Gestational diabetes is a form of diabetes that develops during pregnancy and usually disappears after giving birth. It occurs most commonly during the second and third trimesters and is caused by hormones from the placenta that make the mother less sensitive to insulin. Gestational diabetes increases risks for both mother and baby if not treated, such as large baby size, premature delivery, and increased cesarean delivery rates. It is diagnosed through blood tests and treated initially through medical nutrition therapy, exercise, and sometimes medications like insulin if needed to control blood sugar levels.

2. (By AreeHa Sajid)
Presentation topic

3. Gestational diabetes is high blood sugar (glucose) that
develops during pregnancy and usually disappears after
giving birth. It can happen at any stage of pregnancy,
but is more common in the second or third trimester.
(National Health Service ,2019)
Definition

5. Diabetes during
pregnancy
Type1
diabetes
7.5%
Type 2
diabetes
5%
Gestational
diabetes
87.5%
Prediabetes

6. Hormone Peak elevation
(weeks)
Diabetogenic poteny
Prolactic 10 Weak
Estradiol 26 Very weak
Human chronic
sommatomamotrophin (HCS)
26 Moderate
Cortisole 26 Very strong
Progesteron 32 Strong
The diabetogenic potency of
hormone
(Jovanovic-Peterson L, Peterson C 1996 et. al)

11. If gestational diabetes is not treated, effects on the mother and
baby can include:
 Large birth weight
 Premature delivery
 Increased chance of cesarean delivery
 Slightly increased risk of fetal and neonatal death
 It is also important that you watch for signs of
diabetes after giving birth.
These symptoms include:
 Frequent urination
 Persistent thirst
 Increased sugar in blood or urine

13.  Doctor will likely evaluate risk factors for
gestational diabetes early in pregnancy.
 If at high risk of gestational diabetes for
example, your BMI before pregnancy was 30
or higher or you have a mother, father,
sibling or child with diabetes doctor may
test for diabetes at your first prenatal visit.
 If at average risk of gestational diabetes,
you'll likely have a screening test during your
second trimester between 24 and 28 weeks
of pregnancy.
Diagnosis

14.  Doctors use blood tests to diagnose gestational
diabetes. You may have the glucose challenge test,
the oral glucose tolerance test, or both. These tests
show how well your body uses glucose.
Continue …

15. According to the American Diabetes Association’s
“Standards of medical are in diabetes___2010”
 Hemoglobin A1C (HbA1C) >= 6.5%
 Fasting plasma glucose =>126mg/dL
 A 2-hour plasma glucose level >=200mg/dL during a
75-g OGTT
 A random plasma glucose level is 200 >=mg/dL in a
patient with classic symptoms od hyperglycemia or
hyperglycemic crisis.
Diagnostic criteria of diabetes

17.  1st trimester
Post Diagnostic Testing
• HbA1C
• Blood urea nitrogen (BUN)
• Serum creatinine
• Thyroid stimulating hormone, free thyroxin
levels
• Spot urine protein-to-creatinine ratio
• Capillary blood sugar levels
• Ultrasonographic assessment for pregnancy
dating and viability

18.  2nd trimester
• Spot urine protein to creatinine study
in women with elevated value in first
trimester
• Repeat HbA1C – Capillary blood sugar
levels
• Detailed anatomic ultasonogram at 18-
20 weeks and a fetal echocardiogram
if the maternal glycohemoglobin
value was elevated in first trimester

19.  3rd trimester
• Blood glucose, blood pressure follow up
• Growth ultrasonogram to assess fetal size every
4-6 weeks from 26-36 weeks in women with
overt preexisting diabetes; perform a growth
ultrasonogram for fetal size at least once at 36-
37 weeks for women with gestational diabetes
mellitus

20. Management
 Diet
 Physical activity
• Avoid single large meals and foods with a large percentage of
simple carbohydrates.
• Supplemental calcium and vitamin D at 24 to 28 weeks gestation
may improve metabolic profile of women with GDM.
• Aim for at least 30 minutes most days of the week

21. • To achieve glucose profiles similar to those of non
diabetic pregnant women
Continue…
Glyburide
and
metformin
• These 2 drugs to be effective, and no evidence of harm to
the fetus has been found, although the potential for long-
term adverse affects remains a concern.

23.  The diet schedule must be planned in such a way as to
prevent postprandial hyperglycemia.
 The peak postprandial response is minimized in a
woman with a gestational diabetes if her meal plan is
carbohydrate restricted.
 Saturated fat intake should be, 7% of total calories.
 Reducing intake of trans fat lower LDL cholesterol
and increases HDL cholesterol, therefore intake of
trans fat should be minimized.
Diet therapy

24. Chandla et al.
Dietary regime: Diet management plays a significant
role in regulating blood sugar level in DM. Following can
be included in the diet (in moderation).
Continue…

25.  Vegetables Bitter vegetables like methi (fenugreek)
leaves, karela(bitter gourd), tomatoes, spinach,
cucumber, radish, sponge gourd, sahjan(drumstick)
leaves & fruits, broccoli, cauliflower, cabbage
 Pulses Moonga(green gram), chana daal(Bengal
gram), raungi/lobia(black eyed pea), kaabuli
chana(chick pea)
 Spices Turmeric, cinnamon, fenugreek seeds, garlic
 Cereals Wheat, (jau) barley, oats, shashtika rice,
bajra(pearl millet)
 Fruits Plums, kiwi, lime, oranges, guava, apple,
peaches, gooseberry
 Dry fruits Almond, apricot, walnut
Continue…

26. • Non-pharmacological treatment
• Pharmacological treamtment
Types of treatment

27. Medical Nutrition Therapy (MNT)
• MNT by a registered dietitian is the cornerstone for
diabetes management in women with pregestational and
gestational diabetes.
• The nutritional management of women with preexisting
and gestational diabetes does not differ and has the same
theraputic goals: adequate nutrition and weight gain,plus
prevention of ketosis and postprandial hyperglycemia.
• The diet for a pregnant women with diabetes include at
least 175g/day of carbohydrates, 28gday of fiber and
1.1gday of protein per kg/day. (Reader & Thomas,2008)
Non-Pharmacological treatment

28. • All pregnant women should take a prenatal vitamin
with 600 mcg of folic acid daily (IOM, 1998)
• All pregnant women should limit caffeine to
200mg/day.
• After a thorough assessment, the dietitian and the
women develop and individualized meal plan to
achieve desired treatment goals.
• The dietitian and the women examine and disscuss
lifestyle influences on MNT.
Continue…

29. • Patients GDM should be referred to an effective
ongoing support program targeting weight loss of 7%
of body weight.
• Increasing physical activity to at least 150 min per
week of moderate activity such as walking, yoga etc.
Exercise

30.  Yoga is a very essential component of Ayurveda
treatment regime for GD. Yoga is an ancient mind-
body practice that originated in India and
comprises of a system of postures, deep
breathing and meditation to bring balance to
the physical, mental, emotional and spiritual
dimensions of the individual.
YOGA

31. • When MNT fails, pharmacologic therapy is indicated
• Association for the advancement of cost engineering
( AACE) guidelines recommend insulin as optimal
approach.
• Insulin therapy is required for the treatment of
T1DM during pregnancy.
• Metformin and the sulfonylurea glyburide are the
most commonly prescribed oral antithyperglycemic
agents during pregnancy.
Pharmacological treatment

32. Medication Crosses placenta
Metformin yes
Glyburide Minimal transfer
Continue …

33. • Metformin therapy for prevention of type 2 diabets
may be considered in those women with prior GDM .
• It was as effective as lifestyle in women with a history
of GDM ,metformin and intensive lifestyle led to an
equivalent 50% reduction in the risk of diabetes.
• Metformin therefore might reasonably be
recommended for very high risk individuals (those
with a history of GDM, the very obese ,and/or those
with more severe or progressive hyperglycemia).
(American diabetes association, Standards of medical care in
diabetes – 2011 , Diabetes care 2011)
Metformin therapy for prevention

34. Glucose levels for insulin initiation in GDM
Fasting plasma glucose less than or equal to 105 mg/dl
(5.8 mmol/L)
1-hour postprandial plasma glucose less than or equal to 155 mg/dl
(8.6 mmol/L)
2-hour postprandial plasma glucose less than or equals to 130 mg/dl
(7.2 mmol/L)
Pharmacological treatment –
initiation of insulin

35. Total live births% 127.1
Hyperglycemia in pregnancy in women(20-49 years)
Global prevalence% 16.9
Comparative prevalence% 14.8
Number of live births with live hyperglycemia 21.4
Proportion of cases that may be due to diabetes in pregnancy% 16.0
Global Prevalence

36. Regional difference in the prevalence
% of gestational diabetes
North America and
Caribbean region 10.4%
(Lowest)
South east Asia
region 25%
(highest)

37.  A staggering 91.6% of a cases hyperglycemia in
pregnancy were in low and middle income countries,
where access to maternal care is often limited.

38. • Karen L. Daniel et. al.. Borja, PharmD Assistant
Professor, Pharmacy Practice, University College of
Pharmacy, Fort Lauderdale, Florida, US
Pharmacist, 2007
• American Diabetes Association
Diabetes Care 2004 Jan; 27(suppl 1): s88-s90.
• Thomas A. Buchanan et. Al.. Gestational diabetes
mellitus, March 1, 2005
• Naylor, CD, Sermer, M, Chen, E, Sykora, K. Cesarean
delivery in relation to birth weight and gestational
glucose tolerance: pathophysiology or practice
style? JAMA. 1996. 275:1165-1170.
Citations