Small Steps. Big Rewards. Prevent
type 2
Diabetes Gestational Diabetes
Despite advances, babies born to women with diabetes,
especially women with poor diabetes control, are still at greater risk for
birth defects. High blood glucose levels and ketones (substances that in large
amounts are poisonous to the body) pass through the placenta to the baby. These
increase the chance of birth defects.
For this reason, good blood glucose control before
pregnancy is very important. Most women do not know they are pregnant until the baby has
been growing for two to four weeks. During the first six weeks of pregnancy,
the baby''s organs are forming. Blood glucose levels during these early weeks
affect the baby''s growing organs. High blood glucose levels can lead to birth
defects.
The potential
complications of uncontrolled
gestational diabetes include
For Mother
Hypertension.
Preeclampsia.
Increased risk for developing Type 2 Diabetes
For Baby
Macrosomia.
Hypoglycemia.
Jaundice.
Low calcium and magnesium.
Respiratory distress syndrome (RDS).
Increased risk for childhood and adult obesity.
Increased risk of type 2 diabetes later in life.
The most common birth defects resulting from a diabetic woman becoming pregnant are
problems with the structure of the baby''s heart, spine or kidneys.
Contra-insulin effect @ 20 to 40 weeks
The placenta
supplies a growing fetus with nutrients and water, as well as produces a
variety of hormones to maintain the pregnancy. Some of these hormones
(estrogen, cortisol, and human placental lactogen) can have a blocking effect
on insulin. This is called contra-insulin effect, which usually begins about 20
to 24 weeks into the pregnancy.
Before Pregnancy
Good blood glucose control for three to six months before pregnancy.
Insulin and Diabetes
Pills
If she has type 1 diabetes, pregnancy will affect insulin
treatment plan. During the months of pregnancy, body''s need for insulin will go
up. This is especially true during the last three months of pregnancy.
If she has type 2 diabetes and
on Oral Hypoglycemic Agents, better to switch over to Insulin,
as the suggested Oral
Hypoglycemic Agents are not yet established.
Prenatal Care
Visit 1
a. After taking
history, past obstetric history and family history of Diabetes Mellitus
estimate Body Mass Index (BMI) using height and weight.
b. Record her
vitals including Blood Pressure, and Weight along with LMP and EDD.
c. Estimate
Fasting Blood Sugar (FBS) , 1hr Plasma Glucose and 2hr Plasma Glucose with 75 grams of Glucose in the Venous Blood.
(GTT).
d. GDM
diagnosis is made if 2hr PG is > 140 mg/dl and she is advised meal plan for
2 wks.
e. If FPG >
126 mg/dl and / or 2hr PG > 200 mg/dl, most likely she is GDM and is advised
Insulin on the same day.
f. In the Visit
1 we are not sure about the abnormal Glucose levels till the results are known,
hence we are not doing Lipid Profile or A1C. These tests are done on Visit 2.
Visit 2
(After 2 Wks)
a. She has to
undergo FBS, 1hr PG, and 2hr PG with her Usual Breakfast in the Venous Blood sample.
b. In the fasting sample Lipid Profile and A1C are
estimated.
c. Urine for
Microalbuminuria either by strip / Lab or PC ratio depending upon the
facilities available in the lab.
d. For GDM Fundus examination has to done with out
dilatation.
she is on Insulin Fundus Examination has to be done after dilatation.>
FolUps
She will be followed up every 4 weeks for FPG, 2hr PG along
with BP and Weight until completion of Seven months, then onwards every 2 weeks.
A1C Should be estimated along with Fundus examination every
3 months.
If she has Pedal edema her urinary protein should be
estimated at any Visit along with BP and Fundus Examination.
Note: Insulin
dose should be adjusted to get FBS < 90 mg/dl and 2hr PG < 120 mg/dl.
Delivery
Short acting Intravenous Insulin is the best choice to
control blood sugars during labor. At the start of active labor insulin needs
will drop and most likely not need any insulin during labor and for 24 to 72
hours after delivery.
The baby''s blood glucose levels will be monitored, for
babies who are able to take feedings by mouth, breast-feeding seems to help
protect against low blood sugar. If the baby''s blood glucose level drops below
the acceptable range, he or she may need extra sugar, such as a sugar water
drink or glucose given intravenously.
The baby''s blood may be checked for low calcium, high
bilirubin, and extra red blood cells.
After Delivery
To help prevent low blood glucose levels due to
breastfeeding educate the mother to take high calorie diet along with the
following tips:
Plan to have a snack before or
during nursing
Drink
enough fluids (plan to sip a glass of water or a caffeine-free drink while nursing)
Mother should have a 2 hour glucose tolerance test 6 weeks
after delivery to make sure the diabetes is gone and should be screened for
diabetes on a regular basis.
(GTT @ 6 months, 1 year, 2 years after delivery).
.
What to Think About
The blood glucose levels of most women with gestational
diabetes return to normal within a few hours after delivery. However, women who
have had gestational diabetes in a previous pregnancy are at risk for
developing type 2 diabetes later in life. In addition, between 30% and 69% of
women who have gestational diabetes develop the condition again in future
pregnancies!!!!!!
Dr. B. Suresh Babu Yadav M.B.B.S., Dip. Diab(Aus.), F.R.S.H.(London) Sri
Saikrupa Diabetes Care & Research Institute
16-II-76, Behind
Mayuri Restaurant, Pogathota, Nellore – 1
Phone: 9866331257 / 0861-2306162.
More abstracts about the Gestational diabetes