GESTATIONAL DIABETES n RISKS AND FUTURE Risk assessment
GESTATIONAL DIABETES n RISKS AND FUTURE
Risk assessment A high risk of gestational diabetes mellitus: marked obesity. v personal history of gestational diabetes mellitus. v Poly cystic ovarian disease(PCOD). v Glycosuria. v a strong family history of diabetes. v Member of high risk population-e. g Asian, African v ü Presence of multiple risk factors warrants earlier screening (preconception, 1 st & 2 nd trimester)
Screening for GDM n First step: Early identification of risk factors n Second step: One hour 50 g glucose screen n Third step: Three hour 100 g OGTT for diagnosis
OGTT – 100 g – 3 hour Test sample timing Plasma Glucose value Fasting (mg%) 95 1 hour (mg%) 180 2 hour (mg%) 155 3 hour (mg%) 140 l a m r h o g n u b a o n e e n O e is u l a V
MATERNAL RISKS • Excessive weight gain (obesity) • Preeclampsia • Polyhydraminos • Cesarean section • Preterm delivery • Intrauterine demise • Traumatic delivery (e. g. shoulder dystocia) • And- Operative vaginal delivery • vacuum-assisted • forceps-assisted
• POLHYDRAMINOS (Excess amniotic fluid). • OBESITY (Excess weight gain)
Risks of GDMTo the baby Shoulder dystocia Fetal macrosomia
Risks to the baby (contd. ) Macrosomia (Large baby) n Shoulder Dystocia , Erb’s Palsy due to large size of the baby. n Neonatal hypoglycemia n Neonatal Jaundice n Delayed Lung Maturation n Hypocalcemia, Hypo. Magnesmia n Still Birth n
1. Neonatal Jaundice 2. Erb’s Palsy
Caudal regression syndrome Birth trauma
FUTURE RISKS OF GDM MATERNAL OFFSPRING n. Future n. Obesity in later life ? gestational diabetes in subsequent pregnancy. n. Subsequent type 2 diabetes and heart disease specially in obese and have family history. n. IFG, IGT or Dm in later life ?
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