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Gestational Diabetes Mellitus

Gestational diabetes (GDM) is defined as glucose intolerance of variable degree with onset or first recognition during the present pregnancy. The incidence of gestational diabetes is 15-17 percent in Indian pregnant women. After delivery, approximately 90% of all women with GDM become normoglycemic but are at increased risk of developing GDM earlier in subsequent pregnancies

. Immediately after pregnancy, 5% to 10% of women with GDM are diagnosed with T2DM. Insulin requirement goes up one to three times in pregnancy. It is difficult to stabilize the blood sugar during pregnancy due to altered carbohydrate metabolism and impaired insulin action. The insulin antagonism is probably due to the combined effect of human placental lactogen, estrogen, progesterone, free cortisol and degradation of the insulin by the placenta.

 

 WHOM TO SCREEN?

Low risk

To satisfy all these criteria

  • 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

 

Intermediate risk

  • At least one of the criteria in the list

 High risk

  • Marked obesity
  • Prior GDM
  • Glycosuria
  • Strong family history of diabetes mellitus

Risk stratification based on certain variables   

  •  Low risk: no screening
  • Average risk: at 24-28 weeks
  • High risk: During the First trimester

 

Essentially all Indian women have to be screened for gestational diabetes Mellitus they belong to a high-risk ethnicity

 

How to screen?

  • Oral glucose tolerance test ( OGTT) with 75 gm glucose

 

Fasting

>92 mg/dL

1-hour glucose

>180 mg/dl

2-hour glucose

>153 mg/dl

  >  2 values must be abnormal for the diagnosis of GDM

 

 Complication of GDM

  • Fetal complication
  • Increases the risk of fetal macrosomia
  • Neonatal hypoglycemia
  • Birth trauma
  •  Prematurity
  • Perinatal death
  • Congenital malformation

 Maternal complication

  • Weight gain
  • Maternal hypertensive disorders
  • Miscarriages
  • Third-trimester fetal deaths
  • Cesarean delivery (fetus may be too large)
  • Long-term risk of type 2 diabetes mellitus

 

Glycemic targets for GDM

  • Fasting venous plasma < 95 mg/dl
  • 2 hour postprandial <120 mg/dl
  • 1 hour postprandial <130 mg/dl (140)
  • Pre-meal and bedtime: 60 to 95 mg/dl

 

If diet therapy fails to maintain these targets > 2 times/week, start pharmacologic therapy (medicine or insulin). Women with GDM should be screened for diabetes 6 to 12 weeks postpartum and should be followed with subsequent screening for the development of diabetes or prediabetes.

 

 

This is Copyright Content by Gadge's Diabetes Care Edited and written by Madiha Khan

 

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Gadge Diabetes Care Center

  • Add: 13th Floor, Gold Crest Business Center, LT Rd, Borivali, Mumbai - 92
  • Tel: +91 - 9930078797
  • Tel: +91 - 9595848401
  • Email: diabetesupdates@gmail.com

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