This document discusses screening and diagnosis of gestational diabetes mellitus (GDM). It begins by outlining the learning objectives and explaining why screening for GDM is important. It then discusses different screening protocols including risk-based versus universal screening, timing of screening, and recommended screening tests. The document reviews diagnostic criteria from organizations like the IADPSG and DIPSI and presents case studies applying these criteria. It also discusses implications of pre-existing diabetes in pregnancy like congenital malformations and maternal complications. In summary, the document provides an overview of guidelines and considerations for screening and diagnosing GDM.
1. The document discusses the routine care and special considerations for antenatal care (ANC) of pregnancies achieved through in vitro fertilization (IVF).
2. Special considerations for IVF pregnancies include increased risk of complications like ovarian hyperstimulation syndrome, multiple pregnancies, and genetic abnormalities which require specialized counseling and screening.
3. ANC for IVF pregnancies should be provided by specialists familiar with both obstetrics and IVF in order to monitor for pregnancy complications and provide psychosocial support related to fertility treatments.
The document discusses various fertility preservation strategies for cancer patients undergoing chemotherapy or radiation therapy. It describes how certain cancers are more common in reproductive aged women and men. It then outlines different options for preserving fertility including pharmacological protection with GnRH analogues, IVF with embryo cryopreservation, oocyte cryopreservation, ovarian transposition, and ovarian tissue cryopreservation and transplantation. It notes the limitations, success rates, and complications of each method.
This document discusses fertility preservation options for cancer patients. It begins by outlining how cancer treatments can impact fertility through damage to reproductive organs and systems. For men, sperm banking is the most established option, though there are challenges around timing and ability to produce samples. Alternatives include testicular sperm extraction and intracytoplasmic sperm injection. For women, embryo cryopreservation has the highest success rate, while oocyte cryopreservation and ovarian tissue cryopreservation are also options. The document then reviews potential paths to parenthood post-treatment and challenges to fertility preservation.
Fertility preservation in Cancer patientsArunSharma10
The need for fertility preservation
Chemotherapeutic drugs according to gonadotoxicity level
Fertility preservation: subject of continuous review by experts
Non-oncological conditions requiring fertility preservation
Delayed childbearing
AVAILABLE PROCEDURES FOR FP
Embryo and oocyte cryopreservation
fertililty sparing surgeries in gynecological cancersSreelasya Kakarla
- Fertility preservation is important for cancer patients of childbearing age to maintain their quality of life. Advances in cancer treatment like chemotherapy and radiation can impact fertility.
- For early stage cervical cancers like stage 1A1, 1A2, and 1B1, fertility sparing surgeries like conization or radical trachelectomy combined with lymph node dissection may be options to preserve fertility while treating the cancer.
- For early stage ovarian and endometrial cancers, fertility sparing surgeries like cystectomy or tumor resection with lymph node sampling can be considered to treat the cancer and spare fertility in select cases.
WHAT IS NEW IN ESHRE 2022 AND FIGO 2022 FOR GENERAL GYNAECOLOGISTAboubakr Elnashar
The document summarizes key information from the ESHRE 2022 and FIGO 2022 conferences. It discusses several topics including:
- The ESHRE conference included 97 sessions with 317 oral and 801 poster presentations.
- The FIGO classification system for ovulatory disorders was updated, categorizing disorders into 4 types based on their hypothalamic, pituitary, ovarian, or PCOS origin.
- Subtle distal fallopian tube abnormalities may be treated with laparoscopy, leading to a 46.58% natural pregnancy rate.
- Children born after frozen embryo transfer have a higher risk of childhood cancer than those born after fresh embryo transfer or spontaneously.
Role of Stem Cells in Obstetrics and Gynecology PracticeAsha Jain
Role of Stem Cells in Obstetrics and Gynecology Practice
Talk delivered at 4th Biennial International ISCSGCON 2021
on Febuary 13,2021 by Dr. Asha Jain
1. The document discusses the routine care and special considerations for antenatal care (ANC) of pregnancies achieved through in vitro fertilization (IVF).
2. Special considerations for IVF pregnancies include increased risk of complications like ovarian hyperstimulation syndrome, multiple pregnancies, and genetic abnormalities which require specialized counseling and screening.
3. ANC for IVF pregnancies should be provided by specialists familiar with both obstetrics and IVF in order to monitor for pregnancy complications and provide psychosocial support related to fertility treatments.
The document discusses various fertility preservation strategies for cancer patients undergoing chemotherapy or radiation therapy. It describes how certain cancers are more common in reproductive aged women and men. It then outlines different options for preserving fertility including pharmacological protection with GnRH analogues, IVF with embryo cryopreservation, oocyte cryopreservation, ovarian transposition, and ovarian tissue cryopreservation and transplantation. It notes the limitations, success rates, and complications of each method.
This document discusses fertility preservation options for cancer patients. It begins by outlining how cancer treatments can impact fertility through damage to reproductive organs and systems. For men, sperm banking is the most established option, though there are challenges around timing and ability to produce samples. Alternatives include testicular sperm extraction and intracytoplasmic sperm injection. For women, embryo cryopreservation has the highest success rate, while oocyte cryopreservation and ovarian tissue cryopreservation are also options. The document then reviews potential paths to parenthood post-treatment and challenges to fertility preservation.
Fertility preservation in Cancer patientsArunSharma10
The need for fertility preservation
Chemotherapeutic drugs according to gonadotoxicity level
Fertility preservation: subject of continuous review by experts
Non-oncological conditions requiring fertility preservation
Delayed childbearing
AVAILABLE PROCEDURES FOR FP
Embryo and oocyte cryopreservation
fertililty sparing surgeries in gynecological cancersSreelasya Kakarla
- Fertility preservation is important for cancer patients of childbearing age to maintain their quality of life. Advances in cancer treatment like chemotherapy and radiation can impact fertility.
- For early stage cervical cancers like stage 1A1, 1A2, and 1B1, fertility sparing surgeries like conization or radical trachelectomy combined with lymph node dissection may be options to preserve fertility while treating the cancer.
- For early stage ovarian and endometrial cancers, fertility sparing surgeries like cystectomy or tumor resection with lymph node sampling can be considered to treat the cancer and spare fertility in select cases.
WHAT IS NEW IN ESHRE 2022 AND FIGO 2022 FOR GENERAL GYNAECOLOGISTAboubakr Elnashar
The document summarizes key information from the ESHRE 2022 and FIGO 2022 conferences. It discusses several topics including:
- The ESHRE conference included 97 sessions with 317 oral and 801 poster presentations.
- The FIGO classification system for ovulatory disorders was updated, categorizing disorders into 4 types based on their hypothalamic, pituitary, ovarian, or PCOS origin.
- Subtle distal fallopian tube abnormalities may be treated with laparoscopy, leading to a 46.58% natural pregnancy rate.
- Children born after frozen embryo transfer have a higher risk of childhood cancer than those born after fresh embryo transfer or spontaneously.
Role of Stem Cells in Obstetrics and Gynecology PracticeAsha Jain
Role of Stem Cells in Obstetrics and Gynecology Practice
Talk delivered at 4th Biennial International ISCSGCON 2021
on Febuary 13,2021 by Dr. Asha Jain
Intrapartum sonography can be used to more accurately assess fetal head position, station, descent, and rotation during labor compared to digital examination alone. It also helps predict success of induction of labor and instrumental delivery. The document outlines the basic technique, objectives, and various clinical applications of intrapartum sonography during different stages of labor.
Day care obstetrics and gynecology provides inpatient level care to patients on an outpatient basis. It was first established in 1969 in the US and has since expanded globally. Day care allows for monitoring of high-risk pregnancies, infertility procedures, fetal medicine procedures, and gynecological surgeries. Patients are selected based on surgical, medical, and social criteria to ensure safety. Procedures are performed using local anesthesia, IV sedation, or general anesthesia with rapid induction and recovery. Strict discharge criteria involving patient status and availability of a caretaker ensure safe recovery at home.
This document discusses the use of lasers in gynecology. It begins by explaining the physical properties of lasers including their monochromacity, coherence, and collimation. It then discusses laser tissue interaction and the factors that influence laser effects. Common laser systems used in gynecology are described including their wavelengths and tissue penetration. The advantages of fiberoptic laser laparoscopy are provided. The principal uses of lasers in gynecology are listed as tissue cutting, coagulation, and vaporization. Examples of specific gynecological procedures where lasers are commonly used are given. The limitations and hazards of laser systems are briefly outlined.
Fertility Preservation for Gynecologic Cancer PatientsJibran Mohsin
This document discusses fertility preservation options for young women diagnosed with gynecologic cancers. It covers cervical, endometrial, and ovarian cancers. For early-stage cervical cancer, conization or radical trachelectomy can allow fertility preservation. For early-stage endometrial cancer, hormonal treatment with progesterone may induce remission and allow attempted pregnancy. For early-stage ovarian cancers including borderline tumors and germ cell tumors, fertility-sparing surgery such as unilateral salpingo-oophorectomy may be an option. Patient selection is crucial to balance oncologic and fertility outcomes.
Polycystic Ovarian Syndrome (PCOS) is the most common cause of infertility in women. It is characterized by oligoamenorrhea, hyperandrogenism, and polycystic ovaries. PCOS results from abnormal pituitary-ovarian-adrenal interactions that cause excess androgen production and reduced fertility. Women with PCOS have an increased risk of insulin resistance, diabetes, heart disease, and obesity. The diagnosis of PCOS requires hyperandrogenism, ovarian dysfunction, and the exclusion of other disorders.
interest in stem cells is raising in different field of medicine. The question is : is it successful in Gynecology or it is still too early to say that. The present talk may help to explore this .
This document discusses maternal near miss (MNM), which refers to women who survive severe life-threatening complications during pregnancy, childbirth, or postpartum. MNM is presented as an important tool for evaluating obstetric healthcare beyond just maternal mortality. The document outlines criteria for identifying MNM cases, indicators for assessing healthcare quality using MNM data, advantages of MNM reviews for reducing maternal mortality, and findings from studies on MNM in various hospitals that identified leading complications and opportunities for improvement. MNM reviews are described as complementary to maternal death reviews for gaining insights to reduce preventable morbidity and mortality.
PANEL DISCUSSION ON ENDOMETRIOSIS RELATED INFERTILITY (EVIDENCE BASED)Lifecare Centre
PANEL DISCUSSION ON ENDOMETRIOSIS RELATED INFERTILITY (EVIDENCE BASED)
MODERATOR
DR SHARDA JAIN
DR JYOTI AGARWAL
DR ILA GUPTA
UMA RAI
RAJ BOKARIA
JYOTI AGARWAL
JYOTI BHASKER
RENU CHAWLA
DIPTI NABH
VANDANA GUPTA
This document provides guidelines for elective single embryo transfer (eSET) compared to double embryo transfer (DET) following in vitro fertilization (IVF). It finds that while the cumulative live birth rate is lower for eSET than DET, eSET significantly reduces the risk of multiple pregnancies. The guidelines recommend eSET for good prognosis patients aged 35 or younger in their first or second IVF attempt with at least 2 good quality embryos. This is intended to minimize twin pregnancies while maintaining acceptable live birth rates overall.
The document discusses polycystic ovary syndrome (PCOS), including its prevalence, diagnosis, risk assessment, and treatment. It is the most common reproductive disorder in women, affecting 8-18% depending on the criteria used. Diagnosis involves assessing irregular menstrual cycles, clinical or biochemical signs of hyperandrogenism, and ovarian morphology on ultrasound. Women with PCOS have increased risks of cardiovascular disease, diabetes, obstructive sleep apnea, and endometrial cancer, so risk factors should be regularly monitored. Lifestyle changes including healthy diet, exercise, and weight loss are recommended as first-line treatment, especially for overweight or obese women.
This document discusses endometriosis and its relationship to infertility. It covers several key points:
1. Endometriosis has three main types - peritoneal, ovarian, and rectovaginal - which are different entities.
2. Endometriosis can result in infertility through mechanical effects, endocrine abnormalities, changes to peritoneal fluid, immune system issues, and defects in oocytes.
3. Diagnosis is confirmed through laparoscopy, and mild or minimal endometriosis associated with infertility can be treated through laparoscopic destruction, expectant management, or GnRH agonists. Surgery aims to decrease inflammation and toxicity.
4. For endometriomas,
This document discusses the use of laparoscopy in gynecologic oncology. It notes that laparoscopy can be used for procedures like hysterectomy, node dissection, and bowel surgery. Studies show laparoscopy provides benefits like improved vision, less morbidity, shorter hospital stays, and better patient satisfaction compared to open surgery. However, laparoscopy requires a learning curve and is still being evaluated for oncologic outcomes in some cancers. The document reviews evidence for laparoscopy in endometrial, ovarian, and cervical cancers. It concludes laparoscopy is feasible and effective for gynecologic oncology when performed by trained specialists, though more research is still needed.
1. Cesarean scar pregnancy (CSP) occurs when a gestational sac implants at the site of a previous cesarean section scar and can lead to life-threatening complications if not treated.
2. Ultrasound is the primary diagnostic tool and shows the gestational sac located in the scar without connecting to the uterine cavity.
3. Treatment options include expectant management, medical management with methotrexate, and surgical management ranging from uterine curettage to hysterectomy. The goal is to terminate the pregnancy while preserving the uterus and future fertility.
The document discusses caesarean scar defects, also known as uterine niches. It provides information on the prevalence, risk factors, clinical presentation, diagnosis, and management of this condition. Uterine niches are common, affecting up to 70% of those with a prior c-section, and are usually asymptomatic but can sometimes cause bleeding, pain, or infertility. Diagnosis involves ultrasound imaging to identify a triangular defect in the uterine scar with decreased or absent underlying muscle. Larger niches with less residual muscle are more likely to be symptomatic.
The Accuracy of Diagnostic Colposcopy using IFCPC 2011 TerminologySujoy Dasgupta
This paper was presented in the Annual Conference of Bengal Obstetric and Gynaecological Society (BOGSCON) 2014 held at ITC Sonar, Kolkata- January, 2014
This document provides an overview of intrauterine insemination (IUI). Some key points include:
IUI is a first-line, non-invasive fertility treatment that involves placing processed sperm directly into the uterus. Success rates range from 6-20% depending on the stimulation protocol used. Factors like age, infertility duration and etiology, and semen quality impact success rates. Strict monitoring is important to minimize risks of ovarian hyperstimulation syndrome while maximizing pregnancy chances. Proper sperm processing techniques and timing of insemination relative to ovulation are also important considerations for IUI.
The document is a lecture on the treatment of endometriosis-associated infertility according to 2022 ESHRE guidelines. It discusses various treatment options including medical treatment with hormonal therapies, surgery, assisted reproductive technologies (ART), and fertility preservation. Key recommendations include that ovarian suppression should not be used to improve fertility. Surgery and ART may be considered depending on the stage of endometriosis and patient factors. Extensive counseling is recommended when discussing fertility preservation options.
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) for StudentsUsama Ragab
Gestational diabetes is diabetes that develops during pregnancy. It is diagnosed either pre-existing type 1 or type 2 diabetes, or gestational diabetes diagnosed during pregnancy. Gestational diabetes screening involves a glucose challenge test between 24-28 weeks of pregnancy, or earlier for those at high risk. Treatment involves lifestyle changes like diet and exercise, and may require insulin if needed to control blood glucose levels. After delivery, women with gestational diabetes have increased risk of developing type 2 diabetes and should undergo testing to check for prediabetes or diabetes.
Intrapartum sonography can be used to more accurately assess fetal head position, station, descent, and rotation during labor compared to digital examination alone. It also helps predict success of induction of labor and instrumental delivery. The document outlines the basic technique, objectives, and various clinical applications of intrapartum sonography during different stages of labor.
Day care obstetrics and gynecology provides inpatient level care to patients on an outpatient basis. It was first established in 1969 in the US and has since expanded globally. Day care allows for monitoring of high-risk pregnancies, infertility procedures, fetal medicine procedures, and gynecological surgeries. Patients are selected based on surgical, medical, and social criteria to ensure safety. Procedures are performed using local anesthesia, IV sedation, or general anesthesia with rapid induction and recovery. Strict discharge criteria involving patient status and availability of a caretaker ensure safe recovery at home.
This document discusses the use of lasers in gynecology. It begins by explaining the physical properties of lasers including their monochromacity, coherence, and collimation. It then discusses laser tissue interaction and the factors that influence laser effects. Common laser systems used in gynecology are described including their wavelengths and tissue penetration. The advantages of fiberoptic laser laparoscopy are provided. The principal uses of lasers in gynecology are listed as tissue cutting, coagulation, and vaporization. Examples of specific gynecological procedures where lasers are commonly used are given. The limitations and hazards of laser systems are briefly outlined.
Fertility Preservation for Gynecologic Cancer PatientsJibran Mohsin
This document discusses fertility preservation options for young women diagnosed with gynecologic cancers. It covers cervical, endometrial, and ovarian cancers. For early-stage cervical cancer, conization or radical trachelectomy can allow fertility preservation. For early-stage endometrial cancer, hormonal treatment with progesterone may induce remission and allow attempted pregnancy. For early-stage ovarian cancers including borderline tumors and germ cell tumors, fertility-sparing surgery such as unilateral salpingo-oophorectomy may be an option. Patient selection is crucial to balance oncologic and fertility outcomes.
Polycystic Ovarian Syndrome (PCOS) is the most common cause of infertility in women. It is characterized by oligoamenorrhea, hyperandrogenism, and polycystic ovaries. PCOS results from abnormal pituitary-ovarian-adrenal interactions that cause excess androgen production and reduced fertility. Women with PCOS have an increased risk of insulin resistance, diabetes, heart disease, and obesity. The diagnosis of PCOS requires hyperandrogenism, ovarian dysfunction, and the exclusion of other disorders.
interest in stem cells is raising in different field of medicine. The question is : is it successful in Gynecology or it is still too early to say that. The present talk may help to explore this .
This document discusses maternal near miss (MNM), which refers to women who survive severe life-threatening complications during pregnancy, childbirth, or postpartum. MNM is presented as an important tool for evaluating obstetric healthcare beyond just maternal mortality. The document outlines criteria for identifying MNM cases, indicators for assessing healthcare quality using MNM data, advantages of MNM reviews for reducing maternal mortality, and findings from studies on MNM in various hospitals that identified leading complications and opportunities for improvement. MNM reviews are described as complementary to maternal death reviews for gaining insights to reduce preventable morbidity and mortality.
PANEL DISCUSSION ON ENDOMETRIOSIS RELATED INFERTILITY (EVIDENCE BASED)Lifecare Centre
PANEL DISCUSSION ON ENDOMETRIOSIS RELATED INFERTILITY (EVIDENCE BASED)
MODERATOR
DR SHARDA JAIN
DR JYOTI AGARWAL
DR ILA GUPTA
UMA RAI
RAJ BOKARIA
JYOTI AGARWAL
JYOTI BHASKER
RENU CHAWLA
DIPTI NABH
VANDANA GUPTA
This document provides guidelines for elective single embryo transfer (eSET) compared to double embryo transfer (DET) following in vitro fertilization (IVF). It finds that while the cumulative live birth rate is lower for eSET than DET, eSET significantly reduces the risk of multiple pregnancies. The guidelines recommend eSET for good prognosis patients aged 35 or younger in their first or second IVF attempt with at least 2 good quality embryos. This is intended to minimize twin pregnancies while maintaining acceptable live birth rates overall.
The document discusses polycystic ovary syndrome (PCOS), including its prevalence, diagnosis, risk assessment, and treatment. It is the most common reproductive disorder in women, affecting 8-18% depending on the criteria used. Diagnosis involves assessing irregular menstrual cycles, clinical or biochemical signs of hyperandrogenism, and ovarian morphology on ultrasound. Women with PCOS have increased risks of cardiovascular disease, diabetes, obstructive sleep apnea, and endometrial cancer, so risk factors should be regularly monitored. Lifestyle changes including healthy diet, exercise, and weight loss are recommended as first-line treatment, especially for overweight or obese women.
This document discusses endometriosis and its relationship to infertility. It covers several key points:
1. Endometriosis has three main types - peritoneal, ovarian, and rectovaginal - which are different entities.
2. Endometriosis can result in infertility through mechanical effects, endocrine abnormalities, changes to peritoneal fluid, immune system issues, and defects in oocytes.
3. Diagnosis is confirmed through laparoscopy, and mild or minimal endometriosis associated with infertility can be treated through laparoscopic destruction, expectant management, or GnRH agonists. Surgery aims to decrease inflammation and toxicity.
4. For endometriomas,
This document discusses the use of laparoscopy in gynecologic oncology. It notes that laparoscopy can be used for procedures like hysterectomy, node dissection, and bowel surgery. Studies show laparoscopy provides benefits like improved vision, less morbidity, shorter hospital stays, and better patient satisfaction compared to open surgery. However, laparoscopy requires a learning curve and is still being evaluated for oncologic outcomes in some cancers. The document reviews evidence for laparoscopy in endometrial, ovarian, and cervical cancers. It concludes laparoscopy is feasible and effective for gynecologic oncology when performed by trained specialists, though more research is still needed.
1. Cesarean scar pregnancy (CSP) occurs when a gestational sac implants at the site of a previous cesarean section scar and can lead to life-threatening complications if not treated.
2. Ultrasound is the primary diagnostic tool and shows the gestational sac located in the scar without connecting to the uterine cavity.
3. Treatment options include expectant management, medical management with methotrexate, and surgical management ranging from uterine curettage to hysterectomy. The goal is to terminate the pregnancy while preserving the uterus and future fertility.
The document discusses caesarean scar defects, also known as uterine niches. It provides information on the prevalence, risk factors, clinical presentation, diagnosis, and management of this condition. Uterine niches are common, affecting up to 70% of those with a prior c-section, and are usually asymptomatic but can sometimes cause bleeding, pain, or infertility. Diagnosis involves ultrasound imaging to identify a triangular defect in the uterine scar with decreased or absent underlying muscle. Larger niches with less residual muscle are more likely to be symptomatic.
The Accuracy of Diagnostic Colposcopy using IFCPC 2011 TerminologySujoy Dasgupta
This paper was presented in the Annual Conference of Bengal Obstetric and Gynaecological Society (BOGSCON) 2014 held at ITC Sonar, Kolkata- January, 2014
This document provides an overview of intrauterine insemination (IUI). Some key points include:
IUI is a first-line, non-invasive fertility treatment that involves placing processed sperm directly into the uterus. Success rates range from 6-20% depending on the stimulation protocol used. Factors like age, infertility duration and etiology, and semen quality impact success rates. Strict monitoring is important to minimize risks of ovarian hyperstimulation syndrome while maximizing pregnancy chances. Proper sperm processing techniques and timing of insemination relative to ovulation are also important considerations for IUI.
The document is a lecture on the treatment of endometriosis-associated infertility according to 2022 ESHRE guidelines. It discusses various treatment options including medical treatment with hormonal therapies, surgery, assisted reproductive technologies (ART), and fertility preservation. Key recommendations include that ovarian suppression should not be used to improve fertility. Surgery and ART may be considered depending on the stage of endometriosis and patient factors. Extensive counseling is recommended when discussing fertility preservation options.
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) for StudentsUsama Ragab
Gestational diabetes is diabetes that develops during pregnancy. It is diagnosed either pre-existing type 1 or type 2 diabetes, or gestational diabetes diagnosed during pregnancy. Gestational diabetes screening involves a glucose challenge test between 24-28 weeks of pregnancy, or earlier for those at high risk. Treatment involves lifestyle changes like diet and exercise, and may require insulin if needed to control blood glucose levels. After delivery, women with gestational diabetes have increased risk of developing type 2 diabetes and should undergo testing to check for prediabetes or diabetes.
This document provides guidelines for screening and managing gestational diabetes mellitus (GDM) in India. It recommends universal screening for all pregnant women in India using a 75g oral glucose tolerance test between 24-28 weeks of gestation due to India's high prevalence of GDM. A diagnosis of GDM is made if the 2-hour plasma glucose level is 140 mg/dl or higher. It also recommends classifying glucose levels between 120-140 mg/dl as "decreased gestational glucose tolerance" to indicate the need for closer monitoring and treatment due to increased risks. An intensive team-based approach including diet, glucose monitoring and possible insulin treatment is outlined as the standard of care for managing GDM to improve maternal and fetal
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.
This document discusses gestational diabetes mellitus (GDM), including screening, diagnosis, management challenges, and risks. It notes that universal screening for GDM is essential for pregnant women in India due to high prevalence rates. Screening should occur at 24-28 weeks of gestation and at first booking for high risk women. A positive screening requires a 3 hour glucose tolerance test for diagnosis. Treatment involves a multidisciplinary team approach focusing on diet, glucose monitoring, education and potential insulin or oral medication. Goals are to minimize risks of complications for both mother and baby. Induction of labor may be recommended based on gestational age and glucose control. Postpartum follow up screens for diabetes and provides counseling on long term health
Screening for gestational diabetes an update by dr alka mukherjee nagpur ms i...alka mukherjee
Gestational Diabetes Mellitus (GDM) is defined as any glucose intolerance with the onset or first recognition during pregnancy. This definition helps for diagnosis of unrecognized pre-existing Diabetes also. Hyperglycemia in pregnancy is associated with adverse maternal and prenatal outcome. It is important to screen, diagnose and treat Hyperglycemia in pregnancy to prevent an adverse outcome. There is no international consensus regarding timing of screening method and the optimal cut-off points for diagnosis and intervention of GDM. DIPSI recommends non-fasting Oral Glucose Tolerance Test (OGTT) with 75g of glucose with a cut-off of ≥ 140 mg/dl after 2-hours, whereas WHO (1999) recommends a fasting OGTT after 75g glucose with a cut-off plasma glucose of ≥ 140 mg/dl after 2-hour. The recommendations by ADA/IADPSG for screening women at risk of diabetes is as follows, for first and subsequent trimester at 24-28 weeks a criteria of diagnosis of GDM is made by 75 g OGTT and fasting 5.1mmol/l, 1 hour 10.0mmol/l, 2 hour 8.5mmol/l by universal glucose tolerance testing. Critics of these criteria state that it causes over diagnosis of GDM and unnecessary interventions, the controversy however continues. The ACOG still prefer a 2 step procedure, GCT with 50g glucose non-fasting if value > 7.8mmol/l followed by 3-hour OGTT for confirmation of diagnosis. In conclusion based on Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study as mild degree of dysglycemia are associated with adverse outcome and high prevalence of Type II DM to have international consensus It recommends IADPSG criteria, though controversy exists. The IADPSG criteria is the only outcome based criteria, it has the ability to diagnose and treat GDM earlier, thereby reducing the fetal and maternal complications associated with GDM. This one step method has an advantage of simplicity in execution, more patient friendly, accurate in diagnosis and close to international consensus. Keeping in the mind the diversity and variability of Indian population, judging international criteria may not be conclusive, thus further comparative studies are required on different diagnostic criteria in relation to adverse pregnancy outcomes
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.
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.
Diabetesasia.org is your diabetes resource for asking queries, education, relating and distribution your private diabetes experience or those you care for.
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.
Gestational diabetes mellitus (GDM) is glucose intolerance that develops during pregnancy and can cause complications for both mother and fetus if not properly managed. The document discusses screening and diagnosis of GDM using a one-step approach oral glucose tolerance test, management through nutrition therapy, exercise and potentially insulin treatment, and obstetrical considerations like monitoring during labor and delivery planning. Intensive glucose control through early diagnosis and treatment can help improve outcomes.
Revised PPT GDM- clinical and nutritional perspective.pptxVidushRatan1
This document discusses gestational diabetes mellitus (GDM), including its definition, prevalence, risk factors, diagnostic criteria, complications, management, and monitoring. Some key points:
- GDM is glucose intolerance that is first recognized during pregnancy and can cause complications for both mother and baby if not properly managed.
- The prevalence of GDM is rising worldwide and varies significantly between populations, ranging from 1.4-17.9% depending on location.
- Risk factors include pre-pregnancy overweight/obesity, family history of diabetes, and certain ethnicities.
- Treatment involves medical nutrition therapy, physical activity, blood sugar monitoring, and possibly medication like metformin or insulin to control blood
This document provides information on gestational diabetes mellitus (GDM), including its definition, risk factors, pathophysiology, screening methods, complications, and management. GDM is glucose intolerance that develops during pregnancy and can cause issues for both the mother and baby if not properly managed. The key aspects discussed are:
- GDM is caused by defects in insulin secretion/action leading to abnormal carbohydrate and lipid metabolism.
- Risk factors include family history of diabetes, previous large baby, and obesity.
- Screening typically occurs between 24-28 weeks using a 75g oral glucose tolerance test.
- Complications for the mother include preeclampsia and operative delivery, while risks for
Gestational diabetes (GDM) is glucose intolerance first identified during pregnancy. Risk factors include BMI over 30, previous large or diabetic baby, family history of diabetes. GDM is identified through a 75g oral glucose tolerance test. It is associated with risks like large baby, shoulder dystocia, preeclampsia. Treatment like insulin lowers risks. Other types of diabetes may present as GDM and require identification. Mild maternal hyperglycemia increases risks incrementally without a clear threshold.
Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy and is defined as glucose intolerance that first emerges or is first recognized during pregnancy. Gestational diabetes mellitus (GDM) affects between 2% and 5% of pregnant women. Data show that increasing levels of plasma glucose are associated with birth weight above the 90th percentile, cord blood serum C-peptide level above the 90th percentile, and, to a lesser degree, primary cesarean deliveries and neonatal hypoglycemia
This document discusses diabetes in pregnancy, including gestational diabetes and pre-existing diabetes. It provides details on screening and managing gestational diabetes through medical nutrition therapy, exercise, glucose monitoring, and insulin or oral hypoglycemic agents if needed. It also discusses fetal surveillance, delivery planning, neonatal care, and postpartum management and follow-up. Case examples are presented to illustrate how these guidelines would be applied. The key aspects of managing diabetes in pregnancy are screening, glycemic control through lifestyle and medical interventions, close fetal and maternal monitoring, and delivery planning tailored to each woman's risk factors and disease status.
This document discusses gestational diabetes and gestational hypertension. It begins by defining the two conditions and describing their pathophysiology. It then covers screening and diagnosis of gestational diabetes, including risk factors, diagnostic testing guidelines from different organizations, and treatment targets. Treatment involves nutritional therapy, glucose monitoring, and insulin if needed to control blood glucose levels and prevent complications.
This document discusses diabetes in pregnancy, including gestational diabetes. It defines pre-existing diabetes and gestational diabetes, and describes screening and diagnostic criteria. The pathophysiology of gestational diabetes is explained. Treatment involves medical nutrition therapy, physical activity, blood glucose monitoring, and possibly insulin. Close fetal monitoring is also recommended. The goals are to control blood sugar levels to reduce risks to both mother and baby.
3-5% of pregnant women have glucose intolerance, with 90% having gestational diabetes. Pregnancy increases insulin resistance and if a woman's pancreas cannot sufficiently increase insulin secretion to compensate, gestational diabetes results. Gestational diabetes resolution within 6 weeks of delivery but 50% of women will develop type 2 diabetes later in life. Screening involves a glucose challenge test between 24-28 weeks, followed by a glucose tolerance test if thresholds are met to diagnose gestational diabetes. Management focuses on diet, exercise, blood glucose monitoring and possibly insulin to control blood sugar and minimize risks of complications for both mother and baby.
This document discusses gestational diabetes mellitus (GDM), including its definition, types, risk factors, screening recommendations, and pathophysiology. GDM is a type of diabetes that develops during pregnancy and usually resolves after giving birth. However, women with GDM and their babies are at higher risk for developing type 2 diabetes later in life. The document recommends screening all pregnant women for GDM between 24-28 weeks of gestation using a 75g oral glucose tolerance test. A diagnosis of GDM is made if one plasma glucose value meets or exceeds the threshold.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
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Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
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• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
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2. Learning Objectives
• Learn about the different screening & diagnostic
protocols for GDM
• Appreciate the differences between GDM and
pre-existing diabetes in pregnancy and their impact
2
Slide
4. SCREENING FOR GDM
Key questions:
• Why screen
• Whom to screen
• When to screen
• How to screen
4
Slide
5. SCREENING FOR GDM
Why screen?
• High prevalence of GDM and diabetes in India
• Early diagnosis & treatment improves fetal and maternal
outcomes
• Risk reduction for future maternal diabetes
• Risk identification for diabetes in offspring
• Reduction of trans - generational transmission of diabetes
5
Slide
6. Case Study 1
Mrs. S is a 35 year old nulliparous lady with a bad obstetric history, having
had two miscarriages in the last three years.
She has never tested her blood glucose levels during either of her previous
pregnancies.
Her mother has diabetes.
• Does she need to be screened for diabetes?
• If so, when?
• What screening test is to be used?
6
Slide
7. Case Study 2
Mrs. A is a 22 year old primigravida coming for her first antenatal checkup
at 12 weeks of gestation.
On examination, she is 152 cm tall and weighs 54 kg. Her BMI is 23.3 kg/m2.
She does not have a family history of diabetes.
• Does she need to be screened for diabetes?
• If so, when?
• What screening test is to be used?
7
Slide
8. SCREENING FOR GDM
Whom to screen?
• Selective screening
• Universal screening
8
Slide
Contd…
9. SCREENING FOR GDM
High Risk Approach
The ADA recommends that women “at low risk” for GDM need not be
screened i.e.
Age <25 years
Normal weight before pregnancy
Member of ethnic group with low diabetes prevalence
No diabetes in first degree relatives
No history of abnormal glucose tolerance
No history of poor obstetric outcome
However, the guideline also appreciates that very few women will fall into
this category
9
Slide
Contd…
10. SCREENING FOR GDM
Universal Approach
Asian Indians are a high risk ethnic group for development of
diabetes.
Hence all pregnant Indian women need to be screened for GDM
DIPSI Guidelines, J Assoc Physicians India, 2006
10
Contd…
Slide
This is consistent with the Indian National Guidelines
11. SCREENING FOR GDM
When to screen
• GDM usually develops during late pregnancy (after the first
trimester)
• However, if screening is delayed till that time, there is a
chance that pre-existing diabetes may be missed
• Therefore it is ideal to perform the first screening as early as
possible (during the first antenatal checkup)
11
Slide
Contd…
12. SCREENING FOR GDM
When to screen
• ADA- as early as possible in pregnancy; if negative, retest
between 24 to 28 weeks
• DIPSI - first screening at the first visit (if negative repeat
at 24 to 28 weeks and then at 32 to 34 weeks)
12
Slide
Contd…
13. SCREENING FOR GDM
What test to use?
The 75 g oral glucose tolerance test (OGTT) is the gold
standard for screening and diagnosis of GDM and has
gained international acceptance.
13
Slide
Contd…
15. DIAGNOSIS OF GDM
• There are no universally accepted diagnostic criteria for GDM
• Traditionally, the criteria put forward by Carpenter and
Coustan (modified O’Sullivan - Mahan criteria) and WHO
(1999) have been used
• Based on the results of the Hyperglycemia and Adverse
Pregnancy Outcomes (HAPO) study, the International
Association of Diabetes in Pregnancy Study Groups (IADPSG)
has published guidelines on diagnosis of GDM, which are
outcome based and have gained widespread acceptance
15
Slide
16. IADPSG GUIDELINES
Two Components
1. Detection of overt, hitherto undiagnosed diabetes during
early pregnancy using accepted clinical criteria
2. Diagnosis of GDM in later pregnancy using OGTT
16
Slide
17. IADPSG GUIDELINES
1. Detection of Overt Diabetes
• To be performed at the initial antenatal visit
• FPG, HbA1c or random glucose can be used
• If results suggestive of overt diabetes (FPG ≥ 126 mg/dl;
HbA1c ≥ 6.5% or random glucose≥200 mg/dl with symptoms
of hyperglycemia), start treatment
• If results not suggestive of overt diabetes
And FPG between 92 and 125 mg/dl, diagnose GDM
And FPG <92 mg/dl, repeat screening at 24 to 28 weeks
IADPSG, Diabetes Care, 2010
17
Slide
18. IADPSG GUIDELINES
2. Screening for GDM
• Performed at 24 to 28 weeks of gestation
• 75 g, two hour OGTT used
• If FPG ≥ 126 mg/dl, overt diabetes is diagnosed
• If FPG <126 mg/dl, GDM is diagnosed if any one of the
values exceeds the thresholds shown below
Fasting 1 hour 2 hour
Plasma Glucose
(mg/dl)
≥92 ≥180 ≥153
IADPSG, Diabetes Care, 2010
18
Slide
The WHO recommends that the diagnosis of pre-existing (overt)
diabetes can be made if the 2-hour value is ≥200 mg/dl
WHO, 2019
19. Case Study 3
Mrs. K, a 24 year old primigravida, is screened for diabetes during the
15th week of gestation.
Her results are as follows.
Fasting plasma glucose= 79 mg/dl
HbA1c= 4.9%
• Does she have diabetes?
• Does she need to be retested for diabetes?
• If so, when and using what test?
19
Slide
20. Case Study 3 (Cont.)
Mrs. K undergoes an OGTT with 75 g of glucose at 25 weeks’ gestation.
Her results are as follows.
What is the diagnosis?
Time 0 hr (Fasting) 1 hour 2 hour
Glucose (mg/dl) 90 176 159
20
Slide
21. DIAGNOSIS OF GDM
Merit of IADPSG Guidelines
As of today, IADPSG criteria are the only guidelines based on
pregnancy outcome data as revealed by the HAPO study
So let’s look at the outcome data now.
21
Slide
22. THE HAPO STUDY
• Looked at whether maternal hyperglycemia less severe than
that diagnostic of diabetes mellitus was associated with
adverse pregnancy outcomes
• Studied >25,000 pregnant women from 9 countries from 24 to
32 weeks onwards
• Women with glucose levels not suggestive of diabetes by
OGTT were included
The HAPO Study Cooperative Research Group, N Engl J Med, 2008
22
Slide
23. THE HAPO STUDY
Results
There was a continuous strong association between maternal
glucose levels below those diagnostic of diabetes and adverse
outcomes
23
Slide
24. THE HAPO STUDY Results
The HAPO Study Cooperative Research Group , N Engl J Med, 2008
24
Slide
25. IADPSG GUIDELINES
Pros and Cons
Pros
• The first guideline to be developed based on pregnancy outcomes
Cons
• Only one abnormal value is required for diagnosis. This may lead to
overdiagnosis of GDM mainly due to low plasma fasting glucose cut
off of 92 mg/dl
• May be difficult to perform three blood samples in resource poor
settings like India.
25
Slide
26. IADPSG GUIDELINES-Present Status
These guidelines have been accepted by
• American Diabetes Association
• World Health Organisation
• Endocrine Society
• Australian Diabetes in Pregnancy Society (ADIPS) and
• International Federation of Gynecology and Obstetrics (FIGO)
26
Slide
27. DIAGNOSIS OF GDM
The DIPSI Criteria
• 75 g glucose load
• Sample collected at 2 hours
• A value of ≥ 140 mg/dl is diagnostic of GDM
Seshiah V, J Assoc Physicians India, 2007
27
Slide
The DIPSI guidelines state that the OGTT can also be
administered in the non-fasting state. However, recent studies
have shown conflicting results on its sensitivity and specificity
vis-à-vis the fasting OGTT
Mohan et al, Acta Diabetol, 2015
Vij et al, Int J Diabetes Dev Ctries, 2015
Herath et al, Int Archiv Med, 2015
28. Case Study 4
Diagnosis of GDM using DIPSI criteria
Mrs. C, a 25 year old primigravida, underwent a screening oral glucose
tolerance test (OGTT) with 75 g glucose at 14 weeks’ gestation.
Her results are as follows.
• Does she have diabetes?
• Does she need to be tested again?
• If so, when?
Time 0 hr (Fasting) 2 hour
Glucose (mg/dl) 86 137
28
Slide
29. Case Study 4 (Cont.)
Diagnosis of GDM using DIPSI criteria
Mrs. C undergoes repeat testing at 26 weeks’ gestation.
Her results are as follows.
Does she have GDM?
Time 0 hr (Fasting) 2 hour
Glucose (mg/dl) 88 161
29
Slide
30. PROPOSED GUIDELINES FOR SCREENING FOR GDM
IN INDIA
Source : Modified from Mohan V, Usha
S, Uma R. J Postgrad Med
2015;61:151-4
Slide 30
or
31. • Ideally, and whenever feasible, a single step 75g OGTT using
the IADPSG criteria should be done in the fasting state
• However, in resource limited settings, especially in the rural
areas of developing countries where getting all pregnant
women to come in a fasting state may be difficult, 75g DIPSI
criteria in the non-fasting state can be utilised. Clinicians
should be aware that the sensitivity of this test has not been
unequivocally proven and therefore there is a risk of women
with GDM being missed out
CONCLUSIONS REGARDING SCREENING
FOR GDM
Slide 31
33. Case Study 5
Mrs. C, a 32 year old primigravida, reports for the first antenatal checkup.
She is obese with a body mass index of 35 kg/m2. Both her parents have
diabetes.
Her fasting plasma glucose is 192 mg/dl.
Her HbA1c is 9.2%.
• What type of diabetes does this patient have?
• What is the prognosis for the pregnancy and for future resolution of
diabetes?
33
Slide
34. PRE-EXISTING DIABETES
AND PREGNANCY
• Clinically distinct from GDM
• Type 2 diabetes complicating pregnancy is becoming
more frequent nowadays, due to younger age of onset of
type 2 diabetes in India
• Women with long duration of pre-existing diabetes may
have damaged vasculature even before they become
pregnant
34
Slide
35. IMPLICATIONS OF PRE-EXISTING DIABETES
The Concept of Fuel Mediated Teratogenesis
Preconceptional diabetes (of any type) has more serious implications for
the fetus than GDM, since the former can influence fetal development
periconceptionally as well as throughout pregnancy
35
Slide
Modified from Freinkel, Diabetes, 1980
36. CONGENITAL MALFORMATIONS
Possible Etiologies
• Both environmental and genetic factors are implicated
• The main maternal teratogenic factors are hyperglycemia and
hyperketonemia
36
Slide
38. CONGENITAL MALFORMATIONS
38
Slide
Gastrointestinal system
• Duodenal atresia
• Anorectal atresia
Musculoskeletal system
• Arthrogryposis
• Hypoplastic femur
Functional
• Intraventricular septal hypertrophy
• Small left colon syndrome
While Neural Tube Defects (NTDs) are the commonest congenital anomaly in
Infants of diabetic mothers, they are not specific for diabetes. The most specific
anomaly is sacral agenesis (Caudal regression syndrome), but this is rare
40. Malformation Ratio of incidence (Diabetic vs control)
Caudal regression 252
Situs inversus 84
Ureter duplex 23
Renal agenesis 5
Cystic kidney 4
Cardiac anomalies 4
Anal/ rectal atresia 3
Anencephaly 3
Spina bifida and other CNS anomalies 2
CONGENITAL MALFORMATIONS IN INFANTS OF DIABETIC MOTHERS
Gardner DG, Shoback D (eds). Greenspan’s Basic and Clinical Endocrinology, 10th edn, 2018
40
Slide
41. NEURAL TUBE DEFECTS
Most common but nonspecific manifestation of diabetic embryopathy; routine
periconceptional folate supplementation of pregnant women has drastically reduced the
incidence in non-diabetic pregnancies but its benefits in diabetes are not as clear.
Nevertheless, all pregnant women with diabetes should be advised folate
supplementation
41
Slide
Pic courtesy: Dr. V. K. Abichandani, Ahmedabad
42. SACRAL AGENESIS
(CAUDAL REGRESSION SYNDROME)
Most specific but rare manifestation of diabetic embryopathy
Plain x-ray pelvis showing absence
of sacral segments (arrow)
Shortened spine with absence
of sacral segments
42
Slide
43. SACRAL AGENESIS
(CAUDAL REGRESSION SYNDROME)
Fetus expelled at 14 weeks showing absence of sacrum and lumbar spine
Pics courtesy Drs. P. Suresh Kumar and Jeena Baburaj, Calicut
43
Slide
44. STRUCTURAL ANOMALIES AND PERICONCEPTIONAL HbA1C
44
Slide
Guerin A et al, Diabetes Care, 2007
• High HbA1c is not an indication in itself for terminating the pregnancy
• The pregnancy and neonatal risks associated with high HbA1c should be discussed
and proper counseling offered
45. CONGENITAL MALFORMATIONS
• In pre- existing diabetes, congenital malformations remain a
major cause for pregnancy loss*
• Severe malformations cause early pregnancy loss
• Fetal metabolic acidosis with or without hypoxemia is an
additional factor in late fetal loss**
45
Slide
*Rackham et al, Postgrad Med J, 2009
**Silver et al, Am J Obstetr Gynecol, 2007
46. MATERNAL DIABETES COMPLICATIONS
Diabetic Retinopathy
• Diabetic retinopathy can worsen during pregnancy
• Postulated mechanisms include alterations in levels of hormones
like HPL, estrogen and progesterone, increased cardiac output
leading to increased retinal blood flow and concomitant
hypertension
• Improvement of glycemic control before or during pregnancy can
paradoxically worsen retinopathy
• Some authors have noted a correlation between severity of
retinopathy and adverse perinatal outcomes*
*Klein et al, J Diabet Complications, 1988
46
Slide
Contd…
47. DIABETIC RETINOPATHY IN PREGNANCY
Retinal photographs showing worsening of retinopathy following
pregnancy in a woman with type 1 diabetes
47
Slide
48. MATERNAL DIABETES COMPLICATIONS
Diabetic Retinopathy
Risk factors for worsening of retinopathy include
• Non-modifiable
Duration of diabetes
Severity of retinopathy prior to pregnancy
Poor glycemic control before conception
• Modifiable
Chronic or pregnancy induced hypertension
Rapid normalisation of blood glucose
Anemia
48
Slide
Contd…
49. • If retinopathy is present prior to pregnancy, it needs to be
frequently monitored throughout the pregnancy
• If sight threatening retinopathy is present, laser
photocoagulation or other treatment should be
completed before or early in the pregnancy.
MATERNAL DIABETES COMPLICATIONS
Diabetic Retinopathy
49
Slide
50. MATERNAL DIABETES COMPLICATIONS
Diabetic Nephropathy
• In women with reduced creatinine clearance, there is an
increased risk of deterioration of renal function during
pregnancy
• Pregnancy does not accelerate deterioration in renal function
in women with normal creatinine clearance
50
Slide
Contd…
51. MATERNAL DIABETES COMPLICATIONS
Diabetic Nephropathy
Diabetic nephropathy can significantly affect pregnancy outcome
due to
• Increased risk of maternal hypertensive complications
• Increased risk of preterm delivery due to deteriorating
maternal BP and pre-eclampsia
• Increased risk of fetal growth restriction and fetal distress due
to placental insufficiency
51
Slide
52. TAKE HOME MESSAGES
• All pregnant women in India should be screened for diabetes
• First screening should take place at the first antenatal visit
• Pre-existing diabetes in a pregnant woman has more serious
implications than GDM, both for the mother as well as the
fetus
• There are a number of screening and diagnostic criteria for
GDM; depending on the clinical setting and the availability of
resources, the appropriate criteria may be used.
52
Slide
53. • Wherever possible IADPSG criteria should be used to
diagnose GDM
• However, in situations where all pregnant women cannot
be referred in the fasting state for a diagnostic OGTT, the
DIPSI non-fasting test can be done.
TAKE HOME MESSAGES
53
Slide
54. The Oral Glucose Tolerance Test (OGTT)
Standard Procedure (Modified form WHO, 1999)
• Test preceded by > days of normal, unrestricted diet (>150 g
carbohydrate daily) with normal physical activity.
• Carbohydrate-rich meal (30-50 g) on night before test.
• Overnight fast of 8-14 hours; only water may be ingested
• Record any factors that may affect interpretation of test, such
as medication, inactivity, infection, gestation of pregnancy,
acute psychological stress, etc.
54
Slide
55. The Oral Glucose Tolerance Test (OGTT)
Standard Procedure (Modified form WHO, 1999)
• Collect fasting (and all other) samples in tube that permits measurement
of plasma glucose (e.g. sodium fluoride tube).
• Timing of test (0 hours) starts at beginning of glucose drink.
• Adults ingest 75 g anhydrous glucose (100 g in case of the Carpenter -
Coustan OGTT) or 82.5 g of glucose monohydrate in 250-300 ml water
over 5 minutes.
• No smoking during test.
• Take blood sample at 1 and 2 hours (in case IADPSG criteria are being
used) or at 1, 2 and 3 hours (if Carpenter- Coustan criteria are used)
55
Slide
56. The Oral Glucose Tolerance Test (OGTT)
Standard Procedure (Modified form WHO, 1999)
• Ideally take sample from warmed vein on back of hand (antecubital fossa
samples may be artificially lower).
• An indwelling butterfly or conventional cannula can be left in situ
throughout the test (affix in place and dress); flush with saline after taking
fasting sample, then draw at least 10 ml and discard before drawing
sample for assay tube.
• Glucose should be measured immediately after collection by near-patient
testing or, if a blood sample for a laboratory is collected, plasma should be
immediately separated, or the sample should be collected into a container
with glycolytic inhibitors and placed in ice-water until separated prior to
analysis.
56
Slide
The suggested algorithm for GDM screening in India are very similar to the IADPSG guidelines. However, in view of the high risk of GDM in Indian women, a third screen may be recommended at 32 weeks for women deemed to be at particularly high risk, as suggested by Seshiah et al.
If a two-step approach is adopted, use of the well-validated 50 g glucose challenge test is preferable as the first step.
Potential long-range effects upon the fetus of altered Interactions in maternal fuels during pregnancy. Fuel-mediated teratogenesis as the basis for long-range anatomic and functional changes. Modified from Freinkel N. Diabetes, 1980
Most of the congenital malformations would already have occurred by the time the woman realises she is pregnant.
Hence the importance of pre-conception counselling and achievement of good glycemic control prior to conception