1 / 23

Gestational Diabetes

Gestational Diabetes. Definition. Any degree of glucose intolerance with onset or 1 st recognition during pregnancy. Diabetes Care, 2003 Jan:26(1):s103 prevalence 1.4 – 14% UTD 11.2. Etiology. Early pregnancy

oleg-mason
Télécharger la présentation

Gestational Diabetes

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Gestational Diabetes

  2. Definition • Any degree of glucose intolerance with onset or 1st recognition during pregnancy. Diabetes Care, 2003 Jan:26(1):s103 • prevalence 1.4 – 14% UTD 11.2

  3. Etiology • Early pregnancy estrogen-progesteron counterbalance • 2nd trimester  hPL,  Cortisol,  Prolactin • Underlying  cell defect Evidence-Based Diabetes Care 2001

  4. Risk Factors • Age • +ve F Hx. of DM • Increasing obesity, Wt. gain in early adulthood • Ethnicity Asians5, Hispanics2.5, African Americans2 • Cigarette smoking Evidence-Based Diabetes Care 2001

  5. Short Term Risk for The Fetus • Macrosomia & possible birth trauma • Neonatal hypoglycemia • Jaundice • Hypocalcemia • Polycythemia • RDS • Myocardial hypertrophy

  6. Long Term Risks for The Offsprings • Susceptibility for glucose intolerance •  Insulin resistance during puberty • Obesity

  7. Mother’s Risks • Long term risk for DM 50% diabetes, 75% any IGT • Rarely DKA, Retinopathy • Preeclampsia • Polyhydramnios • Fetal macrosomia • Birth trauma • Operative delivery • Perinatal mortality

  8. Risk Factors for Progression to Diabetes •  Prepregnancy BMI • Severity of glucose intolerance during pregnancy • Earlier gestational age of onset • FPG • Need for insulin • Presence of higher glucose values on postpartum OGTT

  9. Screening • Selective ( ADA & ACOG ) • Universal * If screening had been selective, 10% of women with GDM have been missed

  10. Screening (continued)

  11. Screening (continued) • Low risk • Age<25 yr • Nl weight before pregnancy • Member of an ethnic group with low prevalence of GDM • No known diabetes in 1st degree relatives • No Hx. of abn. Glucose tolerance • No Hx. of adverse pregnancy outcomes often associated with GDM Diabetes Care, 2003 Jan:26(1):S34

  12. Screening(continued) • High Risk • Marked obesity (prepregnancy Wt. of 110% of IBW) • Personal Hx. of GDM • Strong F Hx. of diabetes • Glycosuria Diabetes Care, 2003 Jan:26(1):S34 • Age>25 yr • Hx. of abn. glucose tolerance • Previous large baby • PCO • Maternal low birth Wt. • The mother was large at birth • Member of an ethnic group with a higher than Nl rate of type2 DM • Previous unexplained prenatal loss or birth malformed child UTD 11.2

  13. Screening(continued) • Timing • High risk : 1st prenatal visit If -ve • Mod. risk : between 24-28 wks • Low risk : need no glucose testing Diabetes Care, 2003 Jan:26(1):S34

  14. UTD 11.2

  15. UTD 11.2

  16. Management • Diet : in women who do not meet criteria for gestational diabetes (abnormal GTT) if they have FPG >90 mg/dL or an abnormal GCT. • Exercise • Insulin : ٭when FPG >90 mg/dl & 1hr PP blood sugar >120 mg/dl ٭15% of women with GDM require insulin Rx.

  17. Management (continued) • Caloric Allotment •30 kcal per present weight in kg per day in pregnant women who are 80 to 120 % of IBW at the start of pregnancy. •24 kcal per present weight in kg per day in overweight pregnant women (120 to 150 % of IBW). •12 to 15 kcal per present weight in kg per day for morbidly obese pregnant women (>150 % of IBW). •40 kcal per present weight in kg per day in pregnant women who are < 80 % of IBW.

  18. Management (continued) • Insulin Regimen if ↑FPG : NPH 0.15 IU/kg before bedtime  if ↑PP blood glucose : Insulin regular or lispro 1.5 IU/10gr CHO before breakfast & 1 IU/10gr CHO before lunch and dinner meals.

  19. Management (continued)  if both ↑FPG & ↑PP blood glucose : four-injection per day regimen should be initiated : NPH 45% Regular 55% 30% breakfast 22% breakfast 15% bedtime 16.5% lunch 16.5% dinner

  20. Management (continued) • Goal of glucose concentration FPG <90 mg/dl BS 1hr PP <140 mg/dl Plasma BS 2hr PP <120 mg/dl

  21. Management (continued) • Postpartum F/U ٭1/3 to 2/3 of women will have gestational diabetes in a subsequent pregnancy. ٭As many as 20 % of women with GDM have IGT during the early postpartum period. ٭The risk of type 2 diabetes is also importantly affected by body weight, being 50 to 75 % in obese women versus < 25 % in women who achieve IBW after delivery. ٭GDM is also a risk factor for the development of type 1 diabetes. Specific HLA alleles (DR3 or DR4) may predispose to the development of type 1 diabetes postpartum, as does the presence of islet-cell autoantibodies.

  22. Postpartum F/U •Immediately after delivery, FPG should be < 115 mg/dL & one-hour PP should be <140 mg/dL. •~ 6-8 wks after delivery, or shortly after cessation of breast feeding, a two-hour 75 gr OGTT is recommended by the ADA and the 4th International Workshop-Conference on GDM.

More Related