DR. Maheen Asad.Regional Medical Officer, Apollo.

This diagnosis is given when a woman, who has never had diabetes before, gets diabetes or has high blood sugar, when she is pregnant.

Its medical name is gestational diabetes mellitus or GDM.

It is one of the most common health problems for pregnant women.

The word “gestational” actually refers to “during pregnancy.”

gdm4 of 42

It occurs in about 5% of all pregnancies.

If not treated, gestational diabetes can cause health problems for the mother and the fetus.

gdmkvr

Risk Factors maternal age >25 Family history glucosuria prior macrosomia previous unexplained stillbirth ethnic group: Hispanic, Black, Asians

For most women, the body’s extra insulin is enough to keep their blood sugar levels in the healthy range.

But, for about 5% of pregnant women, even the extra insulin is not enough to keep blood sugar levels normal.

These women end up with high blood sugar or gestational diabetes at around the 20th to 24th week of pregnancy.

gdm10

Screening

◦24-28 weeks routine◦no need to fast◦screen at 1st prenatal visit if hx of previous

GDM◦screen earlier (12-24 weeks ) if risk factors

MATERNAL RISK

Birth trauma Preterm Labor PIH Operative delivery 50% lifetime risk in developing Type II DM Recurrence risk of GDM is 30-50%

Management Goal is to optimize BG levels to minimize risk of adverse perinatal outcomes

Diet Exercise Insulin therapy

Although your glucose levels change during the day, there is a healthy range that is normal. If your glucose level is outside of the healthy target range, speak with your health care provider.

Time of Blood Sugar

Test

Healthy Target Levels (in

mg/dl)

Fasting glucose

level

No higher than 95

One hour after eating

No higher than 140

Two hours after eating

No higher than 120

23 of 42PBRC 2006

If persistent hyperglycemia after one week of dietcontrol proceed to insulin6-14 weeks 0.5u/kg/d14-26 weeks 0.7u/kg/d26-36 weeks 0.9u/kg/d36-40weeks 1 u /kg/d

If fasting hyperglycemia start with NPHhs initial dose 6-8 U if only pc hyperglycemia use Humalog

2-4u ac the specific meal adjust 2u/time ; 1 formula /time

BG target ac <5.3 (90mg.) 2 h pc <6.7 ( 120 mg)

Time Frame Expected Weight Gain

In the first trimester of pregnancy

(the first 3 months)

Three to six pounds for the entire three

months

During the second and third trimester

(the last 6 months)

Between ½ and 1 pound each week

If you gained too much weight early in the

pregnancy

Limit weight gain to ¾ of a pound each week (3 pounds

each month) to help get your blood sugar level

under control

26 gdm

A weight gain of two pounds or more each week is

considered high.

Traditionally not recommended in pregnancy

Recent RCT of oral glyburide vs insulin for GDM 440 patients BG measured 7x daily Treatment started after 11 weeks gestation

THE END