Hypertension during pregnancy

1. Gestational Diabetes
Mellitus
Mohideen Bawa Fathima Sahina

2. Types of Diabetes Mellitus
Type 1 Diabetes
● Type 1 diabetes is an autoimmune condition. It happens when your body attacks your pancreas with
antibodies. The organ is damaged and doesn't make insulin.
Type 2 Diabetes
● Insulin resistance,pancreas usually creates some insulin but when your cells don’t respond to insulin
Gestational Diabetes
● GDM is high blood sugar (glucose) that develops during pregnancy and usually disappears after giving
birth. The insulin requirement varies during pregnancy.
● Doctors often spot it in middle or late pregnancy.
● it’s important to control gestational diabetes to protect the baby's growth and development.
Prediabetes
● it’s a condition where a person has elevated blood sugar levels that aren’t
Quite high enough to qualify as type 2 diabetes.

3. Epidemiology
● Occurs in 5–9% of all pregnancies.
● Usually in the second and third
trimesters (less common in the
first trimester)
● The International Diabetes
Federation (IDF) reports that 1 in 6
(16.8%) pregnancies are affected
by diabetes.
● 3.6% are affected by
pregestational diabetes, while the
majority (86.4%) are affected by
GDM.

4. Causes
● Researchers don't yet know why some women get
gestational diabetes and others don't.
● Excess weight before pregnancy often plays a role.
● Usually, various hormones work to keep blood sugar
levels in check. But during pregnancy, hormone
levels change, making it harder for the body to
process blood sugar efficiently. This makes blood
sugar rise.

5. Pathophysiology
In the first trimester,
● Insulin sensitivity increases and there is a tendency towards
hypoglycemia.
In the second and third trimesters,
● Pregnancy usually causes some form of insulin resistance in Mother.
● This is because Hormones that made by the placenta (Human Placental
Lactogen) prevent insulin functions, trigger progressive insulin
resistance.
● Glucose builds up in the blood instead of being absorbed by the
cells.that can make insulin less effective, that results in hyperglycemia
● Gestational diabetic symptoms usually disappear following delivery.
● But Baby Develops Hypoglycemia, woman’s blood sugars travel through
their placenta to the baby,

6. Maternal Glucose Can cross
placenta vrs Insulin Cannot,
Baby Produce its own insulin

7. Risk factors
● Being overweight or obese
● Not being physically active
● Having prediabetes
● Having had gestational diabetes during a previous pregnancy
● Having polycystic ovary syndrome
● Having an immediate family member with diabetes
● Having previously delivered a baby weighing more than 9 pounds (4.1 kilograms - fetal macrosomia)
● Being of a certain race

8. Clinical features
● Mothers are usually asymptomatic
● Common Diabetic Symptoms such as
● Polyurea
● Polydipsia
● Paresthesia
● warning signs include polyhydramnios
or large-for-gestational age infants
(> 90th percentile)
● May present with edema;

9. Screening and diagnostics
Screening in all pregnancies:
● Recommended During Second trimester (at 24–28 weeks)
Early screening (prior to 24 weeks):
● recommended in women with risk factors for
gestational diabetes (see above)
Initial screening:
● 50-g, one-hour oral glucose challenge test
➢ Blood glucose level should be < 135
mg/dl
➢ If positive, patients are given the 100-g
oral glucose challenge test as
confirmation
Confirmation test:
● 100-g, three-hour oral glucose tolerance test (OGTT) ≥
140 mg/dl

10. Treatment
● Glycemic control
○ Dietary modifications and regular exercise (walking)
○ Strict blood glucose monitoring (4x daily)
○ Insulin therapy if glycemic control is insufficient with dietary modifications
○ Metformin and glyburide in patients who are unwilling or unable to use insulin
● Regular ultrasound to evaluate fetal development
● Consider inducing delivery at week 39–40, if glycemic control is poor or if complications
occur

11. Complications
Maternal:
● Preeclampsia, eclampsia, and HELLP syndrome
● Urinary tract infection
● Gestational hypertension
● HaFuture diabetes. ving a surgical delivery (C-section).
Fetal:
● Excessive birth weight.
● Early (preterm) birth.
● Serious breathing difficulties.
● Low blood sugar (hypoglycemia).
● Obesity and type 2 diabetes later in life.

12. Prognosis
● In most cases, gestational diabetes resolves after pregnancy.
● Increased risk of developing T2DM (up to 50% over 10 years)
○ Screen for DM 6–12 weeks postpartum (75 g 2-hour GTT)
○ Repeat every 3 years
● Increased risk of gestational diabetes recurring in subsequent
pregnancies (∼ 50%)

13. Prevention
● Eat healthy foods.
● Keep active.
● Maintain pregnancy at a healthy weight
● Don't gain more weight than recommended.
● Checking your blood sugar
● Monitoring the baby Weight.

14. Thank you.