Gestational Diabetes (GDM) - Past Paper PDF

DEFINITION & MAGNITUDE GDM is defined as carbohydrate intolerance of variable severity with onset or first recognition during the present pregnancy. Not the same as Type 1 or Type 2 Diabetes Varies worldwide & among different racial and ethnic groups within a country  ETIOLOGY...

DEFINITION & MAGNITUDE GDM is defined as carbohydrate intolerance of variable severity with onset or first recognition during the present pregnancy. Not the same as Type 1 or Type 2 Diabetes Varies worldwide & among different racial and ethnic groups within a country  ETIOLOGY Pregnancy  pre-diabetic state Pregnancy  marked insulin resistance  increased insulin requirement  GDM Complicates 4% of all pregnancies 60% to 80 % of women with GDM are obese & experience insulin resistance & GDM  PHYSIOLOGICAL CHANGES During pregnancy, there is a state called DIABETOGENIC STATE, peak @ 28-32w Due to ↑ hormone produced by placenta : HPL, CORTISOL (insulin antagonist) → relative insulin resistance Glucose crosses the placenta by facilitated diffusion & fetal blood glucose level closely follow the maternal level 4 Fasting and & postprandial venous plasma sugar 2h during pregnancy Fasting postprandial Result 125 mg/ dl >200 mg/ dl Diabetic Border line indicates 100-125 mg/dl 125-200 mg/dl glucose tolerance test Pregnancy Pathophysiology Glucose is a teratogen at high levels Crosses placenta readily while insulin cannot Insulin resistance occurs because hormonal changes associated with pregnancy partially block the effects of insulin Insulin resistance causes glucose to be shunted from mother to the fetus to facilitate fetal growth and development Subsequent increase in insulin resistance causes maternal glucose levels to increase 80% of non-pregnant women Increased insulin resistance Decreased insulin secretion Increased maternal glucose GDM GDM disappears after pregnancy Useful physiologic process out of balance Effects of diabetes on pregnancy Abortion Preterm labour Infection Increase incidence of pre-eclampsia Polyhydramnios Maternal distress Diabetic retinopathy Diabetic nephropathy Diabetic ketoacidosis. Shoulder dystosia Prolong labour PPH Puerperal sepsis Fetal and Neonatal Hazards A) Fetal:  Fetal macrosomia  Congenital malformation  Birth injury  Growth restriction  Fetal death B) Neonatal:  Hypoglycemia  Respiratory distress syndrome  Hyperbilirubinemia  Polycythemia  Hypocalcaemia  Hypomagnesaemia GESTATIONAL DIABETES DIET Water foods are the main concentration. That means plants: vegetables, fruits, grains & legumes Only low-fat and non-fat dairy products Avoid saturated fats Avoid fast foods, processed foods, microwave foods, high-sugar foods, alcohol & high-sodium foods Drink plenty of fresh water every day Eat 5 or 6 small meals everyday Eat your meals at the same times every day GESTATIONAL DIABETES Diet Diet- 30 kcal/kg – normal weight women, 24 Kcal/kg for overweight women, and 12 Kcal/kg for morbidly obese women. Diet should contain carbohydrate 50%, protein 20% and fat 25-30%. Usually three meal regimen, with breakfast 25% of the total intake, lunch 30%, dinner 30%. DIAGNOSIS TWO-STEP STRAREGY 50g oral glucose challenge Single serum glucose measurement @ 1 hr 140mg/dL) 100-g oral glucose challenge Serum glucose measurements in fasting state, I, II & III hrs Normal values Fasting  < 5.8 mmol/L (