This document provides information about gestational diabetes mellitus (GDM), a condition where women without a previous history of diabetes experience high blood sugar levels during pregnancy. The key points are: - GDM occurs in approximately 5% of pregnancies and can cause health issues for both the mother and baby if not treated. - Risk factors include age over 25, family history of diabetes, and certain ethnic backgrounds. - Screening usually takes place between 24-28 weeks of pregnancy with a glucose test. - Treatment involves diet, exercise, and possibly insulin therapy to control blood sugar levels and minimize health risks. - Both mother and baby must be monitored during and after pregnancy due to risks like developing type 2 diabetes

1. DR. Maheen Asad.
Regional Medical Officer, Apollo.

4. This diagnosis is given when a woman, who has
never had diabetes before, gets diabetes or has high
blood sugar, when she is pregnant.
 Its medical name is gestational diabetes mellitus or
GDM.
 It is one of the most common health problems for
pregnant women.
 The word “gestational” actually refers to “during
pregnancy.”

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gdm

5. It occurs in about 5% of
all pregnancies.
If not treated,
gestational diabetes
can cause health
problems for the
mother and the fetus.
kvr
gdm

6. Risk Factors
 maternal age >25
 Family history
 glucosuria
 prior macrosomia
 previous unexplained stillbirth
 ethnic group: Hispanic, Black, Asians

10. For most women, the body’s extra
insulin is enough to keep their blood
sugar levels in the healthy range.
 But, for about 5% of pregnant women,
even the extra insulin is not enough to
keep blood sugar levels normal.
 These women end up with high blood
sugar or gestational diabetes at around
the 20th to 24th week of pregnancy.

10
gdm

16. 
Screening
◦ 24-28 weeks routine
◦ no need to fast
◦ screen at 1st prenatal visit if hx of previous
GDM
◦ screen earlier (12-24 weeks ) if risk factors

20. MATERNAL RISK

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
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Birth trauma
Preterm Labor
PIH
Operative delivery
50% lifetime risk in developing Type II DM
Recurrence risk of GDM is 30-50%

22. Management
Goal is to optimize BG
levels to minimize risk
of adverse perinatal
outcomes

Diet
Exercise
Insulin therapy

23. 
Although your glucose
levels change during the
day, there is a healthy
range that is normal. If
your glucose level is
outside of the healthy
target range, speak with
your health care
provider.
Time of
Blood Sugar
Test
Fasting
glucose level
Healthy Target Levels
(in mg/dl)
No higher than 95
One hour
after eating
No higher than
140
Two hours
after eating
No higher than
120
PBRC 2006
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24. If persistent hyperglycemia
after one week of diet
control proceed to insulin
 6-14 weeks 0.5u/kg/d
 14-26 weeks 0.7u/kg/d
 26-36 weeks 0.9u/kg/d
 36-40weeks 1 u /kg/d

25. If fasting hyperglycemia start with NPHhs
 initial dose 6-8 U
 if only pc hyperglycemia use Humalog
2-4u ac the specific meal
 adjust 2u/time ; 1 formula /time


BG target ac <5.3 (90mg.)
2 h pc <6.7 ( 120 mg)

26. Time Frame
In the first trimester of
pregnancy
(the first 3 months)
During the second and third
trimester
(the last 6 months)
If you gained too much weight
early in the pregnancy
Expected Weight Gain
Three to six pounds for the
entire three
months
Between ½ and 1 pound each
week
Limit weight gain to ¾ of a
pound each week (3 pounds each
month) to help get your blood
sugar level under control
A weight gain of two pounds or more each
week is
considered high.
gdm
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27. Traditionally not
recommended in pregnancy


Recent RCT of oral
glyburide vs insulin for GDM
440 patients
 BG measured 7x daily
 Treatment started after 11 weeks gestation


28. THE END