Transcript
DR. Maheen Asad.Regional Medical Officer, Apollo.
This diagnosis is given when a woman, who has never had diabetes before, gets diabetes or has high blood sugar, when she is pregnant.
Its medical name is gestational diabetes mellitus or GDM.
It is one of the most common health problems for pregnant women.
The word “gestational” actually refers to “during pregnancy.”
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It occurs in about 5% of all pregnancies.
If not treated, gestational diabetes can cause health problems for the mother and the fetus.
gdmkvr
Risk Factors maternal age >25 Family history glucosuria prior macrosomia previous unexplained stillbirth ethnic group: Hispanic, Black, Asians
For most women, the body’s extra insulin is enough to keep their blood sugar levels in the healthy range.
But, for about 5% of pregnant women, even the extra insulin is not enough to keep blood sugar levels normal.
These women end up with high blood sugar or gestational diabetes at around the 20th to 24th week of pregnancy.
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Screening
◦24-28 weeks routine◦no need to fast◦screen at 1st prenatal visit if hx of previous
GDM◦screen earlier (12-24 weeks ) if risk factors
MATERNAL RISK
Birth trauma Preterm Labor PIH Operative delivery 50% lifetime risk in developing Type II DM Recurrence risk of GDM is 30-50%
Management Goal is to optimize BG levels to minimize risk of adverse perinatal outcomes
Diet Exercise Insulin therapy
Although your glucose levels change during the day, there is a healthy range that is normal. If your glucose level is outside of the healthy target range, speak with your health care provider.
Time of Blood Sugar
Test
Healthy Target Levels (in
mg/dl)
Fasting glucose
level
No higher than 95
One hour after eating
No higher than 140
Two hours after eating
No higher than 120
23 of 42PBRC 2006
If persistent hyperglycemia after one week of dietcontrol proceed to insulin6-14 weeks 0.5u/kg/d14-26 weeks 0.7u/kg/d26-36 weeks 0.9u/kg/d36-40weeks 1 u /kg/d
If fasting hyperglycemia start with NPHhs initial dose 6-8 U if only pc hyperglycemia use Humalog
2-4u ac the specific meal adjust 2u/time ; 1 formula /time
BG target ac <5.3 (90mg.) 2 h pc <6.7 ( 120 mg)
Time Frame Expected Weight Gain
In the first trimester of pregnancy
(the first 3 months)
Three to six pounds for the entire three
months
During the second and third trimester
(the last 6 months)
Between ½ and 1 pound each week
If you gained too much weight early in the
pregnancy
Limit weight gain to ¾ of a pound each week (3 pounds
each month) to help get your blood sugar level
under control
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A weight gain of two pounds or more each week is
considered high.
Traditionally not recommended in pregnancy
Recent RCT of oral glyburide vs insulin for GDM 440 patients BG measured 7x daily Treatment started after 11 weeks gestation
THE END
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