Gestational diabetes (or gestational diabetes mellitus, GDM)
When a woman is not diagnosed of diabetes but exhibits high blood pressure level during pregnancy, it is often the condition of gestational diabetes.
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Classification
Pre-gestational Diabetes either type I o r type II
Gestational diabetes: diabetes that develops during pregnancy
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Complications of Diabetes in pregnancy
Maternal
(1) Polyhydroamnios: from fetal polyuria
(2) Nephropathy: common in pregestational diabetes, increasing the risk of preeclampsia
(3) Retinopathy: occurs after several years of pregestational diabetes, often deteriorates during pregnancy
(4) Diabetes ketoacidosis: May occur at lower glucose concentration
Fetus
(1) Fetal demise: increased spontaneous miscarrage and fetal death in utero
(2) Respiratory distress syndrome
(3) Macrosomia(>4000-4500 g)
(4) Fetal hypoglycemia
(5) Hyperbilirubinemia
(6) Polycythemia
(7) Hypocalcemia
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Screening glucose challenge test
All patient screened between 24 and 28 weeks.
With 75gm high concentration sugar water and keep fasting before test 4-6 hours.
2 hours(75gm) Oral glucose tolerance test
|
Time |
National Diabetes Data Group(mg/dl) |
|
fasting |
92 |
|
1 |
180 |
|
2 |
153 |
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Intra-partum management
Nutritional counseling differs individually and it varies with patients’ weight and height.
fasting glucose levels should be under 105 mg/dl. or 2-hr post-meal sugar level should be under 120mg/dl, if not, pharmacologic treatment was suggested(insulin administration)
Fetal evaluation
(1) fetal activity assessment, NST(non-stress test: a 20-minutes-test of fetal movement and fetal heart beat relation) beginning at 32-34 wks
(2) Ultrasound : first time at 18-20 weeks, and the second time is at 30-32 weeks
a. Insulin treatment: It is usually recommended that oral hypoglycemic agents be discontinued once pregnancy is diagnosed
b. Exercises like swimming and bicycle riding are highly recommended; however, riding bicycles is inappropriate toward the last stage of the pregnancy, simple walk is recommended.
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During labor care
Maintain euglycemia(normal sugar level) during labor
Sugar control with Insulin drip and check sugar every hour in labor
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Postpartum management
Home glucose monitoring
Diet instruction
Prevention of hemorrhage and infection
Regular postpartum blood sugar trace, and sugar test within 6 wks of delivery
Breastfeeding encouraged
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