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Gestational Diabetes |
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Gestational Diabetes Overview |
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What is it ? |
| Diabetes that develops during the pregnancy. |
| Gestational diabetes mellitus (GDM) is defined as any
degree
of glucose intolerance with onset or first recognition
during
pregnancy |
| GDM will disappears post birth, but increases the risk
that the mother will develop diabetes later. Usually GDM is managed with
meal planning, activity, and, in some cases, insulin. |
| The goal of management is to keep the blood sugar
within a normal range, to decrease the risks of complications for the mom
and the baby. Pregnancy becomes a good time to pay attention to diet and
exercise, and establish good health habits. |
| It is thought pregnancy is an insulin resistance
condition, and in some individuals, the ability to control blood sugar
becomes more difficult. |
| Approximately 7% of all pregnancies are complicated by
GDM, resulting in more than 200,000 cases annually. The
prevalence
may range from 1 to 14% of all pregnancies,
depending on the
population studied and the diagnostic tests
employed. |
|
Diagnosis |
| Glucose
Challenge Test |
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Follow-up Glucose Challenge Test |
Two-step approach:
Perform an initial screening by measuring the plasma or serum
glucose concentration 1 h after a 50-g oral glucose load (glucose
challenge test [GCT]) and perform a diagnostic OGTT on that
subset of women exceeding the glucose threshold value on the
GCT. When the two-step approach is employed, a glucose threshold
value >140 mg/dl (7.8 mmol/l) identifies approximately 80%
of women with GDM, and the yield is further increased to 90%
by using a cutoff of >130 mg/dl (7.2 mmol/l).
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Healthy Eating and Lifestyle Changes |
| Handouts |
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Current Nutritional Guidelines for Gestational
Diabetes |
| Restriction of carbohydrates to 35–40%
of
calories
has been shown to decrease maternal glucose levels
and improve
maternal and fetal outcomes.
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Post Birth Follow-up |
| Reclassification of maternal glycemic status should be
performed
at least 6 weeks after birth. |
| If glucose levels are normal post-partum, reassessment
of glycemia should be undertaken at a minimum of 3-year intervals.
Women with IFG or IGT in the postpartum period should be tested
for diabetes annually; these patients should receive intensive
nutrition guidance, and should be placed on an individualized
exercise program
because of their very high risk for
development of diabetes.
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| All patients with prior GDM should be educated
regarding lifestyle
modifications that lessen insulin
resistance, including maintenance
of normal body weight through
MNT and physical activity. Medications
that worsen insulin
resistance (e.g., glucocorticoids, nicotinic
acid) should be
avoided if possible. Patients should be advised
to seek medical
attention if they develop symptoms suggestive
of hyperglycemia.
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| Education should also include the need for
family planning to ensure optimal glycemic regulation from the
start of any subsequent pregnancy. Low-dose estrogen-progestogen
oral contraceptives may be used in women with prior histories
of GDM, as long as no medical contraindications exist.
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Gestational Diabetes Mellitus |
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http://care.diabetesjournals.org/cgi/reprint/26/suppl_1/s103
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| Criteria for the diagnosis of diabetes mellitus |
| Normoglycemia |
IFG and IGT |
Diabetes mellitus* |
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| FPG <110 mg/dl |
FPG
 110 mg/dl and <126
mg/dl (IFG) |
FPG
126 mg/dl |
2-h PG
<140 mg/dl |
2-h PG
140 mg/dl and <200
mg/dl (IGT) |
2-h PG
200 mg/dl |
| — |
— |
Symptoms of DM and casual plasma
glucose concentration
200 mg/dl |
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