Gestational diabetes (GDM) is a form of diabetes diagnosed during pregnancy that results from impaired glucose tolerance and insulin resistance. Treatment of GDM through diet, blood glucose monitoring, and possibly insulin has been shown to reduce risks of complications like large-for-gestational-age babies, cesarean delivery, and preeclampsia. Studies have found that lifestyle interventions and metformin are effective alternatives to insulin for treating GDM. After delivery, women with GDM have an increased long-term risk of developing type 2 diabetes and should undergo postpartum screening.
The document discusses gestational diabetes mellitus (GDM). It begins with physiological changes in pregnancy that increase insulin resistance and glucose intolerance. It then defines GDM, discusses prevalence, screening methods, diagnosis, medical and obstetric management, and controversies around screening. Key points include that GDM is associated with adverse maternal and neonatal outcomes. Screening methods include fasting blood glucose and glucose challenge tests. Treatment involves diet, exercise, and potentially insulin or oral hypoglycemic drugs. The goal of management is to maintain euglycemia and prevent macrosomia and other complications.
This document provides information on gestational diabetes mellitus (GDM), including its definition, pathophysiology, risk factors, diagnosis, complications, management, and postpartum follow up. GDM is defined as diabetes diagnosed during the second or third trimester of pregnancy that is not clearly type 1 or 2 diabetes. It results from the pancreas not being able to produce enough insulin to overcome insulin resistance during pregnancy. Management involves glucose monitoring, medical nutrition therapy, exercise if appropriate, and insulin treatment if needed to control blood glucose levels and prevent complications for both mother and baby. Women with GDM require testing after delivery and ongoing screening due to increased risk of developing diabetes.
Identifying women with GDM is important because appropriate therapy can decrease maternal and fetal morbidity .
Can prevent two generations from developing diabetes in the future.
This document provides guidelines for the management of gestational diabetes mellitus (GDM). It defines GDM and discusses screening and diagnosis, including risk assessment and different screening criteria. It covers medical nutrition therapy, insulin therapy if needed, intrapartum management during labor, and postpartum follow up. Guidelines are provided for glycemic control targets, types of insulin therapy, and obstetric management during pregnancy. The document summarizes screening, diagnosis, treatment and management of GDM.
1. There are four criteria for diagnosing diabetes: A1C ≥6.5%, FPG ≥126 mg/dL, 2-hr PG ≥200 mg/dL during OGTT, or random PG ≥200 mg/dL.
2. Lowering A1C below 7.0% can reduce microvascular complications and macrovascular disease.
3. Gestational diabetes is diagnosed using a one-step 75g OGTT or two-step 50g GLT and 100g OGTT, with defined plasma glucose thresholds.
Gestational diabetes and other forms of diabetes that develop during pregnancy can lead to complications for both the mother and baby if not properly managed. Close monitoring of blood sugar levels and insulin therapy if needed are important for treatment. Babies may be born larger than normal or have other issues if the mother's diabetes is not well controlled during pregnancy. Care during labor and delivery and after birth also aims to prevent low blood sugar in both the mother and newborn.
Gestational diabetes affects 2-3% of pregnancies and is characterized by carbohydrate intolerance that is first diagnosed during pregnancy. It increases the risk of complications for both mother and baby, such as preeclampsia, operative delivery, macrosomia, and neonatal hypoglycemia. Treatment involves diet, exercise, and possibly insulin therapy to maintain normal blood glucose levels and minimize risks. Close monitoring of blood glucose and fetal growth is important throughout the pregnancy and delivery.
Gestational diabetes mellitus (GDM) is glucose intolerance that begins or is first diagnosed during pregnancy. The risks associated with GDM are similar to those with pregestational diabetes. Screening and diagnosis typically involves a 75g oral glucose tolerance test. Management of GDM focuses on achieving metabolic control through diet, exercise, insulin or oral hypoglycemic agents. Fetal surveillance is important during pregnancy and delivery should be monitored closely due to risks of complications. Postpartum care involves glucose monitoring and determining if diabetes persists after delivery.
The document discusses gestational diabetes mellitus (GDM). It begins with physiological changes in pregnancy that increase insulin resistance and glucose intolerance. It then defines GDM, discusses prevalence, screening methods, diagnosis, medical and obstetric management, and controversies around screening. Key points include that GDM is associated with adverse maternal and neonatal outcomes. Screening methods include fasting blood glucose and glucose challenge tests. Treatment involves diet, exercise, and potentially insulin or oral hypoglycemic drugs. The goal of management is to maintain euglycemia and prevent macrosomia and other complications.
This document provides information on gestational diabetes mellitus (GDM), including its definition, pathophysiology, risk factors, diagnosis, complications, management, and postpartum follow up. GDM is defined as diabetes diagnosed during the second or third trimester of pregnancy that is not clearly type 1 or 2 diabetes. It results from the pancreas not being able to produce enough insulin to overcome insulin resistance during pregnancy. Management involves glucose monitoring, medical nutrition therapy, exercise if appropriate, and insulin treatment if needed to control blood glucose levels and prevent complications for both mother and baby. Women with GDM require testing after delivery and ongoing screening due to increased risk of developing diabetes.
Identifying women with GDM is important because appropriate therapy can decrease maternal and fetal morbidity .
Can prevent two generations from developing diabetes in the future.
This document provides guidelines for the management of gestational diabetes mellitus (GDM). It defines GDM and discusses screening and diagnosis, including risk assessment and different screening criteria. It covers medical nutrition therapy, insulin therapy if needed, intrapartum management during labor, and postpartum follow up. Guidelines are provided for glycemic control targets, types of insulin therapy, and obstetric management during pregnancy. The document summarizes screening, diagnosis, treatment and management of GDM.
1. There are four criteria for diagnosing diabetes: A1C ≥6.5%, FPG ≥126 mg/dL, 2-hr PG ≥200 mg/dL during OGTT, or random PG ≥200 mg/dL.
2. Lowering A1C below 7.0% can reduce microvascular complications and macrovascular disease.
3. Gestational diabetes is diagnosed using a one-step 75g OGTT or two-step 50g GLT and 100g OGTT, with defined plasma glucose thresholds.
Gestational diabetes and other forms of diabetes that develop during pregnancy can lead to complications for both the mother and baby if not properly managed. Close monitoring of blood sugar levels and insulin therapy if needed are important for treatment. Babies may be born larger than normal or have other issues if the mother's diabetes is not well controlled during pregnancy. Care during labor and delivery and after birth also aims to prevent low blood sugar in both the mother and newborn.
Gestational diabetes affects 2-3% of pregnancies and is characterized by carbohydrate intolerance that is first diagnosed during pregnancy. It increases the risk of complications for both mother and baby, such as preeclampsia, operative delivery, macrosomia, and neonatal hypoglycemia. Treatment involves diet, exercise, and possibly insulin therapy to maintain normal blood glucose levels and minimize risks. Close monitoring of blood glucose and fetal growth is important throughout the pregnancy and delivery.
Gestational diabetes mellitus (GDM) is glucose intolerance that begins or is first diagnosed during pregnancy. The risks associated with GDM are similar to those with pregestational diabetes. Screening and diagnosis typically involves a 75g oral glucose tolerance test. Management of GDM focuses on achieving metabolic control through diet, exercise, insulin or oral hypoglycemic agents. Fetal surveillance is important during pregnancy and delivery should be monitored closely due to risks of complications. Postpartum care involves glucose monitoring and determining if diabetes persists after delivery.
Gestational diabetes can cause complications for both the mother and baby if not properly managed. It is important to monitor blood sugar levels and control glucose through diet, exercise and possibly medication like insulin. Maintaining near-normal blood sugar can help prevent issues like macrosomia, birth injuries, and future diabetes. Treatment aims to control glucose and reduce risks through regular monitoring, medical nutrition therapy, and starting insulin if needed to protect maternal and fetal health.
Preeclampsia is a pregnancy complication characterized by high blood pressure and protein in the urine. It affects over 5-8% of pregnancies worldwide and is a leading cause of maternal and infant illness and death. The condition is caused by poor development of the placenta, which fails to properly remodel the mother's uterine arteries. This results in reduced blood flow to the placenta and release of factors that cause damage to other organs. Risk factors include first pregnancy, obesity, diabetes, and family history. Symptoms range from mild to severe, including headaches, visual issues, pain, and seizures in severe cases. Management involves monitoring and delivery of the baby if the condition worsens. Ongoing research is
This document discusses gestational diabetes mellitus (GDM). It begins by defining GDM as an endocrine disease involving faulty carbohydrate metabolism that complicates 3-5% of pregnancies. The document then discusses the pathophysiology of GDM, screening and diagnostic methods including oral glucose tolerance tests, maternal and fetal complications, and management approaches including careful antenatal supervision and control of blood sugar levels. Key goals of management are finding the optimal time and method of delivery and arranging newborn care.
Gestational diabetes mellitus (GDM) is glucose intolerance that develops during pregnancy and accounts for 90% of cases of diabetes in pregnancy. Risk factors include age over 25, BMI over 25, family history of diabetes, and certain ethnic backgrounds. GDM is caused by insulin resistance during pregnancy and can lead to complications for both mother and baby if not well-controlled such as preeclampsia, macrosomia, and neonatal hypoglycemia. Diagnosis involves screening all pregnant women between 24-28 weeks gestation with a glucose challenge test followed by a 3-hour 100g oral glucose tolerance test for those who fail. Management focuses on tight glycemic control through diet, exercise, glucose monitoring, and possibly insulin
Gestational diabetes affects 2-3% of pregnancies and is characterized by carbohydrate intolerance that develops during pregnancy. Risk factors include maternal age over 25, family history of diabetes, prior macrosomia or stillbirth. Screening involves a glucose challenge test at 24-28 weeks of gestation. A diagnosis requires two abnormal values on a 3-hour oral glucose tolerance test. Treatment focuses on tight glycemic control through diet, exercise and possibly insulin to reduce risks of complications for both mother and baby like macrosomia, birth trauma and neonatal hypoglycemia.
Cord prolapse occurs when the umbilical cord descends through the cervix alongside or past the presenting fetal part. It has an incidence of 0.2% of births and can result in high rates of fetal death from asphyxia. Risk factors include breech presentation, multiple gestation, and premature rupture of membranes. Management involves prompt diagnosis, keeping the presenting part elevated, and expedited delivery by caesarean section if vaginal delivery is not imminent. For live fetuses, minimizing cord compression and reducing the decision to delivery time are critical.
1) Gestational diabetes occurs in 3-5% of pregnancies and 90% of women with abnormal glucose tolerance have gestational diabetes. Approximately 50% will later develop type 2 diabetes.
2) Gestational diabetes increases risks for both mother and fetus, including preeclampsia for the mother and fetal macrosomia, hypoglycemia and birth trauma for the fetus.
3) Gestational diabetes is managed primarily through diet and exercise, with insulin therapy if needed to control blood glucose levels and minimize complications. Women with gestational diabetes have increased monitoring during and after pregnancy.
Shoulder dystocia is when the fetal shoulders become lodged at the maternal pelvis after delivery of the head, occurring in 0.2-2% of births. Risk factors include maternal diabetes, obesity, macrosomia, and prior shoulder dystocia. Management involves calling for help, applying suprapubic pressure and the McRoberts maneuver to widen the pelvis, and rotating the shoulders using maneuvers like Woods screw or Rubin. If unsuccessful, procedures include delivering the posterior arm or rarely symphysiotomy. Fetal risks are brachial plexus injury, fractures, and hypoxic brain injury. Maternal risks include perineal tears and postpartum hemorrhage. Prevention focuses
This topic contains anticonvulsants used in obstetrics such as magnasium sulphate, diazepam, phenytoin and anticoagulants such as heparin and warfarin.
This document provides information on gestational diabetes mellitus (GDM), including its definition, causes, physiological changes during pregnancy that can lead to GDM, effects on pregnancy, fetal and neonatal hazards, diagnosis, screening recommendations, treatment including medical nutrition therapy and insulin management, monitoring during labor and delivery, and postpartum care considerations. GDM is defined as glucose intolerance that begins or is first recognized during pregnancy and results from changes in insulin resistance and secretion during pregnancy. Left untreated, GDM can increase risks for the mother and fetus, so proper screening, diagnosis, and treatment are important aspects of prenatal care.
Shoulder dystocia occurs when the fetal shoulders become lodged at the maternal pelvis during birth, prolonging delivery. It represents an obstetric emergency. Risk factors include macrosomia, gestational diabetes, and prolonged labor. Management involves maneuvers like McRoberts position, suprapubic pressure, and rotational maneuvers to disimpact the shoulders. Complications for the baby include brachial plexus injury. Early diagnosis and treatment are important to prevent neonatal asphyxia. Simulation training is useful for practicing the management of shoulder dystocia.
Pregnancy causes insulin resistance which can lead to gestational or overt diabetes. High blood sugar levels in the mother cross the placenta and stimulate the fetus's pancreas, potentially causing macrosomia and other issues. Diabetes is diagnosed through glucose tolerance tests. It increases risks like fetal abnormalities, death, and complications for both mother and baby. Management depends on the type of diabetes but generally involves diet, exercise, blood sugar monitoring and possibly insulin to control levels, followed by delivery at term if possible.
1. The document discusses the clinical management of diabetes during pregnancy, including screening, diagnosis, and treatment of gestational and pregestational diabetes.
2. It outlines the risks of hyperglycemia for both mother and fetus, including fetal macrosomia, complications during delivery, and long-term risks like childhood obesity.
3. The management of diabetes during pregnancy involves tight glycemic control through diet, glucose monitoring, and insulin when needed to improve outcomes for both mother and baby.
Preterm labor is defined as the onset of labor before 37 weeks of gestation. It can be spontaneous or medically indicated and accounts for a majority of neonatal deaths and disabilities. Risk factors include multiple pregnancies, infections, cervical insufficiency, and genetic factors. Management involves tocolytic drugs to delay labor, corticosteroids to improve neonatal outcomes, and careful fetal monitoring during labor. Prematurity and its complications remain a major challenge in obstetrics.
The document provides details about the panel moderator Dr. Kiran Pandey and her qualifications and experience in the field of obstetrics and gynecology. It lists her positions held including as head of the department of obstetrics and gynecology at GSVM Medical College in Kanpur, and her contributions to several national conferences and publications. It also outlines her areas of interest and awards received for her work.
Based on the results of two randomized controlled trials included in this meta-analysis that compared carbetocin to oxytocin for preventing postpartum hemorrhage, carbetocin was found to significantly reduce the need for additional uterotonic therapy compared to oxytocin, with a risk ratio of 0.44 (95% CI 0.25 to 0.78).
Gestational diabetes mellitus (GDM) is glucose intolerance that develops during pregnancy. Risk factors include obesity, family history of diabetes, and ethnicity. During pregnancy, hormones cause insulin resistance and the pancreas must produce more insulin to maintain blood glucose levels. Untreated GDM can lead to complications for both mother and baby like preeclampsia, macrosomia, and neonatal hypoglycemia. Screening and tight glucose control are important. Pre-gestational diabetes also requires careful management to reduce risks of birth defects, complications, and future diabetes in the child.
This document discusses gestational diabetes, including its definition, risk factors, screening and diagnostic tests, complications, management, and delivery considerations. Gestational diabetes is a type of diabetes that develops during pregnancy due to insufficient insulin production or action. It is characterized by high blood glucose and poses risks to both mother and baby if not properly managed through careful monitoring, medical nutrition therapy, exercise, and possibly insulin treatment. The goal of management is to maintain normal blood glucose levels and reduce complications.
D. Ware Branch, MD is a Professor and Obstetrician/Gynecologist at the University of Utah, Chairman of Obstetrics and Gynecology at the Intermountain Medical Center, and Medical Director of the Women and Newborns’ Clinical Program at Intermountain Healthcare. Dr. Branch has extensive experience in treating women with gestational diabetes and will share his insights into best practices and evidence.
Our aim is to reduce morbidity and mortality related to Non communicable diseases such as hypertension, diabetes, cardiovascular disease, stroke, Obesity, Cancer and lifestyle diseases among those least able to withstand the burden of the disease.
Gestational diabetes can cause complications for both the mother and baby if not properly managed. It is important to monitor blood sugar levels and control glucose through diet, exercise and possibly medication like insulin. Maintaining near-normal blood sugar can help prevent issues like macrosomia, birth injuries, and future diabetes. Treatment aims to control glucose and reduce risks through regular monitoring, medical nutrition therapy, and starting insulin if needed to protect maternal and fetal health.
Preeclampsia is a pregnancy complication characterized by high blood pressure and protein in the urine. It affects over 5-8% of pregnancies worldwide and is a leading cause of maternal and infant illness and death. The condition is caused by poor development of the placenta, which fails to properly remodel the mother's uterine arteries. This results in reduced blood flow to the placenta and release of factors that cause damage to other organs. Risk factors include first pregnancy, obesity, diabetes, and family history. Symptoms range from mild to severe, including headaches, visual issues, pain, and seizures in severe cases. Management involves monitoring and delivery of the baby if the condition worsens. Ongoing research is
This document discusses gestational diabetes mellitus (GDM). It begins by defining GDM as an endocrine disease involving faulty carbohydrate metabolism that complicates 3-5% of pregnancies. The document then discusses the pathophysiology of GDM, screening and diagnostic methods including oral glucose tolerance tests, maternal and fetal complications, and management approaches including careful antenatal supervision and control of blood sugar levels. Key goals of management are finding the optimal time and method of delivery and arranging newborn care.
Gestational diabetes mellitus (GDM) is glucose intolerance that develops during pregnancy and accounts for 90% of cases of diabetes in pregnancy. Risk factors include age over 25, BMI over 25, family history of diabetes, and certain ethnic backgrounds. GDM is caused by insulin resistance during pregnancy and can lead to complications for both mother and baby if not well-controlled such as preeclampsia, macrosomia, and neonatal hypoglycemia. Diagnosis involves screening all pregnant women between 24-28 weeks gestation with a glucose challenge test followed by a 3-hour 100g oral glucose tolerance test for those who fail. Management focuses on tight glycemic control through diet, exercise, glucose monitoring, and possibly insulin
Gestational diabetes affects 2-3% of pregnancies and is characterized by carbohydrate intolerance that develops during pregnancy. Risk factors include maternal age over 25, family history of diabetes, prior macrosomia or stillbirth. Screening involves a glucose challenge test at 24-28 weeks of gestation. A diagnosis requires two abnormal values on a 3-hour oral glucose tolerance test. Treatment focuses on tight glycemic control through diet, exercise and possibly insulin to reduce risks of complications for both mother and baby like macrosomia, birth trauma and neonatal hypoglycemia.
Cord prolapse occurs when the umbilical cord descends through the cervix alongside or past the presenting fetal part. It has an incidence of 0.2% of births and can result in high rates of fetal death from asphyxia. Risk factors include breech presentation, multiple gestation, and premature rupture of membranes. Management involves prompt diagnosis, keeping the presenting part elevated, and expedited delivery by caesarean section if vaginal delivery is not imminent. For live fetuses, minimizing cord compression and reducing the decision to delivery time are critical.
1) Gestational diabetes occurs in 3-5% of pregnancies and 90% of women with abnormal glucose tolerance have gestational diabetes. Approximately 50% will later develop type 2 diabetes.
2) Gestational diabetes increases risks for both mother and fetus, including preeclampsia for the mother and fetal macrosomia, hypoglycemia and birth trauma for the fetus.
3) Gestational diabetes is managed primarily through diet and exercise, with insulin therapy if needed to control blood glucose levels and minimize complications. Women with gestational diabetes have increased monitoring during and after pregnancy.
Shoulder dystocia is when the fetal shoulders become lodged at the maternal pelvis after delivery of the head, occurring in 0.2-2% of births. Risk factors include maternal diabetes, obesity, macrosomia, and prior shoulder dystocia. Management involves calling for help, applying suprapubic pressure and the McRoberts maneuver to widen the pelvis, and rotating the shoulders using maneuvers like Woods screw or Rubin. If unsuccessful, procedures include delivering the posterior arm or rarely symphysiotomy. Fetal risks are brachial plexus injury, fractures, and hypoxic brain injury. Maternal risks include perineal tears and postpartum hemorrhage. Prevention focuses
This topic contains anticonvulsants used in obstetrics such as magnasium sulphate, diazepam, phenytoin and anticoagulants such as heparin and warfarin.
This document provides information on gestational diabetes mellitus (GDM), including its definition, causes, physiological changes during pregnancy that can lead to GDM, effects on pregnancy, fetal and neonatal hazards, diagnosis, screening recommendations, treatment including medical nutrition therapy and insulin management, monitoring during labor and delivery, and postpartum care considerations. GDM is defined as glucose intolerance that begins or is first recognized during pregnancy and results from changes in insulin resistance and secretion during pregnancy. Left untreated, GDM can increase risks for the mother and fetus, so proper screening, diagnosis, and treatment are important aspects of prenatal care.
Shoulder dystocia occurs when the fetal shoulders become lodged at the maternal pelvis during birth, prolonging delivery. It represents an obstetric emergency. Risk factors include macrosomia, gestational diabetes, and prolonged labor. Management involves maneuvers like McRoberts position, suprapubic pressure, and rotational maneuvers to disimpact the shoulders. Complications for the baby include brachial plexus injury. Early diagnosis and treatment are important to prevent neonatal asphyxia. Simulation training is useful for practicing the management of shoulder dystocia.
Pregnancy causes insulin resistance which can lead to gestational or overt diabetes. High blood sugar levels in the mother cross the placenta and stimulate the fetus's pancreas, potentially causing macrosomia and other issues. Diabetes is diagnosed through glucose tolerance tests. It increases risks like fetal abnormalities, death, and complications for both mother and baby. Management depends on the type of diabetes but generally involves diet, exercise, blood sugar monitoring and possibly insulin to control levels, followed by delivery at term if possible.
1. The document discusses the clinical management of diabetes during pregnancy, including screening, diagnosis, and treatment of gestational and pregestational diabetes.
2. It outlines the risks of hyperglycemia for both mother and fetus, including fetal macrosomia, complications during delivery, and long-term risks like childhood obesity.
3. The management of diabetes during pregnancy involves tight glycemic control through diet, glucose monitoring, and insulin when needed to improve outcomes for both mother and baby.
Preterm labor is defined as the onset of labor before 37 weeks of gestation. It can be spontaneous or medically indicated and accounts for a majority of neonatal deaths and disabilities. Risk factors include multiple pregnancies, infections, cervical insufficiency, and genetic factors. Management involves tocolytic drugs to delay labor, corticosteroids to improve neonatal outcomes, and careful fetal monitoring during labor. Prematurity and its complications remain a major challenge in obstetrics.
The document provides details about the panel moderator Dr. Kiran Pandey and her qualifications and experience in the field of obstetrics and gynecology. It lists her positions held including as head of the department of obstetrics and gynecology at GSVM Medical College in Kanpur, and her contributions to several national conferences and publications. It also outlines her areas of interest and awards received for her work.
Based on the results of two randomized controlled trials included in this meta-analysis that compared carbetocin to oxytocin for preventing postpartum hemorrhage, carbetocin was found to significantly reduce the need for additional uterotonic therapy compared to oxytocin, with a risk ratio of 0.44 (95% CI 0.25 to 0.78).
Gestational diabetes mellitus (GDM) is glucose intolerance that develops during pregnancy. Risk factors include obesity, family history of diabetes, and ethnicity. During pregnancy, hormones cause insulin resistance and the pancreas must produce more insulin to maintain blood glucose levels. Untreated GDM can lead to complications for both mother and baby like preeclampsia, macrosomia, and neonatal hypoglycemia. Screening and tight glucose control are important. Pre-gestational diabetes also requires careful management to reduce risks of birth defects, complications, and future diabetes in the child.
This document discusses gestational diabetes, including its definition, risk factors, screening and diagnostic tests, complications, management, and delivery considerations. Gestational diabetes is a type of diabetes that develops during pregnancy due to insufficient insulin production or action. It is characterized by high blood glucose and poses risks to both mother and baby if not properly managed through careful monitoring, medical nutrition therapy, exercise, and possibly insulin treatment. The goal of management is to maintain normal blood glucose levels and reduce complications.
D. Ware Branch, MD is a Professor and Obstetrician/Gynecologist at the University of Utah, Chairman of Obstetrics and Gynecology at the Intermountain Medical Center, and Medical Director of the Women and Newborns’ Clinical Program at Intermountain Healthcare. Dr. Branch has extensive experience in treating women with gestational diabetes and will share his insights into best practices and evidence.
Our aim is to reduce morbidity and mortality related to Non communicable diseases such as hypertension, diabetes, cardiovascular disease, stroke, Obesity, Cancer and lifestyle diseases among those least able to withstand the burden of the disease.
1. Proper management of diabetes before and during pregnancy is important to reduce risks of complications. Tight glucose control through medical nutrition therapy, exercise, and insulin treatment can decrease risks of fetal anomalies and growth issues.
2. Gestational diabetes is diagnosed through an oral glucose tolerance test and treated with lifestyle changes and possibly insulin to control blood glucose. Women with a history of GDM require follow up after pregnancy to screen for diabetes.
3. Preconception counseling and care is crucial for women with pre-existing diabetes to optimize health before pregnancy in order to lower risks during pregnancy through strict glucose monitoring and management.
This document provides information about diabetes mellitus in pregnancy. It discusses the following key points:
- Gestational diabetes and pregestational diabetes are the most common medical complications of pregnancy. Excellent glycemic control is important to improve maternal and fetal outcomes.
- Screening methods for gestational diabetes typically involve a glucose challenge test between 24-28 weeks of gestation. A one-step or two-step approach can be used to diagnose gestational diabetes based on oral glucose tolerance test thresholds.
- Complications of uncontrolled diabetes in pregnancy for both mother and baby include congenital anomalies, macrosomia, preeclampsia, and stillbirth. Proper medical nutrition therapy, exercise, glucose monitoring
Gestational diabetes (GDM) is glucose intolerance first identified during pregnancy. Risk factors include BMI over 30, previous large or diabetic baby, family history of diabetes. GDM is identified through a 75g oral glucose tolerance test. It is associated with risks like large baby, shoulder dystocia, preeclampsia. Treatment like insulin lowers risks. Other types of diabetes may present as GDM and require identification. Mild maternal hyperglycemia increases risks incrementally without a clear threshold.
Gestational diabetes (GDM) and preexisting diabetes during pregnancy carry risks for both mother and baby. GDM is diagnosed through a two-step screening and testing process involving glucose challenges. Left untreated, GDM can lead to complications like fetal overgrowth and hypoglycemia. Treatment involves lifestyle changes like medical nutrition therapy, exercise and glucose monitoring. If needed, oral medications or insulin may be used to control blood sugar. Close monitoring and control of blood sugar levels during pregnancy and delivery can help reduce risks. After pregnancy, women with GDM have an elevated risk of developing diabetes and require follow up testing.
This document discusses diabetes and pregnancy, focusing on gestational diabetes (GDM). It provides information on:
1) The pathophysiology and risk factors of GDM, noting that it is characterized by increased insulin resistance and inadequate insulin secretion as pregnancy progresses.
2) Findings from the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study that showed associations between higher maternal glucose levels and increased risk of adverse pregnancy outcomes.
3) International recommendations and criteria for screening and diagnosing GDM, which vary between organizations like ADA, IADPSG, and WHO. Regular screening is recommended between 24-28 weeks gestation.
This talk was delivered for postgraduates and faculty of Dr. TMA Pai Hospital, Udupi on 07 March, 2017. This talk covered pathophysiology, screening, diagnosis, complications and management of diabetes mellitus in pregnancy.
<마더리스크라운드>Type 2 diabetes in pregnancymothersafe
This document discusses the risks and management of type 2 diabetes during pregnancy. Strict glycemic control is emphasized as key to improving outcomes for both mother and baby. Women with diabetes who want to become pregnant should receive preconception counseling and care to optimize health and control before and during pregnancy. Preconception screening for undiagnosed diabetes is also important given increasing rates of obesity and type 2 diabetes.
In this interactive lecture Dr. Vicky Guanzon joins me in discussing the updates on the Diagnosis and Treatment of Diabetes in Pregnancy. Delivered at the L'Fischer Hotel in Bacolod City on August 6, 2015.
1. Diabetes in pregnancy can lead to complications for both the mother and baby if not properly managed. Pre-existing diabetes and gestational diabetes (GDM) require strict glucose control through medical nutrition therapy, exercise, glucose monitoring, and insulin when needed.
2. The risks of birth defects, fetal/neonatal complications, and maternal risks like preeclampsia are much higher if glucose levels are not well-controlled before and during pregnancy. Tighter control is associated with significantly lower risks.
3. Proper preconception counseling and care are important for women with pre-existing diabetes to optimize health before pregnancy. During pregnancy, glucose goals and management including insulin are aimed at reducing complications and maintaining
Gestational diabetes mellitus (GDM) is glucose intolerance that develops during pregnancy and can cause complications for both mother and fetus if not properly managed. The document discusses screening and diagnosis of GDM using a one-step approach oral glucose tolerance test, management through nutrition therapy, exercise and potentially insulin treatment, and obstetrical considerations like monitoring during labor and delivery planning. Intensive glucose control through early diagnosis and treatment can help improve outcomes.
Revised PPT GDM- clinical and nutritional perspective.pptxVidushRatan1
This document discusses gestational diabetes mellitus (GDM), including its definition, prevalence, risk factors, diagnostic criteria, complications, management, and monitoring. Some key points:
- GDM is glucose intolerance that is first recognized during pregnancy and can cause complications for both mother and baby if not properly managed.
- The prevalence of GDM is rising worldwide and varies significantly between populations, ranging from 1.4-17.9% depending on location.
- Risk factors include pre-pregnancy overweight/obesity, family history of diabetes, and certain ethnicities.
- Treatment involves medical nutrition therapy, physical activity, blood sugar monitoring, and possibly medication like metformin or insulin to control blood
This document discusses gestational diabetes, including its definition, causes, importance of treatment, and treatment guidelines. Gestational diabetes is a form of diabetes that develops during pregnancy due to insulin resistance. Left untreated, it can lead to complications for both mother and baby like increased birth weight. Treatment aims to control blood sugar levels and can involve lifestyle changes as well as insulin if needed. Guidelines recommend screening and treatment according to established evidence-based protocols.
This document discusses pregnancy and diabetes. It notes that the prevalence of diabetes among pregnant women is rising. Pregnancy causes insulin resistance and hormonal changes that can lead to gestational diabetes if the pancreas cannot keep up. Good control of blood sugar levels is important for the health of both the mother and baby by avoiding complications like macrosomia. Screening and treatment involve monitoring blood sugar, medical nutrition therapy, exercise, and potentially insulin treatment. Close monitoring is needed throughout pregnancy and delivery.
This document discusses gestational diabetes, including its definition, epidemiology, consequences for both mother and fetus, screening recommendations, management, and controversies around diagnostic criteria. Some key points:
- Gestational diabetes is defined as carbohydrate intolerance first recognized during pregnancy and can include undiagnosed preexisting diabetes.
- It affects 2-9% of pregnancies and screening is recommended for at-risk women between 24-28 weeks using a 75g oral glucose tolerance test.
- Risks for the fetus include macrosomia, jaundice, and hypoglycemia. Risks for the mother include preeclampsia, infections, and long-term risk of type 2 diabetes.
Gestational Diabetes mellitus (GDM) for StudentsUsama Ragab
Gestational diabetes is diabetes that develops during pregnancy. It is diagnosed either pre-existing type 1 or type 2 diabetes, or gestational diabetes diagnosed during pregnancy. Gestational diabetes screening involves a glucose challenge test between 24-28 weeks of pregnancy, or earlier for those at high risk. Treatment involves lifestyle changes like diet and exercise, and may require insulin if needed to control blood glucose levels. After delivery, women with gestational diabetes have increased risk of developing type 2 diabetes and should undergo testing to check for prediabetes or diabetes.
This document discusses diabetes in pregnancy, including gestational diabetes and pre-existing diabetes. It provides details on screening and managing gestational diabetes through medical nutrition therapy, exercise, glucose monitoring, and insulin or oral hypoglycemic agents if needed. It also discusses fetal surveillance, delivery planning, neonatal care, and postpartum management and follow-up. Case examples are presented to illustrate how these guidelines would be applied. The key aspects of managing diabetes in pregnancy are screening, glycemic control through lifestyle and medical interventions, close fetal and maternal monitoring, and delivery planning tailored to each woman's risk factors and disease status.
3-5% of pregnant women have glucose intolerance, with 90% having gestational diabetes. Pregnancy increases insulin resistance and if a woman's pancreas cannot sufficiently increase insulin secretion to compensate, gestational diabetes results. Gestational diabetes resolution within 6 weeks of delivery but 50% of women will develop type 2 diabetes later in life. Screening involves a glucose challenge test between 24-28 weeks, followed by a glucose tolerance test if thresholds are met to diagnose gestational diabetes. Management focuses on diet, exercise, blood glucose monitoring and possibly insulin to control blood sugar and minimize risks of complications for both mother and baby.
This document provides an overview of diabetes in pregnancy. It defines diabetes mellitus and describes the main types: type 1, type 2, and gestational diabetes. Risk factors, screening, and diagnostic criteria for gestational diabetes are covered. The document also discusses complications of diabetes in pregnancy for both mother and baby, as well as management through medical nutrition therapy, exercise, medication and insulin. Postpartum care is also summarized.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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2. What is Gestational Diabetes?
• Impaired glucose intolerance due to
insulin resistance coupled with beta-cell
insufficiency
• Associated with:
BMI
maternal age
– Known glucose intolerance
– Type II DM in 1st degree relative(s)
– Certain racial backgrounds
3. What is Gestational Diabetes?
• A multigenic condition that may involve
abnormalities in genes of:
– Insulin secretion
– Insulin or insulin signaling
– Lipid and glucose metabolism
– Other pathways
4. What is Gestational Diabetes?
• Similar in nature to type II DM
– “GDM is a window to reveal a predisposition
to type II DM”
– 17% to 63% of women with GDM develop
type II DM over 5-16 years
6. Metabolic Syndrome in Children of
Women with GDM
• Longitudinal cohort study of children at
ages 6, 7, 9 and 11 years
– LGA offspring of control mothers
– LGA offspring of mothers with GDM
– AGA offspring of control mothers
– AGA offspring of mothers with GDM
• Obtained biometric and anthropomorphic
measurements, postprandial glucose and
insulin levels, triglyceride and HDL
cholesterol
Boney et al, Pediatr 2005; 115: 290
7. Metabolic Syndrome in Children of
Women with GDM
Boney et al, Pediatr 2005; 115: 290
10
20
30
40
50
60
PrevalenceofMS(%)
LGA/GDM AGA/GDM LGA/Con AGA/Con
9. Gestational Diabetes and
Morbidity
• Worsening glucose intolerance associated
with increasing rates of:
– Preeclampsia
– Macrosomia >4,000 g
– Birth trauma
– Hyperbilirubinemia
– Neonatal hypoglycemia
– Cesarean delivery
– DM and metabolic syndrome in offspring
• But… there have been doubts about the
effectiveness of diagnosis and treatment!
10. Gestational Diabetes
Effect of Treatment
• Randomized clinical trial in 18
centers (ACHOIS)
• Women with GDM, 24-34 weeks’
– Singletons or twins
– Risk factor(s) for GDM, or
– Positive 50 g OGCT ( 140 mg/dL), and
– 75 g GTT with FBG 140 mg/dL and 2
hour BG 198 mg/dL
Crowther et al, N Engl J Med 2005;352:2477
11. Gestational Diabetes
Effect of Treatment
• Intervention group
– Dietary counseling
– Self monitoring of BGs
• 4 times daily until BGs in acceptable range
for 2 weeks
• Insulin treatment as necessary
• Routine care group
– OGCT and GTT results not made
available
Crowther et al, N Engl J Med 2005;352:2477
12. Gestational Diabetes
Effect of Treatment
• Outcome variables
– Infant: Primary – a composite
• One or more “serious” perinatal events
– Perinatal death, shoulder dystocia, bone fracture,
nerve palsy
• Admission to NICU
• Jaundice requiring phototherapy
– Maternal
• Need for induction and cesarean
• Maternal health status (physical and
psychological)
Crowther et al, N Engl J Med 2005;352:2477
13. Gestational Diabetes
Effect of Treatment
Outcome
Birthweight
LGA
Macrosomia
Treated
(N=506)
Routine Care
(N=524) P value
<0.001
<0.001
3,335 ± 551
68 (13%)
49 (10%)
3,482 ± 660
115 (22%)
110 (21%) <0.001
Crowther et al, N Engl J Med 2005;352:2477
14. Gestational Diabetes
Effect of Treatment
Outcome
Death
Shoulder
dystocia
Bone fx
Treated
(N=506)
Routine Care
(N= 524)
Adj
P value
0.07
0.08
0.38
Crowther et al, N Engl J Med 2005;352:2477
Nerve palsy 0.11
Composite
0
7 (1%)
0
0
7 (1%)
5 (1%)
16 (3%)
1 (<1%)
3 (1%)
23 (4%) 0.01
15. MFMU Network Randomized
Treatment Trial of Mild GDM
• Multicenter randomized trial of
women with
– Abnormal 50 g OGC
– 3-hr GTT GDM, but
– Normal FBS on 3-hr GTT
• Subjects randomized to
– Usual care (GTT results not available)
– Dietary intervention, SBGM, and
insulin if required
Landon et al, N Engl J Med 2009; 361:1339
17. Gestational Diabetes
Effect of Treatment
Outcome
Birthweight
LGA
Macrosomia
Treated
(N=485)
Routine Care
(N=473) P value
<0.001
<0.001
3,302 ± 502
34 (7.1%)
28 (5.9%)
3,408 ± 589
66 (14.5%)
65 (14.3%) <0.001
Landon et al, N Engl J Med 2009; 361:1339
Fat Mass (g) 427 ± 198 464 ±
222
<0.003
18. Gestational Diabetes
Effect of Treatment
Outcome
Treated
(N=485)
Routine Care
(N= 473) P value
Death 0 0
Hyperbili-
rubinemia
0.1243 (10%) 54 (13%)
Hypoglycemia 0.7562 (16%) 55 (15%)
Elevated cord
C-peptide
0.0775 (18%) 92 (23%)
Composite 149 (32%) 163 (37%) 0.14
3 (<1%) 6 (1%)Birth trauma 0.33
Landon et al, N Engl J Med 2009; 361:1339
19. Gestational Diabetes
Effect of Treatment
Outcome
Treated
(N=485)
Routine Care
(N= 473) P value
Cesarean 0.02128 (27%) 154 (34%)
Shoulder
dystocia
0.027 (1.5%) 18 (4%)
Landon et al, N Engl J Med 2009; 361:1339
GHTN - PE 41 (9%) 62 (14%) 0.01
20. MFMU Network Randomized
Treatment Trial of Mild GDM
Landon et al, Am J Obstet Gynecol 2009; 199:S2
Outcome Number Needed to Treat
Macrosomia
Cesarean Delivery
Shoulder Dystocia
PE+GHTN
12
14
40
20
21. The Treatment of GDM
• The best studies of GDM treatment
included self blood glucose
monitoring; “ you manage what you
measure.”
22. Daily Home Blood Glucose
Monitoring in Diet-controlled GDM
• Retrospective cohort study of diet
controlled GDM patients at a single
institution (UT Southwestern)
– 675 women tested weekly in the office (1991-
1997)
– 315 women tested 4 times daily at home with
a glucose monitor
– Women with FBS >105 given insulin and
excluded from study
• Primary outcomes – birthweight
>4000 g and LGA
Hawkins et al, Obstet Gynecol 2009; 1307
23. Outcome
BW>4000 g
LGA
Cesarean
Weekly
(N=675)
Daily x 4
(N=315) P value
Erb’s palsy
199 (30%)
232 (34%)
222 (33%)
3 (0.4%)
69 (22%)
73 (23%)
116 (37%)
2 (0.6%)
0.013
<0.001
0.22
0.69
Daily Home Blood Glucose
Monitoring in Diet-controlled GDM
Hawkins et al, Obstet Gynecol 2009; 1307
24. Gestational Diabetes
• GDM diagnosis and treatment has a
beneficial effect on
• LGA/Macrosomia
• Cesarean delivery
• Shoulder dystocia
• PE+GHTN
25. Screening and Diagnosis of
GDM in the U.S.
• Use the 50 g oral glucose challenge
with BS taken 1 hour later
– Screen all pregnant women @ 24-28
weeks
• Test earlier in selected patients
– Threshold of 140 mg/dL or greater
26. Screening and Diagnosis of
GDM in the U.S.
• Use the 100 g oral glucose tolerance
test for the diagnosis of GDM
– No need to test women with 50 g OCT
results of 200 mg/dL or greater
– Experts recommend against using a
capillary glucose meter
– Use either NDDG or Carpenter &
Coustan modification for diagnosis
27. Diagnosis of Gestational
Diabetes using 100 g OGTT
Time of BS
Fasting
1 h
2 h
NDDG
(mg/dL)
Carpenter/Coustan
(mg/dL)
105
190
165
95
180
155
3 h 145 140
28. Screening and Diagnosis of
GDM in the U.S.
• Women with one abnormal value on
the 3 h OGTT are at increased risk for
– Preeclampsia
– Macrosomia
– ? CS
• Treat as GDM versus repeat testing
in 4 weeks?
29. Treatment of GDM
Diet
• Diet based on ideal prepregnancy
weight
– 30 kcal/kg for average weight
– 35 kcal/kg for underweight
– 25 kcal/kg for overweight
• Generally, 2000-2200 calories per day
– Avoid concentrated sweets – utilize
complex, high-fiber carbohydrates
30. Treatment of GDM
Diet
• Experts recommend checking FBS
and 1 or 2 h postprandial BSs
– Normals:
• FBS 95 or less
• 1 h pp 130-140 or less
• 2 h pp 120 or less
– Decrease monitoring (number of BS per
day) if BSs are normal after several
days of testing
32. Original Article
Metformin versus Insulin for the
Treatment of Gestational Diabetes
Janet A. Rowan, M.B., Ch.B., William M. Hague, M.D., Wanzhen
Gao, Ph.D., Malcolm R. Battin, M.B., Ch.B., M. Peter Moore, M.B.,
Ch.B., for the MiG Trial Investigators
N Engl J Med
Volume 358(19):2003-2015
May 8, 2008
33. Metformin for the Treatment of
GDM
• Randomized, open-label trial comparing
metformin to insulin for the treatment of
GDM
– 363 metformin
– 370 insulin
• Primary outcome a composite
– Neonatal hypoglycemia, RDS, need for
phototherapy, birth trauma, 5 min AS <7,
prematurity
Rowan et al, N Engl J Med 2008; 358:19
34. Metformin for the Treatment
of GDM
• Metformin started at 500 mg once or twice
daily and increased over 2 weeks as
needed to a max dose of 2500 mg daily
– Supplemental insulin eventually required in
46% of metformin patients
Rowan et al, N Engl J Med 2008; 358:19
36. Metformin for the Treatment
of GDM
Rowan et al, N Engl J Med 2008; 358:19
Outcome
Metformin
(N=363)
Insulin
(N=370)
Relative Risk
(95% CI)
Primary outcome 116 (32%) 119 (32%) 0.99 (0.80-1.23)
Neon BS <28.8 12 (3%) 30 (8%) 0.41 (0.21-0.78)
Birth trauma 16 (4%) 17 (5%) 0.96 (0.49-1.87)
Preterm birth 44 (12%) 28 (8%) 1.60 (1.02-2.52)
Adm to NICU 68 (19%) 78 (21%) 0.89 (0.66-1.19)
37. Metformin for the Treatment
of GDM
Rowan et al, N Engl J Med 2008; 358:19
Outcome
Metformin
(N=363)
Insulin
(N=370)
P Value
GA at birth 38.3±1.4 38.5±1.3 0.02
Birth weight 3372±572 3413±569 0.33
Birth weight
>90th
70 (19%) 69 (19%) 0.83
Maternal
glycated Hgb 36-
37 week
5.6±0.5 5.7±0.6 0.25
38. Metformin for the Treatment
of GDM
• In women with gestational diabetes
mellitus, metformin (alone or with
supplemental insulin) is not associated
with increased perinatal complications as
compared with insulin
• Patients prefer metformin over insulin
Rowan et al, N Engl J Med 2008; 358:19
39. Metformin for the Treatment
of GDM
• Start with 500 mg once or twice daily
• Increase by 500 mg per week
• Maximum dose 2000 mg per day
40. Potential Adverse Effects of
Metformin
• Lactic acidosis: Occurs in 1:30,000 cases;
predispositions include renal or liver
compromise, heart failure, serious illness,
dehydration
• Nausea, bloating, diarrhea: dose
dependent
• Drug interactions: cimetadine
45. Postpartum Management of GDM
• ~15% of women with GDM have impaired
glucose tolerance or diabetes after
delivery
– Greater likelihood if
• Obese
• GDM diagnosed early in pregnancy
• Treatment required
• ADA recommends that all women with
GDM be evaluated postpartum for diabetes
46. Smirnakis et al, Obstet Gynecol 2005;106:1297
Kaplan-Meier estimates of the time to screening in women with GDM