A brief slide on GDM and its management.

1. By
Tushar Ranjan
MBBS 1st Yr
AIIMS GKP
Gestational diabetes mellitus
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2. introduction
 It is defined as carbohydrate intolerance of variable
severity with onset or first recognition during
pregnancy.
 Presents usually in 2nd or 3rd trimester.
 Note that women with diabetes who become pregnant
are not included in this category.
Worldwide, one in 10 pregnancies is associated with
diabetes, 90% of which are GDM.
Undiagnosed or inadequately treated GDM can lead to
significant maternal & fetal complications. Moreover,
women with GDM and their offsprings are at increased
risk of developing type 2 diabetes later in life.
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3. Introduction ctd…
In India, one of the most populous country globally,
rates of GDM are estimated to be 10-14.3% which is
much higher than the west.
As of 2010, there were an estimated 22 million women
with diabetes between the ages of 20 and 39 & an
additional 54 million women in this age group with
impaired glucose tolerance (IGT) or pre-diabetes with
the potential to develop GDM if they become pregnant.
The incidence of GDM is expected to increase to 20%
i.e. one in every 5 pregnant women is likely to have
GDM.
Ref -National Health
Mission(MoHFW)
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4. Classification
Diabetes
in
pregnanc
y
Pre-existing
Diabetes
IDDM
(Type 1)
NIIDM
(Type 2)
Gestational
Diabetes
Occur
during
pregnancy
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5. causes
 During pregnancy there are many changes that takes
place in mother’s metabolism-Rise in insulin
resistance is one of these changes.
 The placenta supplies a growing fetus with nutrients
and produces a variety of hormones to maintain the
pregnancy.
 Some of these hormones, such as human placental
lactogen, have a blocking effect on insulin that usually
begins 20 to 24 weeks into the pregnancy.
 The contra-insulin effect of placental hormones leads
to higher levels of maternal blood glucose after eating
(post-prandial levels) that may aid fetal growth.
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6. CAUSES CTD…
Normally, the mother's beta cells can produce
additional insulin to overcome the insulin
resistance of pregnancy.
As the placenta grows, more hormones are
produced, and insulin resistance becomes
greater.
When the mother's production of insulin is not
enough to overcome the effect of the placental
hormones, gestational diabetes mellitus (GDM)
results.
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12. Neonatal Complications
 Most women having GDM give birth to healthy
babies,especially when they keep their blood sugar under
control,eat healthy food,get regular exercise,and maintain
healthy weight.
 In some cases,though,the condition can affect the
pregnancy.
 Some conditions which can be Neonatal Complications
are:
1. Macrosomia
2. Hypoglycemia
3. Respiratory Distress Syndrome
4. low calcium and magnesium level in baby blood.
The overall perinatal mortality loss is increases by 2-3 times.
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13. 13

14. Does GDM causes Birth
Deformities??
 GDM usually does not cause birth defects or
deformities.
 As,most developmental or physical defects
happen during 1st trimester of pregnancy between
1st and 8th week.
 GD typically develops around or after 24th week
of pregnancy.
 Women with gestational diabetes usually have
normal blood sugar levels during the 1st trimester.
 Thus allowing the body and body systems of the
fetus to develop normally.
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15. Universal testing for GDM
PregnantWoman
Testing for GDM at1stAntenatal
visit(75 g oral glucose- 2 hr Blood
sugar value)
Positive
(2 hr BS  140 mg/dL)
Positive
(2 hr BS  140 mg/dL)
Negative
(2 hr BS <140 mg/dL)
Negative
(2 hr BS <140 mg/dL)
Manage as GDM
as per
guidelines
RepeatTesting at
24-28 weeks
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16. DIAGNOSIS
GDM diagnosis can be accomplished by the
OGTT(Oral Glucose Tolerance Test) either of two
strategies:
1. “One step”75-g OGTT or
2. “ Two step” approach with first50-g (non fasting)
screen followed by a 100 g OGTT for those who
screen positive.
These are done at 24-28 weeks of gestation.
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17. One-step strategy
Perform a 75-g OGTT, with plasma glucose measurement
when patient is fasting and at 1 and 2 hours, at 24–28 weeks of
gestation in women not previously diagnosed with diabetes.
 The OGTTshould be performed in the morning
after an overnight fast of at least 8 h.
 The diagnosis of GDM is made when any of the
following plasma glucose values are met or
exceeded:
o Fasting: 92 mg/dL (5.1 mmol/L)
o 1 h: 180 mg/dL (10.0 mmol/L)
o 2 h: 153 mg/dL (8.5 mmol/L)
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18. Two-step strategy
 Step 1(SCREENING): Perform a 50-g GLT (Non-Fasting), with
plasma glucose measurement at 1 h, at 24–28 weeks of
gestation in women not previously diagnosed with glucose
intolerance.
If the plasma glucose level measured 1 h after the load is >140
mg/dL , proceed to a 100-g OGTT.
 Step 2(DIAGNOSIS): The 100-g OGTT should be performed
when the patient is fasting.(on otherday )
The diagnosis of GDM is made if at least two of the following
four plasma glucose levels (measured fasting and 1 h, 2 h, 3 h
during OGTT) are met or exceeded
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19. Carpenter-Coustan or NDDG
 Fasting 95 mg/dL (5.3 mmol/L) 105 mg/dL (5.8
mmol/L)
 1 h
 2 h
180 mg/dL (10.0 mmol/L)
155 mg/dL (8.6 mmol/L)
190 mg/dL (10.6
mmol/L)
165 mg/dL (9.2
mmol/L)
3 h 140 mg/dL (7.8 mmol/L) 145 mg/dL (8.0
mmol/L)
If results are normal in a clinically suspect situation, repeat
during the 3rd trimester.
Ref.-
NDDG, National Diabetes Data Group.
American diabetes association
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20. AWARENESS PlAN TO ROLL OUT GDM
 Mass Media Activities such as;
 Radio and TV spots giving messages on GDM programme.
 Poster designs , Wall paintings at important roads,markets,public transport
places .
 Advertisement in local newspapers.
 Mid-media activity
 street shows,health campus,community meetings.
 Interpersonal communication activities:
 Role of ASHAs, Anganwadi workers to counsel family members on routine
blood sugar tests.
 Promote breastfedding .
 Govt programmes like PMSMA(Pradhan Mantri Surakshit Matritva Abhiyan)
provide Antenatal care to mothers.
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21. References
 American Diabetes Association,Diabetes care,Vol
41,supplement 1
 National Health Mission,MoHFW
 Tietz fundamentals of clinical chemistry 7th
edition.
 ncbi.nlm.nih.gov
 Park textbook of preventive and social medicine.
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