Diabetes in Pregnancy: An Overview of Gestational Diabetes

Diabetes in Pregnancy
an overview of gestational diabetes

By: Karlo Roberto Mariano
Diabetes defined
Diabetes mellitus, more commonly referred to as
simply diabetes, is characterized by high blood
sugar level resulting from either inability of the
body to produce enough insulin, or because the
cells do not respond to the insulin produced.
There are three main types of diabetes:

Type 1 : insulin-dependent diabetes mellitus, IDDM
Type 2: results from insulin resistance
and Gestational Diabetes
Gestational Diabetes
• It is when a pregnant woman who have never
had diabetes before, have a high blood glucose
level during pregnancy.
▫ This may precede Type 2 DM later in life
Gestational Diabetes
• It has 2 classifications:
▫ Type A1: abnormal OGTT but normal blood glucose levels

during fasting and 2 hours after meals; diet modification is
sufficient to control glucose levels
▫ TypeA2: abnormal OGTT compounded by abnormal

glucose levels during fasting and/or after meals; additional
therapy with insulin or other medications is required
OGTT – Oral Glucose Tolerance Test

OGTT for screening GDM
OGTT for screening GDM
• A blood test is then taken 2 hours later after
drinking a special glucose solution.
• The following results suggest different conditions:
▫ OGTT levels are normal up to 140 mg/dL.
▫ Levels of 140 - 199 mg/dL are referred to as
impaired glucose tolerance, or pre-diabetes.
▫ Diabetes is diagnosed when OGTT levels are 200
mg/dL or higher.
▫ Patients who have the FPG and OGTT tests must
not eat for at least 8 hours prior to the test.
Risk Factors
• The following risk factors may cause GDM:
▫ Previous dx of GDM or pre-diabetes, impaired glucose
tolerance, impaired fasting glycemia
▫ Family hx – 1st deg relative with Type 2 DM
▫ Maternal age- woman over 35 years of age
▫ Overweight, obese or severely obese
▫ A previous pregnancy resulting in a child with high birth
weight
▫ Poor obstetric history
▫ Smoker *double the risk of GDM
▫ Polycystic ovarian syndrome
Pathophysiology of GDM
↑ insulin resistance during 2nd trimester →
↓ insulin binding into receptor cells→
↑ glucose in bloodstream →
↑ insulin production to overcome resistance →
(because glucose can cross the placenta) →
↑ fetal glucose level →
↑ fetal level of insulin →
(insulin has growth stimulating effects) →
Macrosomic/LGA
(↓ glucose environment) → Hypoglycemia
Symptoms and Complications
• Symptoms:
▫ Some women may demonstrate increased thirst(polydipsia), increased
urination(polyuria), fatigue, nausea, vomiting, bladder infection, yeast
infections, blurred vision.
• Complications:
▫ Mother: CS delivery – shoulder dystocia can be a
problem for vaginal delivery, risk for Type 2 DM later on
life
▫ Child: risk for instrumental deliveries, LGA,
hypoglycemia, jaundice, polycythemia, hypocalcemia,
hypomagnesemia, may interfere maturation resulting to
respiratory distress syndrome
Shoulder dystocia
Screening Tests
• Non-challenge blood glucose tests
• Screening glucose test/ O’Sullivan Test
• Oral glucose tolerance test
• Urinary glucose testing

Management
• Medication
▫ Insulin therapy should be considered if the
blood glucose goals are exceeded on two or
more occasions within a 1 to 2 week interval,
particularly in association with clinical or
investigational suspicion of macrosomia.
However, the benefit of instituting insulin
therapy after 38 weeks' gestation is unproven.
Management
• Lifestyle
▫ Diet – “G.I. Diet” – spreading carbohydrate intake
over meals and snacks throughout the day
▫ Exercise – Regular moderately intense exercise is
advised
▫ Regular self monitoring – target ranges on the next
slide
▫ Breastfeeding – may reduce risk of DM for both
mother and child
Target Ranges
• fasting capillary blood glucose levels <5.5 mmol/L
• 1 hour postprandial capillary blood glucose levels

<8.0 mmol/L
• 2 hour postprandial blood glucose levels

<6.7 mmol/L
Postprandial – after a meal

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Diabetes in Pregnancy

an overview of gestational diabetes

There are three main types of diabetes:

▫ Type A1: abnormal OGTT but normal blood glucose levels

▫ TypeA2: abnormal OGTT compounded by abnormal

OGTT – Oral Glucose Tolerance Test

• Screening glucose test/ O’Sullivan Test

• Oral glucose tolerance test

• Urinary glucose testing

• 1 hour postprandial capillary blood glucose levels

• 2 hour postprandial blood glucose levels

Postprandial – after a meal

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