GESTATIONAL DIABETES MELLITUS (GDM)

Classification
Whites Classification
Diabetes mellitus DM= Fasting venous glucose
type I --- insulin
concentration > 8.0 mmol/l and 2
dependent
hrs (75 gm load ) > 11.0 mmol/l
(Ketosis-prone)
(or) one of the above + Symptoms
Diabetes mellitus IGT = Fasting < 8.00 mmol/l, but 2
type II--- nonhr (75 gm load) = (9.0-10.9)
How
do diabetic pt present
insulin
Symptoms
dependent
Risk factors ( history &
(Ketosisexamination)
resistant)
Impaired Glucose Blood tests--screening
Tolerance and
Screening
Gestational
30% have none of the Above risk
Diabetes (IGT)
factors
Diabetogenic
Effects of
Not all DM, IGT, have persistent
Pregnancy
glucosuria
Insulin resistance 50% of pregnant women have
Increased
glucosuria at some time
lipolysis
Altered maternal
gluconeogenesis
Risk Factors
DM, IGT, must be suspected
4. Obesity
in Pregnant women with
5. Hypertension in multipara
1. Age > 30
6. Polyhydramnios
2. Family history of DM
7. Recurrent

WHO recommended modified GTT ( 75 gm load)

Normal
Fasting
Impaired glucose tolerance
6.0 >
Hours 2
6.0-7.9
Or
And
9.0>
9.0-10.9

3. Past history of:

- Diabetes in a previous
pregnancy
- Unexplained I.U.F.D.,
Neonatal death
- Congenital abnormalities
- Recurrent abortions
- Large babies > 90th centile
Risk factors

Complications
Maternal

Obstetric
- Polyhydramnios

infections:Urinary, Fungal
8. Significant Glycosuria

Complications

Neurol
ogic

Fetal
(1) Macrosomia &
Traumatic delivery

Central Nervous
system

** Note: when a two-vessel

cord is found, suspect a high

- pre-eclampsia (10- Peripheral

(30% in seemingly
15%)
neuropathy
controlled)
(2) Delayed organ

Diabetic
Gastrointestinal
maturity (RDS) 6x
Emergencies
disturbance
(3) Congenital
- Hypoglycaemia
malformations:
- Ketoacidosis

Infecti
Cardiovascular :
- Diabetic coma
ons

Vascular &
- Urinary
Transposition of great
End-Organs
vessels
-Renal
Ventricular septal defect
- Ophthalmic
Aortic coarctation
Artial septal defect
- Peripheral vascular
Complications
Principles of management:
(Neonatal)

Start in preconception time

Hypoglycaemia

Specific during pregnancy

RDS
Specific

- Anencephaly
Holoprosencephaly
- Encephalocele
Skeletal & spinal
-Caudal regression
Genitourinary
- Renal agenesis
- ureteral dupliction
Gastrointestinal
- anal atresia

Control

incidence of congenital
anomalies
(4) Intrauterine fetal
Death
(5) Growth restriction (in
advanced DM)

Hypocalcaemia
Polycythaemia

Diet:
16 x Wt. (pounds ) + 300 = CALORIES
Carbohydrates
60%
Fat
20%
Protein
20%
Insulin:
Regiment A
* 3 times sol.-with meals
+ lnt. Evening
Or
- Regiment B
* 2 types (short &
intermediate)
Twice Daily
Dose (daily) = wt. (kg) x 0.6 first
x 0.7 second
x 0.8 third
2/3 in A.M.
2/3 1nt + 1/3 short
1/3 in P.M.
1/2 1nt + short.

Control :
Fasting < 5.0 mmol/1
2 hrs P.P. < 7.0 mmol/1
Adjustment when necessary
Glycosylated Hb A1c (retrospective) < 6
Fetal well being:
AFP 16-18 wks
Detailed scan 19-20 wks
Biophysical assay from 28 wks
Fetal wt. & growth two weekly (3rd)
Delivery:
- Timing depends on: (Around 38 wks)
Maternal factors
Biochemical control
Fetal status
- Method --- LSCS in any medical or obstetric
complication.
**Insulin dose adjusted on hourly basis with caloric
requirements intravenously.