Pregnancy Diabetes Mellitus - Slideshow

Introduction

• Medically, Gestational Diabetes Mellitus (Pregnancy Diabetes Mellitus) is defined as glucose intolerance, which is diagnosed during pregnancy.
• It is reported to affect approximately 7% of all pregnancies.
• It can adversely affect both the mother and the baby; hence, a diagnosis, if made, should be taken seriously.

How does Gestational Diabetes Mellitus develop?

• During pregnancy, the placenta (which connects the mother and the fetus and supplies nutrition to the baby) produces hormones (estrogen, cortisol and human placental lactogen) that are important for a healthy pregnancy.
• Unfortunately, these hormones inhibit the functioning of insulin, which helps in pushing the blood glucose into the cells.
• When insulin function is compromised there is rise in the level of blood glucose.
• In the 2nd (13-28 weeks) & 3rd (28-40 weeks) trimesters, these hormones are produced in excess, resulting in further insulin resistance.
• When the pancreas cannot meet the increased insulin demand, it results in Gestational Diabetes Mellitus (GDM).

Symptoms & Signs

• Unusual thirst
• Frequent urination
• Fatigue
• Nausea
• Blurred vision
• Sugar in urine
• Infections of bladder, vagina and skin

Diagnosis

The diagnosis of GDM is carried out with two tests:

• Glucose Challenge Screening- performed between 26 and 28 weeks of pregnancy
• Glucose Tolerance Test

• During Glucose challenge screening, pregnant women are given a glucose drink and after one hour, blood is drawn to test the glucose level.
• If the test result is greater than 140 mg/dL (7.8 mmol/L), glucose tolerance test will be carried out to confirm the diagnosis of pregnancy diabetes.
• Remember that no fasting is required for this test.

Glucose Tolerance Test

• The patient undergoing Glucose tolerance test is asked not to eat anything for 8 to 12 hours and then the blood is drawn for testing fasting blood glucose level
• After the intake of glucose (100 gm or 75 gm), blood samples are drawn three times with the time interval of one hour.
• If the values exceed the stipulated range, then the diagnosis of pregnancy diabetes is confirmed.

Risk factors

• Age - more than 30 years
• Obesity
• A family history of diabetes (especially type 2 diabetes)
• Ethnicity - mainly South Asian, African Americans, Hispanic or Latino Americans, and American Indians
• GDM in a previous pregnancy or large babies or polycystic ovarian syndrome

Fetal Complications

• Baby weighing greater than 4 kg (Macrosomia)
• Blood glucose level less than 40 mg/dl in first few days after birth (Neonatal hypoglycemia)
• Deaths in the first week of life as well as fetal deaths (Perinatal mortality)
• Congenital malformation
• Elevated level of bile pigment (Hyperbilirubinemia)
• Increased number of red blood cells (Polycythemia)
• Decreased level of calcium in the blood (Hypocalcemia)
• Respiratory distress syndrome

Maternal Complications

• Hypertension
• Gestational hypertension and presence of protein in the urine (proteinuria) - Pre-eclampsia
• Increased risk of cesarean delivery
• Chances for developing diabetes, especially type 2 diabetes, after pregnancy period