GESTATIONAL DIABETES MELLITUS

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GESTATIONAL DIABETES MELLITUS

• Anna Mae Smith, MPAS,
• PA-C

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Defined

• Complicates 3-5 of all pregnancies!
• Glucose intolerance identified during pregnancy
• Accounts for more gestational complications than
  any other adverse factors!

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ETIOLOGY

• Most women revert back to euglycemia post-partum
• HPL- human placental lactogen stimulates insulin
  release
• HPL also decreases glucose uptake
  gluconeogenesis
• mom gets progressively more insulin resistant as
  pregnancy progresses!!!

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ETIOLOGY cond

• Estrogen progesterone also increase during
  pregnancy and in turn increase maternal insulin
  levels!!
• As the placenta grows it releases more more
  hormones(HPL) included.
• As the pregnancy progresses into the 3rd
  trimester hyperinsulinemia
  hyperglycemia!!!

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Etiology cond

• The pathologic defect in GDM is a diminished
  compensatory response to the increased insulin
  resistance commonly associated with pregnancy!!

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RISK FACTORS - Environ/Maternal

• Obesity (60-80)
• Age gt30
• Previous delivery of infantgt 4000gms
• Previous unexplained stillbirth
• Multiple spontaneous abortions
• Persistent gylcosuria

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RISK FACTORS - Hereditary

• Family History of DM in a first degree relative
  of Latino, African American, Asian, or Native
  American background.

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Gold standard

• Screen everyone at 28 wks gestation!
• 50 gm oral glucose load on a fasting stomach.
• Glucose level 1 hour later

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Fetal Complications

• Macrosomia - weight gt 90th percentile for a given
  gestational age.
• Shoulder dystocia
• Dystocia

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Congenital malformations

• Heart
• CNS
• Kidneys
• Skeleton

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Neonatal Hypoglycemia

• Blood glucose lt 30mg/dL
• Fetal hypertrophy of pancreatic tissue
  secretion of more insulin

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Newborns also at greater risk for...

• Hyperbilirubinemia
• Hypocalcemia
• Polycythemia
• Infants will present with irritability,
  respiratory distress, apnea, hypotonia, lethargy
  cyanosis

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Maternal Risks

• Polyhydramnios
• 10 of GDM
• amniotic fluid gt 2000 mL
• increased risk of abruptio placentas
• preterm labor
• postpartum uterine atony

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Maternal Risks

• C-section - 3 times more likely to have
• Infection (UTI)
• Chronic Hypertension
• Preeclampsia
• Eclampsia
• Retinopathy
• 50 will go on to develop DM at some point in
  their lives!!

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TREATMENT

• GDM DIET
• 50-55 CHO ( complex fiber best)
• 20-30 fat
• 20-30 protein

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TREATMENT

• 10-15 of GDMs go on to require Insulin
• Daily glucose monitoring 7 times!
• If strict glycemic control is achieved these
  women are at no greater risk of having macrosomic
  infants!

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Oral hypoglycemic agents

• Not successfully studied!
• Have same effect on fetal pancreas as moms!
• Infants experience prolonged hypoglycemia (4-10
  days) to moms who took sulfonylureas