Gestational diabetes is a form of diabetes that develops during pregnancy and usually resolves after giving birth. It occurs when hormones produced during pregnancy interfere with the mother's body's ability to produce and use insulin properly. This can cause high blood glucose levels. Left untreated, gestational diabetes can increase the risk of complications for both mother and baby, such as preeclampsia in the mother, and macrosomia, shoulder dystocia, and jaundice in the baby. It is diagnosed through a glucose tolerance test between 24-28 weeks of gestation. Treatment may involve lifestyle modifications like diet and exercise or insulin therapy if needed. Close monitoring during pregnancy and screening for diabetes after pregnancy is important.
Gestational diabetes mellitus (GDM) is a condition that develops during pregnancy when the body is not able to make enough insulin. GDM affects 2-10% of women during pregnancy.It is important to recognize and treat gestational diabetes as soon as possible to minimize the risk of complications to mother and baby.
Gestational diabetes mellitus (GDM) is a condition that develops during pregnancy when the body is not able to make enough insulin. GDM affects 2-10% of women during pregnancy.It is important to recognize and treat gestational diabetes as soon as possible to minimize the risk of complications to mother and baby.
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 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.
Please find the power point on Gestational Diabetes Mellitus (GDM) . I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy and is defined as glucose intolerance that first emerges or is first recognized during pregnancy. Gestational diabetes mellitus (GDM) affects between 2% and 5% of pregnant women. Data show that increasing levels of plasma glucose are associated with birth weight above the 90th percentile, cord blood serum C-peptide level above the 90th percentile, and, to a lesser degree, primary cesarean deliveries and neonatal hypoglycemia
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 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.
Please find the power point on Gestational Diabetes Mellitus (GDM) . I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy and is defined as glucose intolerance that first emerges or is first recognized during pregnancy. Gestational diabetes mellitus (GDM) affects between 2% and 5% of pregnant women. Data show that increasing levels of plasma glucose are associated with birth weight above the 90th percentile, cord blood serum C-peptide level above the 90th percentile, and, to a lesser degree, primary cesarean deliveries and neonatal hypoglycemia
The Primary Care Physician's guide to management of Pregnancy DiabetesHanifullah Khan
A guide on the screening, diagnosis and management of diabetes in pregnancy aimed at facilitating the handling of this condition in a primary care setting. Includes details on medications and dosages
—Gestational Diabetes Mellitus (GDM) is a problem which may occur during pregnancy. For treatment of GDM either the Metformin or Insulin is used. So this prospective randomized multicenter trial in women with GDM was conducted to compare the treatment outcomes of metformin and insulin. This study was conducted at Rajkiya Mahila Chikitsalaya, in Obstetrics & Gynaecology Department of Jawaharlal Nehru Medical College, Ajmer. This study was done on 110 women who were diagnosed GDM by DIPSI criteria with a singleton pregnancy and meet entry criteria are randomized to insulin or metformin treatment (55 cases in each group).It was observed that metformin is equally efficacious and safe as insulin with a lot of advantages like less costly, better compliance, less weight gain, less change of hypoglycaemic attack and more feasible as insulin require several daily injection with not much difference in perinatal outcome except statistically significant difference in baby weight, mean cord blood sugar level at birth, large for gestation age. So it can be concluded that Metformin treatment is suitable for non-obese as well as obese type 2 diabetes patients in pregnancy without complications. Metformin is a safer alternate to insulin in GDM management with no adverse maternal and fetal outcome.
Pregestational diabetes a major obstetrical problem now a days. These PPT contains modern as well as Ayurveda aspect for preventing a pregnant women & her baby from developing complications.
The effect of Metformin on endometrial tumor-regulatory genes and systemic metabolic parameters in polycystic ovarian syndrome – a proof-of-concept study
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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1. Gestational
Diabetes
Presented by: Dr. Neville M.G & Dr. Jonas L.F ( O&G Housemen SGH)
Supervisor: Dr Muniswaran Ganeshan (MRCOG, M MED O&G)
2. Gestational diabetes is carbohydrate intolerance of
variable severity, with onset or first recognition of
hyperglycaemia during pregnancy.
Gestational diabetes is a condition in which women
without previously diagnosed diabetes exhibit high blood
glucose levels during pregnancy (especially during third
trimester).
3. Introduction
• Represents most common metabolic complication during
pregnancy; early manifestation of type 2 diabetes
• Studies have shown that gestational hyperglycaemia is associated with highe
incidence of adverse maternal and fetal outcomes than is seen in normal
pregnancy
• High proportion (>50%) have GDM in the subsequent pregnancy
• Increased risk of subsequent T2DM
- approx. 50 % of women with GDM progressed to DM within 5 years duration
- 35 to 60% of women develop T2DM within 10 years after being diagnosed w
GDM.
4. PATHOPHYSIOLOGY
Early in pregnancy, maternal estrogen and progesterone increase and promote
pancreatic ß-cell hyperplasia and increased insulin release
As pregnancy progresses, increased levels of human placental lactogen,
cortisol, prolactin, progesterone, and estrogen lead to insulin resistance in
peripheral tissues.
Table 1 describes the diabetogenic potency and time of peak effect of these
hormones. The timing of these hormonal events is important in regard to
scheduling testing for GDM
Hormone Peak elevation (weeks) Diabetogenic potency
Prolactin 10 Weak
Estradiol 26 Very weak
HPL 26 Moderate
Cortisol 26 Very strong
Progesterone 32 Strong
Adapted from Jovanovic-Peterson L, Peterson C: Review of gestational diabetes mellitus and low-calorie diet
and physical exercise as therapy. Diabetes Metab Rev 12:287-308, 1996.
5. GDM results when there is delayed or insufficient insulin secretion in the
presence of increasing peripheral resistance
6. Risk factors (WHO/NICE)
Patients were considered to be risk-factor positive if any of the
following is present:
age 35 years and above
previous macrosomic baby with birth weight 4.0kg or more
previous unexplained still birth
previous baby with congenital abnormally
previous pregnancy with gestational diabetes mellitus
history of Diabetes Mellitus in first degree relatives
Obese or pre-pregnancy weight more than 80kg, BMI > 30
Ethnicity
7. In the public health service in Malaysia, screening for
gestational diabetes is done selectively where only
patients with risk factors are screened and
diagnosed using a 1-step 75g OGTT.
This is done at least once at or around 24-28 weeks
gestation, unless there are indications for it to be
done earlier.
However, as Asian ethnicity is considered a risk
factor, selectively screening our women without
regard to their Asian background may results in gross
under-detection of gestational diabetes (~50%)
On the other hand, to have all pregnant women
undergo the 75g OGTT may be cumbersome and have
some economic implications, particularly in low
resource areas.
8. Effects on Pregnant Women
Pre-eclampsia
Polyhydramnios
Operative delivery in pregnancies complicated with
GDM/length of hospital stay, risks of infection.
significant risk of developing diabetes later in life
higher triglycerides,free fatty acids,and lower high-density
level (HDL) cholesterol. (cardiovascular risk)
9. Effects on Fetus
• increased rate of stillbirths in untreated GDM
• increased risk of macrosomia
(fetal weight >90th percentile
for gestational age or >4 kg)
• fetal hyperinsulinemia and subsequently increase fetal
growth
• shoulder dystocia is increased 2-6X; brachial plexus injury
• Neonatal hypoglycemia. In severe case, intravenous (IV)
glucose solution may needed or else the baby will suffer
brain damage
10. Respiratory distress symptom
Neonatal jaundice/hyperbilirubinemia
Long Term Outcome:
IGT in adolescent children
By 8 years of age, 50% of children of diabetic mothers
had weights above the 90th percentile compared to
children of women without diabetes
high incidence of obesity
neurodevelopmental course- child’s poorer
performance on standard measures of psychomotor
development at 6 and 9 years of age.
11. How to Diagnose GDM
FBS??
RBS??
Glucosuria??
MOGTT??
12. ANSWER:
MOGTT
So how’s it done??
Screening for GDM is performed with a 75-g oral
glucose load given between 24 and 28 weeks
gestation, with venous plasma glucose level
taken pre and 2 hours post. The screening
test is performed at a time when the
diabetogenic effects of pregnancy are
peaking.
13. WHO HAPO ADA IADPSG
Fasting 7.0 5.1 5.3 5.1
2 hours 7.8 8.5 8.6 8.5
notes One abnormal Two abnormal One abnormal
value required value required value required
14. HAPO STUDY:
This was an international multicentre observation
study in which over 23,000 pregnant women
were assessed for glucose intolerance using the
75 g OGTT. The results remained blinded,
providing fasting glucose <5.8 mmol/l and 2-h
glucose <11.1 mmol/l.
The study showed relation between high blood
glucose levels with macrosomia n neonatal
hypoglycemia
Other outcomes: caesarean section, shoulder
dystocia,
birth injury, pre-eclampsia, premature delivery,
admission to neonatal intensive care and neonatal
hyperbilirubinaemia
15. ACHOIS
Women with gestational diabetes (WHO criteria)
were randomized either to an intervention group
which received dietary advice, glucose
monitoring and insulin therapy if required, or a
control group receiving usual care.
The intervention group showed a significantly
lower rate (1% vs 4%) of serious perinatal
complications including death, shoulder dystocia,
bone fracture and nerve palsy.
rates of caesarean section were similar between
the intervention and the control group
however there was an increased incidence of
induction of labour in the intervention group (39%
vs 29%).
16. MANAGEMENT:
Exercise
. Jovanovic-Peterson and associates studied 19 women
with GDM, assigning 9 to dietary treatment and 10 to
diet plus 20 minutes of monitored exercise 3 times a
week for 6 weeks.
They found a significantly lower OGTT and fasting
blood glucose in patients assigned to the exercise
group beginning 6 weeks after initiating therapy.
What type of exercise??
Non weight bearing (ex: swimming, cycling, brisk
walking)
17. Diet control
ADA has recommended dietary therapy to
start with 2,000–2,500 kcal/day (35 kcal/kg
present pregnancy weight), with 50–60%
carbohydrates (complex, high fiber), 10–
20% protein, and 25–30% fat (<10%
saturated). New ADA recommendations
specify a protein level of 10–20% of calories
but now allow greater flexibility in the levels
of carbohydrate and fat.
18. Insulin
The ACOG criteria for initiating insulin therapy
include a fasting plasma glucose level 5.8 mmol/l and
2-hour plasma postprandial levels 6.6 mmol/l.
Total insulin doses can be calculated and given with
split dosing by three injections. If insulin is required,
the target plasma glucose levels are:
fasting 1hour 2 hours 2-6 am
3.3-5.8 mmol/l Not > 7.2-7.8 < 6.7 mmol/l 3.3- 5.0 mmol/l
mmol/l
19. OHA
1) Gilbenclamide (sulphonylurea): MOA: enhance insulin secretion
by beta cells. Older sulphonylurea medications such as tolbutamide
and chlorpropamide can cause fetal hyperinsulinaemia. Glibenclamide
has minimal passage across the placenta.
Study: A trial published in 2000 randomized 404 women with
gestational diabetes to receive either glibenclamide or insulin
treatment.
Results: no difference in the glycaemic control achieved between the
two groups and no significant differences in rates of macrosomia or
metabolic neonatal complication.
2) Metformin: MOA: increase insulin sensitivity.
Study: MiG trial randomized 751 women to insulin or metformin
treatment with insulin supplementation if required.
Results:There was no difference in peri-natal morbidity between the
two groups. 46% of the metformin group received supplemental
insulin to meet glucose targets.
20. Timing and mode of delivery
Timing:
-Uncomplicated, well controlled DM not requiring insulin with
normal fetal growth- 38 to 40 weeks
-GDM requiring insulin therapy- 38 weeks/earlier if indicated
Mode Of Delivery:
Studies have documented an increase in the rate of shoulder
dystocia when macrosomia is suspected. Consequently,
estimated fetal weight plays an important role in the decision-
making process for route of delivery. When it is suspected that
the fetus is macrosomic, cesarean delivery should be
considered. Providers must remember that ultrasonography has
a range of error of ±10–15% in estimating fetal weight at term.
21. Look for unrecognized DM2 or GDM at 1st prenatal
visit if risk factors
New criteria for diagnosing GDM ’ 2-hr, 75 g OGTT
Increased no. of women with GDM
Rx hyperglycemia in pregnancy to prevent maternal &
fetal complications
Lifestyle modifications: diet & exercise (during & after
pregnancy)
Pharmacologic options: MFM, Glyburide, Insulin
Screen for DM2 or pre-diabetes at 6-12 wks post-
partum