Gestational diabetes mellitus (GDM) is a type of diabetes that is first recognized during pregnancy. An oral glucose tolerance test is used to diagnose GDM, with abnormal fasting or post-meal blood glucose levels indicating GDM. Women with GDM are at higher risk of complications during pregnancy like preeclampsia and delivering a large baby, so treatment focuses on maintaining normal blood glucose levels through diet, exercise, and possibly insulin or metformin. After delivery, women with GDM have an increased long-term risk of type 2 diabetes and should undergo screening.
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.
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.
This presentation covers an introduction to Abortion, classification, etiologies, clinical types, diagnostic criteria and basic management.
At the end its a detailed discussion of Post abortion management.
Important core knowledge about management of diabetic female in pregnancy and what are the possible fetal and neonatal complications and risk factors.
book: Obstetrics by Ten teachers.
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 presentation covers an introduction to Abortion, classification, etiologies, clinical types, diagnostic criteria and basic management.
At the end its a detailed discussion of Post abortion management.
Important core knowledge about management of diabetic female in pregnancy and what are the possible fetal and neonatal complications and risk factors.
book: Obstetrics by Ten teachers.
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.
Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries. For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources. The total value of the WDF project portfolio reached USD 377 million, excluding WDF’s own advocacy and strategic platforms.
Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries. For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources. The total value of the WDF project portfolio reached USD 377 million, excluding WDF’s own advocacy and strategic platforms.
—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.
Our aim is to reduce morbidity and mortality related to Non communicable diseases such as hypertension, diabetes, cardiovascular disease, stroke, Obesity, Cancer and lifestyle diseases among those least able to withstand the burden of the disease.
In this interactive lecture Dr. Vicky Guanzon joins me in discussing the updates on the Diagnosis and Treatment of Diabetes in Pregnancy. Delivered at the L'Fischer Hotel in Bacolod City on August 6, 2015.
Similar to Gestational diabetes mellitus(gdm) (20)
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
2. DEFINITION OF GDM
7/22/2018
2
The definition of Gestational diabetes from
National Data Group (1985) is : “Carbohydrate
intolerance of variable severity with onset or
first recognition during the presence of
pregnancy”
It also includes women with pre-existing but
previously unrecognized diabetes.
GDM: impaired carbohydrate tolerance
resulting in hyperglycemia which is identified
first time during pregnancy.
3. OGTT
7/22/2018
3
The oral glucose tolerance test (OGTT)
measures the body's ability to use a type of
sugar, called glucose, that is the body's main
source of energy. An OGTT can be used to
diagnose prediabetes and diabetes
Over night fast for 8 hours is required for it
then 75mg of glucose is taken orally after
taking a fasting glucose and two readings at
one hour and two hours after ingestion are
taken.
Values are then interpearted according to
criteria.
4. Normal Blood Glucose Levels
7/22/2018
4
For the majority of healthy individuals, normal
blood sugar levels are Between 4.0 to 6.0
mmol/L (72 to 108 mg/dL) when fasting. Up to
7.8 mmol/L (140 mg/dL) 2 hours after eating.
Impaired glucose tolerance (IGT):
FBS<7.0mmol/l 2hours > 7 .8 mmol/l but
<11mmol/l.
Diabetes in non pregnant: RBS >11mmol/l,
FBS >7.0 mmol/l, or 2 hour glucose
>11mmol/l on 75mg OGTT.
5. Incidence of GDM
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5
Using definition of IGT in non pregnant woman
the incidence is about 3%-6%.
Using the new diagnostic criteria by the
International Association of the diabetes and
pregnancy study group (IADPSG), the
frequency of GDM was 18% but varied from
9% to 26% in different countres.
High risk in south asian women
(india,pakistan,and bangladesh) who have a
relative risk 7.6 to 11 fold.
6. Risk factors for screening GDM
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6
First degree relatives with diabetes :
Type I: 15% Type II : 6.7%
Previous baby 4.5 kg or more : 12.2%
Glycosuria : 50% Be aware that glycosuria of
2+ or above on 1 occasion or of 1+ or above
on 2 or more occasions detected by reagent
strip testing during routine antenatal care may
indicate undiagnosed gestational diabetes. If
this is observed, consider further testing to
exclude gestational diabetes.
7. Risk factors for screening GDM
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7
Current suspected macrosomia and
polyhydroamnios (both 40%)
Previous Gestational Diabetes: recurrence
rate 30% to 84%
Body mass index >30 kg/m2
Ethinic origin: south asia (pak, bangladesh,
india) black caibbean, middle eastern ( saudi
arabia, UAE, jorden, oman, syria, qater,
kuwait, egypt.)
8. IMPORTANCE OF GDM
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8
Increased risk of developing DM type II in 10-15
years.
Undiagnosed DM type I, so increased risk of
ketoacidosis.
Higher incidence of Macrosomia and adverse
pregnancy outcomes.
Increased risk of Pre-eclampsia,
polyhydroamnios, IUD, still births,operative
delivery.
Increased risk of preterm, macrosomia, late still
birth, hypoglycemia, ARDS, polycythemia,
juandice and neonatal mortality.
9. Screening And Diagnosis
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9
NICE advocate screening only women with
risk factors with an OGTT at 24-28 weeks
gestation.
Women with previous GDM should be offered
self monitoring of blood glucose or be
screened with an OGTT at 16-18 weeks and
again at 28 weeks if this is negative.
NICE does not recommend screening with
random blood glucose, fasting blood glucose,
urinalysis or glucose challenge test.
HbAIc should not be used as screening
10. NICE criteria for GDM
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10
According to NICE diabetes in pregnancy 2015 a
diagnosis of GDM is made if the:
Fasting plasma glucose is 5.6 mmol/liter or more
(100 mg/dl)
Or the two hour level is 7.8mmol/liter or more
(140mg/dl)s
11. HAPO study/IADPSG
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11
The Hyperglycemia and Adverse Pregnancy Outcome
(HAPO) study was performed in response to the need for
internationally agreed upon diagnostic criteria for gestational
diabetes, based upon their predictive value for adverse
pregnancy outcome. Increases in each of the 3 values on the
75-g, 2-hour oral glucose tolerance test are associated with
graded increases in the likelihood of pregnancy outcomes
such as large for gestational age, cesarean section, fetal
insulin levels, and neonatal fat content. Based upon an
iterative process of decision making, a task force of the
International Association of Diabetes and Pregnancy
Study Groups(IADPSG) recommends that the diagnosis of
gestational diabetes be made when any of the following 3 75-
g, 2-hour oral glucose tolerance test thresholds are met or
exceeded: fasting 92 mg/dL, 1-hour 180 mg/dL, or 2 hours
153 mg/dL.
12. Criteria for the 2hour 75 g OGTT in
the diagnosis of GDM at 24-28
weeks
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12
IADPSG
mmol/liter
NICE
mmol/liter
fasting 5.1 (92mg/dl) > 5.6 (100 mg/dl) >
1 hour 10 (180 mg/dl) > ------
2 hour 8.5 (153 mg/dl) > 7.8 (140 mg/dl) >
13. Clinical features
7/22/2018
13
GDM is usually asymptomatic and develops in
second and third triamester induced by
maternal changes in carbohydrate metabolism
and decreased insulin sensitivity.
It may be diagnosed on routine investigation or
may be suspected in case of macrosomia
polyhydramnios , persistent heavy glucosuria,
recurrent infections.
14. Targets for daily capillary plasma
glucose
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14
Fasting less than 5.3 mmol/liter ( 95 mg/dl)
1 hour after meals less than 7.8 mmol/liter
(140 mg/dl)
2 hours after meals less than 6.4 mmol/liter
(115mg/dl)
15. MANAGEMENT OF GDM
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15
Women should be managed in a specialist
multidisciplinary diabetes pregnancy clinic.
The mainstay of treatment is lifestyle advice
including dietary modification with reduced fat,
increased fiber and regulation of carbohydrate
intake.
No excess risk of major malformations.
After diagnosis women should be offered a
review in a joint diabetic antenatal clinic within
a week.
16. Management Of GDM
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16
Women are at increased risk of preeclampsia
needs regular B.P and urinlysis for proteinuria.
Women with a fasting plasma glucose at
diagnosis of less than 7mmol/liter(126 mg/dl)
should be offered diet and exercise as a method
of controlling blood glucose as long as there are
no other complications present such as
polyhydramnios and macrosomia. Regular daily
30 min of moderate exercise is encouraged.
Blood glucose should be checked daily fasting
and one hour after meal.
17. Management Of GDM
7/22/2018
17
If after 1-2 weeks of diet and exercise blood
glucose is not within these recommended
levels additional therapy should be offered.
Pharmaocological treament with INSULIN and
METFORMIN will be required when diet and
exercise fails or woman develops
complications.
18. Recommended management of
GDM at diagnosis (NICE 2015)
7/22/2018
18
Fasting plasma
glucose mmol/l
at diagnosis
Complications Management Recommended
pattern of blood
glucose
monitoring
< 7 None 1-2 weeks tial diet
and exercise
Fasting + 1 hour
post meal daily
6.0-6.9 Polyhydramnios
macrosomia
Insulin +
Metformin in
addition to diet &
excercise
Oral therapy or
single dose
intermediate or
long acting
insulin.
> 7 Insulin +
Metformin in
addition to diet &
excercise
Multiple daily
insulin doses:
fasting, premeal,
post meal and
19. FETAL MONITORING
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19
Regular ultrasound scans for growth liqour
volume and umblical artery Doppler at 4-
weekly intervals
Fetal abdominal circumfernce to detect
macrosomia
20. TIME AND MODE OF
DELIVERY
7/22/2018
20
Pregnant women with uncomplicated GDM be
offered elective birth no latter than 40 +6 weeks
gestation.
Women with complications should be elecitvily
delivered before this gestation.
Normal vaginal delivery is indicated and
operative delivery for other reasons and in
complications may be needed.
21. INTRAPARTUM CARE
7/22/2018
21
Blood glucose should be checked every hour
in labour and levels should be maintained
between
4-7 mmol/liter (72-126 mg/dl)
A sliding scale of intravenous insulin and
dextrose should be initiated if blood glucose
falls outside this range.
Women who require steroid cover for lung
maturity should be treated in same way like
pre-existing diabetes.
22. POST NATAL CARE
7/22/2018
22
GDM will not require any treatment after
delivery so all hypoglycemic treatment should
be discontinued.
Pre-meal and bed time testing should be
continued until levels returns to normal (4-6
mmol/liter), then once daily while an inpatient.
Contraception should be discussed prior to
discharge.
Six week follow up with OGTT or FBS. Then
annual fasting blood glucose or HbAIc.
23. SUMMARY
7/22/2018
23
GDM is the disease of second/third triamstar.
Only at risk population is screened for GDM
Maternal and fetal outcomes are same as
nondiabetics if glycemic control is kept under
targeted levels.
Future development of diabetes type II is
higher so require annual screening.
Recurrence risk is higher in subsequent
pregnancies.