Diabetes in pregnancy

Sujata Sahu
Msc Tutor

1. DIABETES IN PREGNANCY PRESENTED BY SUJATA SAHU MSC TUTOR

2. Introduction DM is a chronic metabolic disorder due to either insulin deficiency or either peripheral tissue resistance to the action of insulin .

3. Cont…. Pathophysiology involved are: Decreased sensitivity of skeletal muscles & liver to insulin Inadequate secretion of insulin This is associated with increased circulating levels of C- reactive protein & interleukin-6. Both these factors enhance insulin resistance. The defect lies both in insulin secretion & action.

4. Types of diabetes Type-1 (IDDM) Type-2 (NIDDM) GDM Other : Genetic, Drugs, Mody (maturity onset diabetes of the youth) is due to BETA cell dysfunction

5. GESTATIONAL DIABETES MALLITUS Gestational diabetes is defined as carbohydrate intolerance of variable severity with onset or first recognition during the present pregnancy. GDM  is a condition in which a woman without diabetes develops high blood sugar levels during  pregnancy

6. GESTATIONAL DIABETES MALLITUS A woman is diagnosed with gestational diabetes when glucose intolerance continues beyond 24 to 28 weeks of gestation

7. Risk factor Obesity Family history Have had GDM before Have high blood pressure or other medical complications Have given birth to a large baby (weight >4 kg)

8. Risk factor Have given birth to a baby who was stillborn or had certain birth defects Age > 30 years Ethnic group- Are African-American, Asian, Hispanic, or Native American

9. Investigation If blood glucose level is higher than 140 mg/ dL (7.8 mmol /L) after the one-hour test, doctor will recommend the three-hour test. If blood glucose level is higher than 190 mg/ dL (10.6 mmol /L) after the one-hour test, it ' ll be diagnosed with gestational diabetes.

10. Investigation For the three-hour test: A normal fasting blood glucose level is lower than 95 mg/ dL (5.3 mmol /L). One hour after drinking the glucose solution, a normal blood glucose level is lower than 180 mg/ dL (10 mmol /L).

11. Investigation Two hours after drinking the glucose solution, a normal blood glucose level is lower than 155 mg/ dL (8.6 mmol /L). Three hours after drinking the glucose solution, a normal blood glucose level is lower than 140 mg/ dL (7.8 mmol /L).

12. Investigation If one of the results is higher than normal, it ' ll likely need to test again in four weeks. If two or more of the results are higher than normal, diagnosed with GDM.

13. Treatment Check  blood sugar levels four or more times a day Frequent antenatal supervision Periodic check up FBS should be > 90 Maintain mean plasma glucose level 105mg/dl -110mg/dl for good fetal outcome .

14. Treatment The control of high glucose is done by restriction of diet, exercise with or without insulin. Insulin start if FBS>90 mg/dl & PPBS > 120mg/dl even on diet control.

15. Treatment Exercise Exercise is safe in Pregnancy are as: Aerobic exercise Brisk exercise

16. Treatment Diet Recommend 2000-2500kcal/day for normal weight woman Restriction to 1200-1800 kcal/day for over weight woman Carbohydrate should be 40 %-50% of total calories. Complex carbohydrate are preferred ( peas, beans, whole grains, and vegetables).

17. Obstetric management Spontaneous labour. If good glycemic control & who don’t require insulin. Elective delivery (induction of labour or CS) If patient is taking insulin or with complication ( macrosomia ) at 38 weeks.

18. Complications of Gestational Diabetes Fetal Complications Excessive birth weight. Early (preterm) birth.  Serious breathing difficulties Low blood sugar (hypoglycemia) Obesity and type 2 diabetes later in life Stillbirth. Serious breathing difficulties.  Low blood sugar (hypoglycemia).

19. Maternal Complications High blood pressure and preeclampsia.  Having a surgical delivery (C-section).  Future diabetes.  Take these simple steps to hold off gestational diabetes:

20. Prevention of Gestational Diabetes Eat healthy foods . Choose foods high in fiber and low in fat and calories. Focus on fruits, vegetables and whole grains. .

21. Prevention of Gestational Diabetes Keep active .  Exercising before and during pregnancy can help protect you from developing gestational diabetes. Aim for 30 minutes of moderate activity on most days of the week. Take a brisk daily walk.  

22. Prevention of Gestational Diabetes Start pregnancy at a healthy weight.   If some one are planning to get pregnant, losing extra weight beforehand may help have a healthier pregnancy. Focus on making lasting changes to eating habits that can help through pregnancy, such as eating more vegetables and fruits.  

23. Prevention of Gestational Diabetes Don't gain more weight than recommended .  Gaining some weight during pregnancy is normal and healthy. But gaining too much weight too quickly can risk of gestational diabetes.