This document discusses metabolic diseases in pregnancy, focusing on gestational diabetes mellitus (GDM). It defines GDM as carbohydrate intolerance that develops during pregnancy. Risk factors include family history of diabetes, being overweight, previous GDM, and age over 30. GDM is caused by insulin resistance emerging in the second trimester due to pregnancy hormones. It is screened for using an oral glucose tolerance test and managed through diet, exercise, glucose monitoring, and possibly medications like insulin or oral hypoglycemic agents. Both mothers and babies face risks if GDM is not well-controlled.

1. METABOLIC DISEASES IN
PREGNANCY
PRESENTEDBY,
SONAL PATEL,
S.Y.M.SC (n),
JG COLLEGE (N)

2. METABOLIC
DISEASES IN
PREGNANCY

3. Definition
A metabolic condition
characterized by chronic
hyperglycemia as a result of
defective insulin secretion, insulin
action or both.

4. Impact of elevated blood sugar
1. Pregnancy
complication
2. Multi-organ
dysfunction
3. Excess
mortality

5. Classification of Diabetes
• B-cell destructionType 1
Diabetes
• Progressive insulin
secretary defect
Type 2
Diabetes
• Insulin secretary
defect in pregnancy
Gestational
Diabetes
mellitus

6. GESTATIONAL
DIABETES
MELLITUS

7. Definition
Defined as carbohydrate
intolerance of variable
severity that develop or first
recognition during
pregnancy.

8. Risk Factors
1. Strong familial history of
diabetes
2. Being overweight
3. Previous gestational
diabetes.
4. Have given birth to large
infants
5. Previous Polyhydramnios.
6. Previous unexplained fetal
losses
7. Over the age of 30 years

9. Pathophysiology
• Insulin resistance emerging in the 2nd
trimester of pregnancy
–Progesterone
–Cortisol
–Human placental lactogen
–Prolactin and estrogen also contribute.

10. Insulin
Resistance

11. Screening

12. Oral glucose tolerance test (OGTT)
Procedure :
Collect samples at1 , 2 and 3 hours
To give 75 grams of glucose solution to drink
within 5 minutes.
A zero time blood sample is drawn. Blood sugar
level measured.
CHO intake of at least 150 g/day 3 days prior then
Fast for 10 to 16 hours.

13. Result:
Category Normal Results
Fasting blood glucose
level
≥95 mg/dl (5.33
mmol/L)
1 hour blood glucose
level
≥180 mg/dl (10
mmol/L)
2 hours blood glucose
level
≥155 mg/dl (8.6
mmol/L)
3 hours blood glucose
level
≥140 mg/dl (7.8
mmol/L)

14. Management
1.Diet
2. Exercise
3. Glucose
Monitoring
4.
Medications
5. Pre-
pregnancy
Counseling

15. 1. Diet
• Recommended Daily Caloric Intake:
Pregravid BMI Category kcal/kg/day
Low (BMI <18.5 kg/m2) 36-40
Normal (BMI 18.5-24.9 kg/m2) 30
High (BMI 25-29.9 kg/m2) 24
Obese (BMI >29.9 kg/m2) 12

16. Cont…
• The recommended overall dietary
ratio
Category Dietary
Ratio
Complex Carbohydrates 35%-40%
Fat 35%-40%
Protein 20%
Calorie 75%-80%

17. Cont…
Avoid:
concentrated
sweets, and
dairy
products.
Eat Small
frequent
meals
Eat Breakfast
should be
small and
low in carbs.
Foods rich in
antioxidants.

18. 2. Exercise
Better done after meals.
Contracting muscle help stimulate
glucose transport hence decrease blood
sugar.
Light exercise help by lowering fatty
acid.

19. 3. Glucose Monitoring
Daily self blood-
glucose
monitoring had
fewer macrosomic
infants and gained
less weight after
diagnosis.
Glycosylated
hemoglobin
should be
determined at the
end of 1st
trimester and
three months
thereafter.

20. 4. Medications
A. Insulin
Therapy
B. Oral
Hypoglycemic
Agents (OHA)

21. A. Insulin Therapy:
• Total dose of 20 to 30 units OD, before breakfast,
is commonly used to initiate therapy. Usual dose
of Intermediate-acting insulin is given at bedtime.
• Alternatively, weight-based split-dose insulin is
administered twice daily.
• During the stabilization process of insulin dose,
frequent blood sugar estimation especially at
night may be necessary.
• Achieve postprandial B.G. targets better.
• Less risk of hypoglycemia
• Greater lifestyle flexibility and better quality of
life.

22. B. Oral Hypoglycemic Agents (OHA)
• If blood glucose cannot be adequately controlled
with a single agent, the combination of Metformin
and insulin may be better than insulin alone.
• 1. On initial calculation of insulin dose, especially in
unreliable patients.
• 2. Patient with Pregnancy-induced Hypertension.
• 3. Sever vascular diabetic disease.
• 4.At any time if there are concerns about glycaemic
control, especially if hyperemesis gravidarum
develops.
• 5. In cases of diabetic complications, e.g., diabetic
ketoacidosis

23. 5. Pre-pregnancy Counseling
• To prevent early pregnancy loss and
congenital anomalies.
• Complete assessment of diabetic status
should be done to find out whether she is fit
to go through pregnancy.
• Sufficient glycemic control.
• Discontinuing unsafe medications.
• Folate Supplementation.
• Smoking cessation.
• Better preconception glycemic control.

24. Post-partum Follow-up
Insulin (type 1 DM)- safe
for use during
breastfeeding.
Metformin (type 2 DM)-
considered safe, as very
little of the drug is excreted
in breast milk.

25. Schedule 75-g OGTT after 6 weeks:
*Prognosis :
60-70% chance
- GDM in
subsequent
pregnancies.
40-60% chance
- type 2
diabetes in the
future.
2nd pregnancy
within 1 year -
a high rate of
recurrence.
Children of women
with GDM -increased
risk for childhood,
adult obesity, type 2
diabetes later in life.

26. Complications :
1. Maternal
Complication
During
Pregnancy
During
Labor
Puerperium

27. 1. Maternal Complication
a. During Pregnancy:
1. Preterm
labour (20%)
2. UTI
3. Preeclampsia
(25%)
4.
Polyhydramnios
5. Maternal
distress
6. Diabetic
retinopathy &
Diabetic
nephropathy
7. Ketoacidosis

28. b. During Labor 1. Prolongation
of labour due to
big baby
2. Shoulder
dystocia
3. Perineal
injuries
4. Postpartum
hemorrhage

29. c. Puerperium
1. Puerperal
sepsis
2. Lactation
failure

30. 2. Fetal and Neonatal Complication
a. Fetal complications
1. Fetal
macrosomia
(30%-40%)
2. Congenital
Malformations
(10%) - Neural
tube defect or
VSD.
3. Birth injuries
4. Growth
restriction
5. Unexplained
fetal death

31. b. Neonatal complications
Hypoglycemia
Respiratory distress syndrome
Hyperbilirubinemia
Polycythemia
Hypocalcemia