Gestational diabetes mellitus

this PPT will help to nursing students and also mother to know about the gestational diabetic mellitus during pregnancy and its management

1. Gestational Diabetes M ellitus Presented by- P reeti Shukla Lecture RCN, Kanpur

2. Objectives- At the end of the presentation student will able to- Define gestational diabetes mellitus Enlist the causes of gestational diabetes mellitus. Describe the investigation of gestational diabetes mellitus. List-down the effect of GDM in pregnancy and fetus. Explain the management of GDM. Describe the prevention of GDM.

3. Gestational diabetes mellitus GDM is defined as carbohydrate intolerance or glucose intolerence of variable severity with onset of first recognition during present pregnancy. Usually present late in second or during third trimester.

4. Gestational diabetes starts when the body is unable to make all of the insulin it needs for pregnancy. Low insulin levels, combined with hormonal changes, can lead to insulin resistance. When this happens, high levels of glucose build up in the blood.

5. Causes- Positive family history of diabetes. Previous birth of overweight baby. Previous stillbirth with pancreatic islet hyperplasia. Unexplained perinatal loss Presence of polyhydromnios Age over 30 year Obesity

6. S creening - - Blood glucose test as soon as possible. Glucose tolerance test

7. GLUCOSE TOLERENCE TEST- A glucose screening test is a routine test during pregnancy that checks a pregnant woman's blood glucose (sugar) level. Gestational diabetes is high blood sugar (diabetes) that starts or is found during pregnancy. The person will have a fasting blood test, then drink a glucose drink and have further blood tests 1, 2, and maybe 3 hours later. If blood sugar levels are high, and the person has not had a diagnosis of diabetes before, the doctor will probably diagnose gestational diabetes.

8. Effect of diabetes on pregnancy-

9. Maternal effect- (during pregnancy)- Abortion Preterm labour Infection (UTI, vulvo vaginitis) Increased incidence of preeclampsia. Polyhydramnios Maternal distress Diabetic retinopathy Diabetic nephropathy ketoacidosis

10. D uring labour - Prolongation of labour due to big baby. Shoulder dystocia Postpartum hemorrhage Operative interferences During puerperium - Puerperal sepsis Lactation failure

11. Fetal and neonatal hazards: Fetal macrosomia Congenital malformation ( neural tube defects, anencephaly, microcephaly, VSD, ASD, coarctation of aorta, fallots tetrology , renal agenesis, hydronephrosis , double ureter, polycystic kidneys, duodenal atresia, anorectal atresia, omphalocoele ).

12. Management- Principles- Careful antenatal supervision and glycemic control, so as to maitain the glucose level near to physiolgical level as possible. To find out the optimum time and method of delivery. Arrangement for the care of the newborn.

13. Pre conceptional counseling Antenatal care:- Antenatal supervision should be at monthly intervals up to 20 weeks and thereafter at 2 weeks intervals. At times patient needs admission for stabilization of blood glucose and for monitoring the fetus. D iet- 30 kcal/kg for normal weight women, 24 kcal/kg for overweight women and 12 kcal/kg for morbidly obese women.

14. Frequent blood sugar estimation is required as the urine examination for sugar is not informative. Monitoring of blood glucose by glucose meter can give an accurate idea about the control. Examination of HbAIc level. Sonographic evaluation in pregnancy is extremely helpful, not only to diagnose varieties of congenital malformation of fetus but also to detect fetal macrosomia or growth restriction.

15. Biophysical profile and NST should be performed weekly. Insulin therapy- when diabetes is first detected during pregnancy and cannot be controlled by diet alone, it should be treated with insulin. A post prandial plasma glucose level of 140 mg% even on diet control is an indication of insulin therapy. during the stabilization process of the insulin dose, frequent blood sugar estimation specially at night (2am – 6am) may be necessary using glucose meter.

16. Induction of labour . Cesarean section Fetal monitoring during labour or after delivery- during the labour process shoulder dystocia may be a problem. The cord should be clamped immediately after delivery to avoid hypervolemia. Examination of placenta and cord- placenta is large, the cord is thick and there is increased incidence of single umbilical artery. Puerperium care- antibiotics should be given, insulin requirement falls dramatically following delivery. breast feeding is encouraged . Women who had breast feed should have additional 500kcal daily in diet. In lactating women insulin dose is lower.

17. Prevention of GDM