Gestational Diabetes Mellitus ( GDM )

Gestational Diabetes

Gestational Diabetes

  • Diabetes that develops during pregnancy is known as gestational diabetes.
  • It occurs because your body cannot produce enough insulin (a hormone important in controlling blood glucose) to meet its extra needs in pregnancy. This results in high blood glucose levels.
  • Gestational diabetes usually starts in the middle or towards the end of pregnancy.

  • Gestational diabetes is very common. It may affect up to 20 in 100 women during pregnancy.
  • You are more likely to develop gestational diabetes if you have any of the following risk factors:
    • Your body mass index (BMI) is 30 or higher
    • You have previously given birth to a large baby, weighing 4 kg or more
    • You have had gestational diabetes before.
    • You have a parent, brother or sister with diabetes.

  • Gestational diabetes is checked by simple blood test called OGTT (Oral Glucose Tolerance Test). 75 gm OGTT recommended by DIPSI.
  • It is to be done in early pregnancy & to be repeated at 24 – 28 weeks of pregnancy as per your doctor’s advice.
  • This test is done routinely at our SAAVI women’s hospital.

  • Take 75gm glucose – in powder form or mixed with water & consume it within 15 min.
  • Normal diet can be taken on the day of test to be performed.
  • Reach the hospital in 1.5hrs of consuming glucose for the blood test & Inform staff for the same.
  • Sample is to be given 2hrs after consuming glucose (75 gm).
  • You should not consume anything other than water after consuming glucose.
  • If you vomit after 30 mins – Don’t worry.
  • If you vomit within 30 mins – Repeat the test on the next day.
DIPSI CRITERIA FOR GDM

DIPSI CRITERIA FOR GDM

IF OGTT value is more then 140 then you need to be investigated further. (Fbs,PP2BS,Hb1AC) Ref. DIPSI : DIABETES IN PREGNANCY STUDY GROUP OF INDIA GDM : GESTATIONAL DIABETES MELLITUS. FOR MORE DETAILS KINDLY VISIT : DIPSI CRITERIA FOR GDM

For Mother

Consequnces of Gestational Diabetes

Consequnces of Gestational Diabetes

  • Most women who develop diabetes in pregnancy have healthy pregnancies and healthy babies but occasionally gestational diabetes can cause serious problems, especially if it goes unrecognised. Diagnosing and treating gestational diabetes reduces these risks.
  • It is important to control the level of glucose in your blood during pregnancy. If your blood glucose is too high, your baby will produce more insulin, which can make your baby grow bigger ( Macrosomic Baby ( WT > 4.0 KG )) and increases the likelihood of having, caesarean section, serious birth problems like shoulder dystocia during vaginal delivery, neonatal hypoglycemia and stillbirth. These risks are higher if gestational diabetes is not detected and not controlled.
  • A baby that is making extra insulin may have low blood glucose levels after birth and is more likely to need additional care in a neonatal unit. NICU.
  • Controlling your levels of blood glucose during pregnancy and labour reduces the risks of all these complications for you and your baby.
  • If you are diagnosed with gestational diabetes, you will be under the care of a specialist (Diabetologist), who will help you in monitoring your blood glucose level and your treatment plan.

For Baby

Risk of Macrosomia in baby

Risk of Macrosomia in baby

  • Fetuses of mother with GDM have higher chances of congenital anomaly like neural tube defects , Congenital Heart Disesase ( CHD ).
  • The amniotic fluid volume is prone to be increased in diabetic pregnancies,higer level of amniotic fluid is called polyhydramnios.

Estimated Fetal Wight Chart

Estimated Fetal Wight Chart

Estimated Fetal Wight Chart

  • Fetus of mother with uncontrolled GDM will have macrosomia ( newborn who is significantly larger then average is called macrosomic baby ), These babies are usually more then 4.000kg in weight and these babies are called LGA ( Large Gestational Age ) babies.

  • If OGTT < 120 mg/dl – No Treatment.
  • If OGTT > 120 – 139 mg/dl – Healthy eating plan
    • Diet modification
    • Exercise
  • If OGTT > 140 mg/dl - Then first FBS , PP2BS , Hb1AC should be done and accordingly management is Planned.
    • Healthy eating plan
    • Diet modification
    • Exercise
    • & if required – tablets and/or insulin
  • The most important treatment for gestational diabetes is a healthy eating plan and exercise. Gestational diabetes usually improves with these changes although some women, despite their best efforts, need to take tablets and/or insulin injections.

  • You should be offered extra ultrasound scans to monitor your baby’s growth more closely which is done routinely at our SAAVI women’s hospital.
  • Ideally you should have your baby between at 38 and 40 weeks of pregnancy, depending on your individual circumstances.
  • If your ultrasound scans have shown that your baby is large, your doctor should discuss the risks and benefits of vaginal birth, induced labour and caesarean section with you.

  • Your baby should have his or her blood glucose level tested after birth to make sure that it is not too low. If baby’s blood glucose level is low, baby may be shifted for NICU care.
  • Breastfeeding is best for babies, and there’s no reason why you shouldn’t breastfeed your baby if you have gestational diabetes.
  • You should start feeding him or her as soon as possible after birth, and then every 2–3 hours to help your baby’s blood glucose stay at a safe level.
  • Gestational diabetes usually gets better after birth and therefore you are likely to be advised to stop taking all diabetes medications immediately after your baby is born.
  • Before you go home, your blood glucose level will be tested to make sure that it has returned to normal.
  • If your blood glucose levels are very high even after few days of delivery , you will be referred to a doctor specializing in diabetes ( Diabetologist )

  • Being the right weight for your height (having a normal BMI) eating a healthy diet and taking regular physical exercise before you become pregnant reduces your risk of developing gestational diabetes again.
  • As soon as you find out you’re pregnant, contact your doctor for advice about your antenatal care.

  • The formula is BMI = kg/m2 where kg is a person’s weight in kilograms and m2 is their height in metres squared.
  • A BMI of 25.0 or more is overweight , while the healthy range is 18.5 to 24.9
  • BMI of 25 – 30 is consider over weight.

BMI-graph

BMI-graph

BMI

BMI

  • GDM occurs because your body cannot produce enough insulin (a hormone important in controlling blood glucose) to meet its extra needs in pregnancy. This results in high blood glucose levels.
  • Gestational diabetes is very common. It may affect up to 20 in 100 women during pregnancy.
  • Gestational diabetes is checked by simple blood test called DIPSI OGTT (Oral Glucose Tolerance Test).
  • Mothers with uncontrolled GDM will have macrosomic ( LGA ) baby and increase fluid ( Liquor ) around baby ( Polyhydramnios )
  • A baby of GDM mother may have low glucose levels after birth.
  • Gestational diabetes usually gets better after birth.
  • The most important treatment for gestational diabetes is a healthy eating plan and exercise. Gestational diabetes usually improves with these changes although some women, despite their best efforts, need to take tablets and/or insulin injections.
  • Being the right weight for your height,eating a healthy diet and taking regular physical exercise before you become pregnant reduces your risk of developing gestational diabetes again.

  • This information aims to helps you make the best decision regarding your care. It is not meant to replace advice from a doctor about your own situation.