obesity, family history, previous gestational diabetes or large baby, and age over 30. It is diagnosed through glucose tolerance tests. Treatment involves diet, exercise, blood sugar monitoring, and possibly insulin. Complications can affect both mother and baby's health. Maintaining a healthy lifestyle before and during pregnancy can help prevent gestational diabetes.

2. DIABETES IN
PREGNANCY
PRESENTED BY
SUJATA SAHU
MSC TUTOR

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.