Gestational Diabetes

INTRODUCTION
 Glucose intolerance of variable degree with onset or
first recognition during pregnancy.

 3-10% of women in UK (higher in Asia)

Pathophysiology

GDM characterized by hyperinsulinemia and insulin resistance

resulting in abnormal carbohydrate intolerance.

In first and early second trimester INCRESED insulin sensitivity due to

INCRESED estrogen

In late second and early third trimesters INCREASEAD INSULIN

RESISTANCE and due to antagonist hormones such as placental
lactogen leptin progesterone prolactin

Accelerated starvation increased lipolysis increase ketoacids during

fasting and or emesis or iatrogenic drugs to induce labour
Risk Factors
 Age more than 25
 BMI more than 25
 Previous history
 Family history
 Asian Pacific or east Asian
 History of stillbirth or unexplained fetal loss
 History of diabetes mellitus type 1 or 2
Signs and Symptoms
 Symptoms
 Asymtomatic
 Polyuria Poluphagia
 Vague symptoms of fatigue and abdominal discomfort and weight loss
 May have established Diabetes mellitus type 1 or 2
 Signs
 Elevated serum glucose
 Glycosuria
 Ketonuria
 Elevated glycosylated haemoglobin
 Screening fasting blood glucose level more than 7.0 mmol/L
Investigations
 Glucose challenge at 24-28 weeks gestation
 50g glucose drink
 Blood drawn after 1 hour if blood glucose is more than 7.2mmol/L
 We do the modified OGTT using 75g glucose drink in 12h fasted state
 HbA1c
 Fetal ultrasound
 Amniotic fluid index
Fetal Complications
 IUD due to increased size and accumulation of anaerobic
respiration products

 Neonatal hyperbilirubinemia due to increase erythropoiesis

and RBC break down due to increase oxygen demands

 Shoulder dystocia leading to ERBS palsy or Birth asphyxia

 Fetal Macrosomia

 Neonatal RDS due to hyperglycemia causing decreased

cortisol secretion
Maternal Complications
 (During pregnancy)
 Abortion Polyhydramnios Maternal distress
 Microangiopathy causing nephropathy neuropathy
retinopathy
 Large vessel disease such as coronary heart disease or
thrombotic events

 (During delivery)
 PPH and or prolonged labor
 C section
 Shoulder dystocia
Treatment
 Diet and exercise
 Biguanides
 Sulfonylurea
 Thiazolidiones
 INSULIN
 Check blood sugar upto six monthes after delivery