2. Gestational Diabetes
(GD)
Presented by
DR . HINA KHUDA-I-DAD
Working under supervision of
PROF. DR .TASNEEM ASHRAF
HEAD OF DEPARTMENT GYNAE UNIT IV

3. INTRODUCTION
Gestational diabetes is Any degree of
Glucose intolerance with onset or first
recognition during pregnancy.
It affects 3-5% of all pregnancies.

4. PRENATAL MANAGEMENT
1- Screening and diagnosis
2-PATIENT’S EDUCATION
3-GLYCEMIC TARGETS
4-DIET AND EXERCISE
5-INSULIN AND ORAL HYPO-
GLYCEMIC DRUGS
6-MONITORING FETAL
GROWTH

5. WHO SHOULD BE SCREENED
AND WHY
Risk stratification
 Low risk: no screening
 Average risk: at 24-28 weeks
 High risk: as soon as possible

6. LOW RISK
 Age <25 years
 Weight normal before pregnancy
 Member of an ethnic group with a low
 prevalence of GDM
 No known diabetes in first-degree relatives
 No history of abnormal glucose tolerance
 No history of poor obstetric outcome
In the presence of all these factors no screening
is recommended

7. INTERMEDIATE RISK
 Must exhibit one risk factor of GDM.

8. Caution
High risk of gestational diabetes
 Marked obesity BMI >30.
 Previous history of gestational diabetes mellitus.
 Strong family history of diabetes .
 Native Americans, Asians, Hispanics, African AND
arabic specially of mid-eastern origin.
 Previous macrosomic babies, unexplained stillbirths.
women with risk factors should be screened as
soon as possible

9. Oral glucose tolerance
test
Prerequisites:
 Normal diet for 3 days before the test.
 At least 10 hours fast ,in morning at rest.
Give 100 gm of glucose in 250 ml water
Criteria for glucose tolerance test:
fasting 5.3 mmol/L
1 hour 10 mmol/L
2 hours 8.6 mmol/L
3 hours 7.8 mmol/L
If any 2 or more of these values are elevated, the patient is DIAGNOSED to
have GDM.ADA CRITERIA

10. Patient education
cornerstone in GDM management
 Inform mother about maternal and fetal
complications
 Diet therapy
 Teach mother about self monitored blood
glucose measurement and glycemic targets
 Fetal monitoring: ultrasound
 Planning on delivery

11. Potential Risks of
Untreated GDM
IN CHILD
1,Growth abnormalities
-Macrosomia
2,Chemical imbalance
-Hypoglycemia
-Jaundice
-Hypocalcemia
Prone for diabetes in future

12. Potential Risks of Untreated
GDM in mother
 PIH and Pre-eclampsia: affects 10-25% of all pregnant
women with GDM
 Infections: high incidence of chorioamnionitis and
postpartum endometritis
 Postpartum bleeding: caused by exaggerated uterine
distension
 Ceasarian section due to fetal macrosmia and cephalo-
pelvic disproportion
 Weight gain
 Third trimester fetal deaths
 Long term risk of type-2 diabetes mellitus

13. GLYCEMIC TARGET
1.Fasting <5.9mmol/L
2.1 hr post prandial <7.8 mmol/L

14. Self monitored blood glucose
(SBMG)
4 times/day minimum, fasting and 1 or 2 hours
after meals
Maintain log book

15. DIET

16. Diet
Proteins not more than 1g/kg
Fats < 35% of energy intake
Cho <55% of energy intake
Salt <6g/day
In 3 meals and 3 snacks

17. Exercise
 Means regular, moderate
physical activity like
1. Walking for 14-30 minutes
2. Prenatal Aerobic classes
3. Swimming

18. INSULIN
THERAPY
 If persistent hyperglycemia after one week of
diet control proceed to insulin

19. INSULIN IN GDM
 Insulin used if fasting blood glucose >105
mg/dl or 2 hr postprandial blood glucose >120
mg / dl on a diet
 Use intermittent bolus regime of Short
acting insulins to cover each meal.
 Insulin requirements increase by 50% from
20-24 weeks to 30-32 weeks, after which
insulin needs often stabilize.

21. ORAL HYPOGLYCEMIC
AGENTS
 Glyburide is a clinically effective alternative to
insulin in GDM (Langer et al. 2000)
 Metformin may be effective in GDM (Ratner
et al., 2008; Coustan, 2007

22. HYPOGLYCEMIA
 During treatment with insulin patient can
have low blood sugar <60mg/dl
 Why does low blood sugar occur?
1. Too much exercise
2. Skipping meals or snacks
3. Delaying meals or snacks
4. Not eating enough
5. Too much insulin

23. SYMPTOMS OF
HYPOGLYCEMIA
 Very hungry
 Very tired
 Shaky or trembling
 Sweating or clamminess
 Nervous
 Confused
 Like going to pass out or faint
 Blurred vision

24. Hypoglycemia
Prevention Strategies
Consistent monitoring

25. Fetal monitoring
(1) Ultrasound :NICE guideline is to assess
fetal growth on 4 weekly basis from 28-36wks
 Fetal growth ,Amniotic fluid volume at
28,32,36 wks polyhydramnios
(2) cardiotocography (C.T.G). after 32 wks
(3) Doppler.
(4) Biophysical profile B.P.P.

26. TIMING OF DELIVERY
 In well controlled diabetic mother ,the
pregnancy can be continued till 40 wks in the
absence of any complications .
Indication for induction of labour.
 Uncomplicated diabetes at 40 wks
 Developing macrosemia at 38 wks
 Pre eclampsia

27. MANAGEMENT DURING
LABOUR
 Vaginal delivery: preferred
 Cesarian section only for routine obstetric
indication
 GDM alone is not an indication !
 > 4.5 Kg fetus: Cesarean delivery may reduce the
likelihood of brachial plexus injury in the infant
and still birth
 Maintain euglycemia during labor 4-7mmol/L
 Monitor sugars 1-4 hrly intervals during labour
 Give insulin only if blood sugar >120 mg/dl

28. IV INSULIN DURING C-
SECTION
 I.V insulin infusion.
 50 ml N/S +50 unit regular insulin Aim at 1-2
unit (1ml)/hr.
 At the same time 10% of glucose started on
other arm.
 BSL b/w 4.0-7.0 mmol/L

29. POST-PARTUM FOLLOW UP
 Check blood sugars before discharge
 Lifestyle modification: exercise, weight
reduction
 Oral glucose tolerance test at 6-12 weeks
postpartum
 Counseling for contra-ception, and pre-
conception care for next pregnancy

30. IMMEDIATE MANAGEMENT OF
NEONATE
 Hypoglycemia<40 mg/dl : 50 % of
macrosomic infants
 Encourage early breast feeding
 If symptomatic give a bolus of 2- 4 ml/kg, IV,
10% dextros
 Check for calcium, if seizure/irritability/RDS

31. Conclusion
 Gestational diabetes is a common problem in
worldwide
 Risk stratification and screening is essential
in all pregnant women.
 Tight glycemic targets are required for good
maternal and fetal outcome
 Patient education and Long term follow up is
essential

32. 17 POUNDS BABY BORN OF A WOMEN
WITH GDM