Gestational diabetes

GESTATIONAL DIABETES

1. Metabolic conditions Any disorder that causes dysfunction of the metabolic action of the body, resulting in loss of homeostasis.

2. METABOLIC CONDITIONS 1.Diabetes Mellitus 2. Hypothyroidism 3. Hyperthyroidism 4. Phenylketonuria

3. Diabetes mellitus (DM) is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both. diabetes mellitus in pregnancy

4. types

5. Gestational diabetes is a carbohydrate intolerance of variable severity that starts or is first recognized during pregnancy or the inability of the tissues to absorb glucose from the bloodstream during pregnancy due to a lack of the hormone insulin.

6. Overt diabetes A patient with symptoms of diabetes mellitus & causal plasma glucose concentration 200mg/dl or more

7. 1. Older maternal age. 2.Family history of Type-2 diabetes. 3. Obesity in the women. 4. Poor obstetric history. 5.The presence of a birth defect in previous pregnancy.

8. 6.Gestational diabetes in previous pregnancy. 7 . A previous delivery of a large baby. 8. Wrong eating habits during pregnancy. 9 . Previous still-birth or spontaneous miscarriage. 10.A history of pregnancy induced UTI,HTN etc.

9. Non-challenge blood glucose tests Fasting glucose test 2-hour postprandial (after a meal) glucose test Oral glucose tolerance test (OGTT)

10. Non-challenge blood glucose tests involve measuring glucose levels in blood samples without challenging the subject with glucose solutions.

11. Fasting and 2 hours postprandial venous plasma sugar during pregnancy. Border line indicates glucose tolerance test. 125-200 mg/dl. 100-125 mg/dl Diabetic >200 mg/ dl. >125 mg/ dl Not diabetic < 145mg/ dl. <100 mg/dl Result 2h postprandial Fasting

12. Oral glucose tolerance test (OGTT) 50g oral glucose challenge test: A value of 140mg/dl(7.8mmol/l)or higher will identify 80% of all women with gestational diabetes The test involves drinking a solution containing a certain amount of glucose, and drawing blood to measure glucose levels at the start and on set time intervals thereafter.

13. American college of Obstetricians and Gynecologists 1994 Criteria for Diagnosis of GestationalDiabetes Using 100g of Glucose Taken Orally Timing of Measurement Plasma Glucose National diabetes Data Group(1979) Carpenter and Coustan (1982) Fasting 105mg/dl(5.6mmol/l) 95 1hour 190mg/dl(10.5mmol/l) 180 2hour 165mg/dl(9.2mmol/l) 155 3hour 145mg/dl(8.0mmol/l) 140

14. For Mother : During pregnancy 1) Hypertension: High blood glucose levels can cause high blood pressure. 2)Pre- eclampsia: If high blood pressure becomes severe, pre- eclampsia may develop. 3) Increased chances for developing Type-2 diabetes.

15. DURING LABOUR Prolongation of labour due to big baby Shoulder dystocia Perineal injuries Operative interference DURING PUERPERIUM Puerperal sepsis Lactation failure

16. For Baby: 1) Macrosomia 2) Jaundice 3) Still-birth 4)Die in infancy

17. Respiratory Distress Syndrome 6) Neonatal Hypoglycemia Low blood Calcium Shoulder dystocia

18. MANAGEMENT Pre-conception counseling- To achieve tight control of diabetes during pregnancy

19. Antenatal Care -Diet Therapy Diet therapy is critical to successful regulation of maternal diabetes. A program consisting of three meals and several snacks is used for most patients. Dietary composition should be : 50 to 60 percent carbohydrate, 20 percent protein, 25 to 30 percent fat with less than 10 percent saturated fats, up to 10 percent polyunsaturated fatty acids.

20. antenatal Care (I)First trimester i . Careful monitoring of glucose control is essential to management ii . Diet:Total caloric intake of 30-35kcal/kg of ideal body weight

21. (II)Second trimester i.Maternal serum AFP ii.Ultrasonoscan (at 18-20w) to detect neural-tube defects and other anomalies (III)Third trimester i.Weekly visits to monitor glucose control and to evaluate for preeclampsia ii.Serial ultrasonography to evaluate fetal growth and amnionic fluid volume iii.Other fetal surveillance tests iv.Accept hospitalization from 34w until delivery

22. Insulin therapy is recommended when medical nutrition therapy fails to maintain self-monitored glucose at the following levels: Fasting whole blood glucose < 95 mg/ dL Fasting plasma glucose < 105 mg/ dL 1-hour postprandial whole blood glucose < 140 mg/ dL 1-hour postprandial plasma glucose < 155 mg/ dL 2-hour postprandial whole blood glucose < 120 mg/ dL 2-hour postprandial plasma glucose < 135 mg/ dL Insulin therapy

23. The total first dose of insulin is calculated according to the patient’s weight as follow: Insulin therapy …..cont. In the first trimester .......... weight x 0.7 In the second trimester........ weight x 0.8 In the third trimester........... weight x 0.9

24. Insulin therapy … ..cont. Twice daily (before breakfast and before dinner) injections of a combination of short and intermediate acting insulin's are usually sufficient to control most patients otherwise a subcutaneous insulin pump is used.

25. TIMING AND MODE OF DELIVERY

26. There is very little evidence to support either elective delivery or expectant management at term in pregnant women with insulin-requiring diabetes. Limited data from a single randomized controlled trial suggest that induction of labour in women with gestational diabetes treated with insulin reduces the risk of macrosomia . From The Cochrane Library, Issue 4, 2003

27. Delivery (I)Timing of delivery i.Women with gestational diabetes who do not require insulin ii.Women with gestational diabetes who require insulin iii.Overt diabetes women iv.Others

28. (II)Mode of delivery i . In general , women with GDM(who does not require insulin), the way of delivery is spontaneous labor ii. Women with sonographic diagnosis of fetal macrosomia , elective induction of labor or cesarean section to prevent shouder dystocia iii . In the overtly diabetic, cesarean delivery has commonly been used to avoid traumatic birth of a large infant, or to avoid maternal or fetal complication due to more advanced diabetes . Especially for those with vascular diseases

29. • Usual dose of intermediate-acting insulin is given at bedtime. • Morning dose of insulin is withheld. • Intravenous infusion of normal saline is begun. • Once active labor begins or glucose levels fall below 70 mg/dl, the infusion is changed from saline to 5% dextrose and delivered at a rate of 2.5 mg/kg/min. • Glucose levels are checked hourly using a portable meter allowing for adjustment in the infusion rate. • Regular (short-acting) insulin in administered by intravenous infusion if glucose levels exceed 140 mg/dl. Insulin Management during Labor and Delivery

30. Neonatal care i.detecting of blood glucose, plasma calcium, plasma bilirubin ii.Be care for a preterm neonatal iii.To find respiratory distress and treatment iv.Prevention of postpartun hemorrhge

31. 1)http://nutrihealth.in/2009/08/gestational diabetes-in-moms-to-be/ 2) http://www.dlife.com/diabetes/information 3)http://diabetes.niddk.nih.gov/dm/pubs/gestational/ 4) http://www.ehow.com 5) http://www.womenfitness.net 6)http://www.marchofdimes.com

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