Gestational Diabetes
By
Dr/ Mervat Mostafa Abd-El Monem
Definition of gestational diabetes:
- Gestational Diabetes is a type of diabetes, or high blood
sugar, that occurs in pregnant women who have never had
Risk factors of GDM:
Maternal age above 35 years
Overweight (Obesity)
History of gestational diabetes
Family history of type 2 diabetes
Polycystic ovarian syndrome.
Why isn't insulin doing its job?
The placenta is a system of vessels that passes nutrients,
blood, and water from mother to fetus.
The placenta makes certain hormones that may prevent
insulin from working the way that it should.
When this condition happens, it is referred to as insulin
resistance.
In order to keep metabolism normal during pregnancy, the
body has to make three times more insulin than normal to
offset the hormones made by the placenta.
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Elevated
Diabetes Mellitus “ Type 1 “ In control
Signs & Symptoms:
- Polyuria ( ↑ urination )
- Polydipsia ( ↑ thirst ) Non Diabetic
- Polyphagia ( ↑ hunger )
- Weight loss
- Fatigue
- ↑ Frequency of infection
Average blood glucose (mg/di)
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Effect of Pregnancy on Diabetes:
Pregnancy is diabetogenic due to increased production of
human placental lactogen, placental insulinase , cortisol
and progesterone.
Insulin requirements increases during pregnancy due to
increased production of placental hormones while it
decreases postpartum.
Effects of pregnancy on diabetes:-
1- Maternal complications:
During pregnancy:
- Preeclampsia
- Infections : vulvo-vaginitis , urinary tract infections
- Placenta previa: due to large placenta
During labor:
- Prolonged and obstructed labor due to large sized baby.
- Shoulder dystocia
- Birth canal injuries
During puerperium:
- puerperal sepsis
- PPH. Shoulder Dystocia
- Breast infection and lactation failure.
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2- Fetal complications:
Abortions.
Polyhydramnios: due to large placenta and fetal size.
Congenital anomalies: due to uncontrolled diabetes during
fetal organogenesis.
Preterm labor: with its complications (RDS).
Intrauterine fetal death: especially in the last 4 weeks
due to: ketosis, hypoglycaemia, pre-eclampsia, congenital
anomalies, and placental insufficiency
Macrosomia:
Fetal weight > 4 kg at term: due to maternal
hyperglycemia.
Fetal hyperglycemia and Fetal hyperinsulinemia
- ( insulin is growth hormone resulting in deposition
glycogen, fats )
Gestational Diabetes:-
Assessment of gestational diabetes
History
Examination
Investigation
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History:
- Previous GDM
- Family history of diabetes
- Preeclampsia
- Polyhydramnos
- Abortion
- Preterm labor
- Delivery of large baby
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
Antenatal care:
Women should be seen at a combined antenatal and
diabetic clinic
Frequent antenatal visits: for maternal and fetal follow up
Diet: restriction of carbohydrates, less fat and more
proteins and vitamins.
Exercises
Insulin therapy
Oral hypoglycemics are contraindicated during pregnancy ,
labor and early puerperium as they are not adequate for
controlling diabetes, have teratogenic effects and may
result in neonatal hypoglycemia.
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Management
Blood glucose testing
Medical Nutrition Therapy ( diet )
Medication / insulin
Exercise
Antepartum testing
Keeping blood sugar level under control
Keep daily records of your diet, physical activity, and
glucose levels
Keep track of the following:
- Blood sugar level
- Food
- Physical wellness
- Physical activity
- Weight gain
Management of Labor and delivery:
1- Timing: pregnancy is terminated at 37 completed weeks to
avoid intrauterine fetal death.
2- Mode of delivery: vaginal delivery is induced in normal
presentation, favorable cervix, average sized baby and
no fetal distress. Otherwise, caesarean section is indicated.
3- Monitor fetal condition throughout the labor
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Neonatal care:
The neonate is managed as a premature baby as it is more
liable for RDS.
Newbornshouldbeexaminedcarefully for congenital
abnormality.
The baby should be fed soon after delivery to prevent
hypoglycemia as the baby continues to produce insulin
than he needs. (to avoid brain damage)
Post-natal care:
Carbohydrate metabolism returns to normal within 24
hours after delivery and insulin requirements will fall
rapidly.
Careful observation for PPH
Diabetic mother is liable to infection: advice her, to change
her pads frequently keeps any wound clean and dry.
Contraception
Barrier methods ( condom and diaphragm ) The best
combined hormonal contraceptive pills, Contraindicated
- increases hyperglycemia
Progestin only pills can be used
- as it not cause metabolic changes
the intra uterine device (IUD)
- increase risk of pelvic infection
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Gestational Diabetes Mellitus:
- It is diagnosed for the first time when a woman is
pregnant.
Risk Factors:
- Overweight
- Glucose in urine
- Family history of dabeles
- if you had gestational diabedia before
Symptoms
- Increasod thirst
- increasod urinatonation
- Larger than normal baby during pregnancy
How It Will Affect Baby ?
- Born very large and with extra fat
- Low blood glucose right after birth
- Breathing problems
How Is Gestational Diabetes Treated ?
- Healthy diet
- Exercise
- Monitor blood glucose
- Patient education after delivery regarding weight loss
exercise to prevent future diabetes
اسألكم الدعاء لزميلكم أسامة نبيل بالتوفيق والنجاح
