Diabetes in pregnancy_presentation 101.pptx

Diabetes in pregnancy _ preexisting diabetes and gestational diabetes mellitus

1. DIABETES IN PREGNANCY P resented by: Midha Amer 72 Samra Ejaz 88

2. 2 During pregnancy, there is a state called DIABETOGENIC STATE, peak at 28-32w Due to ↑ hormone produced by placenta : HPL, CORTISOL (insulin antagonist) → relative insulin resistance Glucose crosses the placenta by facilitated diffusion & fetal blood glucose level closely follow the maternal level PATHOPHYSIOLOGY

3. Risk factors Marked obesity BMI>30kg/m2 Age >25 Prior GDM Glycosuria BMI>30kg/m2 Polycystic ovarian syndrome Essential hypertension or pregnancy-related hypertension history of spontaneous abortions and unexplained stillbirths strong family history of diabetes (especially in first-degree relatives)

4. In Pre existing Diabetes type 1 or 2 PRE PREGNANCY COUNSELLING is done Aim is to achieve best possible glycemic control before pregnancy and to educate diabetic woman and family. Includes; HbA1c of <6.5g/dl as higher is associated with risk of fetal anomalies and early fetal loss High dose of folic acid of 5mg to reduce risk of NTD Since first 42 days are important for organogenesis glycemic control will reduce risk of congenital abnormalities. i.e.>100mg/dl

5. Clinical presentation Polyuria Polydipsia Polyphagia Nausea & Vomiting Tiredness & Fatigue Yeast infection frequently After Baseline investigation, we will proceed towards Management.

6. Management • Multidisciplinary team including diabetic specialist obstetrician dietician nurses and midwives • Blood glucose should be monitored 7 times a day i.e , before and 1 hour after every meal • Oral hypoglycemic such as metformin and insulin dosage is adjusted • Insulin resistance increases during course of pregnancy so dosage is increased accordingly

7. Pregnancy plan 1 st trimester Maternal renal and retinal screening Scan for dating Insulin doc Metformin Dietary modifications 2 nd trimester Maternal serum AFP 16-20 weeks USG 18-22 weeks Fetal anomaly scan 19-20 weeks 3 rd trimester fetal growth monitoring and medication

8. Plan of delivery The aim is to achieve normal vaginal birth at 38-39 weeks if there are no complications If there is Maternal hyperglycemia in labor or pre eclempsia patient is managed accordingly If baby is >4kg we will go for elective cesarian section Women should be informed of increased risk of hypoglycemia in post natal period particularly during breastfeeding

9. Neonatal management Call to pediatrician is given As insulin suppresses steroid production , RDS should be ruled out Neonatal hypoglycemia and hypothermia should be ruled out

10. Puerperium Antibiotics Insulin Blood glucose monitoring Breast Feeding Care of baby contraception(IUCD) and follow up

11. GDM is defined as glucose intolerance first time during pregnancy. Usually occurs during 2 nd and 3 rd trimester and resolves after birth. GESTATIONAL DIABETES MELLITUS

12. SCREENING AND DIAGNOSIS Oral glucose tolerance test OGTT Glucose challenge test

13. For GDM Universal screening is done at 1 st visit and repeat at 24-28 weeks. If random blood sugar is >200mg/dl overt diabetes mellitus >140mg/dl GDM Oral glucose tolerance test 75g two hour OGTT is used. GDM is diagnosed if any one value exceeds the thresholds shown below. fasting 1hr 2hr Plasma glucose ≥92 ≥180 ≥153 (mg/dl) -

14. Management pan Multidisciplinary approach Treatment plan include oral hypoglycemic and regular insulin administration Complications and plan of delivery is same as that of overt diabetes Screening with fasting glucose or HbA1C should be offered 6-13 weeks after childbirth

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