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Pelvic inflammatory disease, (PID)

DIABETES IN PREGNANCY

Dr. JograjiyaPost Graduate Student, Department of Gynaecology and ObstetricsPGIMSR, ESIC, Basaidarapur, New Delhi-110015

Proposed Classification System for Diabetes in Pregnancy

DefinitionsGestational diabetesPre-gestational diabetes (Overt)

Definitions

Anydegree ofglucose intolerancewithonsetorfirst recognition duringpregnancyGestationalDiabetesMetzger BE, Coustan DR (Eds.): Proceedings of the Fourth International Workshop- Conference on Gestational Diabetes Mellitus. Diabetes Care 21 (Suppl. 2):B1 B167, 1998

DefinitionsPre-gestationalDiabetesDiabetesdiagnosedbefore pregnancy

Etiological Classification of Diabetes Mellitus

White Classification in Diabetes Complicating Pregnancy

Screeninganddiagnosis Rationalefortreatment Monitoringofbloodglucose DietandexerciseInsulininitiationandfollow-up Maternalandfetalsurveillance Laboranddelivery Postpartumfollow-up

GestationalDiabetes

Gestational diabetesScreening

Risk factors for GDM Increasing maternal age and weight Previous GDMPrevious macrosomic infant Family history of diabetes amongfirst-degree relatives

Ethnic background with a high prevalence of diabetes

International Diabetes Federation (2009) Global Guideline on Pregnancy and Diabetes

Gestational diabetesScreeningUniversal Screening recommend for High risk pregnantwomen

International Diabetes Federation (2009) Global Guideline on Pregnancy and Diabetes

Gestational diabetesScreeningAllwomenshouldundergo screening at first prenatal visit and after26 to 28 weeks if negative on previoustesting.

AFES Study Group on Diabetes in Pregnancy (ASGODIP), 1996

Gestational diabetesScreeningInternational Diabetes Federation (2009)

50-g glucose challenge test (GCT)

Global Guideline on Pregnancy and Diabetes>140mg/dL

Gestational diabetesDiagnosis

>140mg/dL

50-g glucose challenge test (GCT)Oral glucose tolerance test (OGTT) 75-g or 100 g?

Thresholds for diagnosisADAASGODIP75-gWHO75-g100-g75-gFBS9595--1 h180180--2 h1551551401403 h140---

100-g OGTTCarbohydrate intake of at least 150 g/day 3days prior Fast for 8 to 10 hours but not more than 14 hours

75 grams of anhydrous dextrose powder as chilled 25% solution (400 cc) flavoredDrink within 5 minutes (first swallow is time zero) Terminate test should nausea and vomiting occur

Collect samples at 0, 1 , 2 and 3 hours

100-g OGTT

Abstainfromtobacco,coffee,tea,foodand alcoholduringtest

Situprightandquietlyduringthetest

Slowwalkingispermittedbutavoidvigorous exercise

Gestational diabetesRationalefortreatment

Increasedriskfor macrosomicorLGA infants

25

050100

75MMCVMMCPoGHCSMCPGH

%

GDM

Normal

AFES Study Group on Diabetes in Pregnancy (ASGODIP), 1996Isip-Tan unpublished data

Gestational diabetesRationalefortreatment

Increasedriskfor Cesareansections

20406080100MMCVMMCPoGHPGH

%

GDM

Normal

AFES Study Group on Diabetes in Pregnancy (ASGODIP), 1996Isip-Tan unpublished data

Gestational diabetesMonitoringbloodglucoseSelf-monitor bloodglucoselevels bothfasting andpostprandial, preferably1hafter ameal.

International Diabetes Federation (2009) Global Guideline on Pregnancy and Diabetes

MonitoringbloodglucoseFifth International Workshop-Conference on Gestational Diabetes Mellitus (2007)

National Institute for Health & Clinical Excellence (2008)Canadian Diabetes Association(2008)5th Intl WorkshopNICECDAFasting90-99 mg/dL(5.0-5.5 mmol/L)63-106 mg/dL(3.5-5.9 mmol/L)68-94 mg/dL(3.8-5.2 mmol/L)1 h after meal130/80 mm Hg despite treatment)

Severe gastroenteropathy

Nausea/vomiting, diarrhea

Preconception Care

Diabetes Care 26:S91-93, 2003

MonitoringbloodglucoseFifth International Workshop-Conference on Gestational Diabetes Mellitus (2007)

National Institute for Health & Clinical Excellence (2008)Canadian Diabetes Association(2008)5th Intl WorkshopNICECDAFasting90-99 mg/dL(5.0-5.5 mmol/L)63-106 mg/dL(3.5-5.9 mmol/L)68-94 mg/dL(3.8-5.2 mmol/L)1 h after meal