Gestational Diabetes Mellitus

Gestational Diabetes Mellitus
Presentation by: Anna Mae Smith, MPAS,

PA-C
Defined
* Complicates 3-5% of all pregnancies!
* Glucose intolerance identified during pregnancy
* Accounts for more gestational complications than any other adverse factors!
ETIOLOGY

* Most women revert back to euglycemia post-partum
* HPL- human placental lactogen stimulates insulin release
* HPL also decreases glucose uptake & gluconeogenesis
* 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!!!
* The pathologic defect in GDM is a diminished compensatory response to the increased insulin resistance commonly associated with pregnancy!!

RISK FACTORS - Environ/Maternal

* Obesity (60-80%)
* Age >30
* Previous delivery of infant> 4000gms
* Previous unexplained stillbirth
* Multiple spontaneous abortions
* Persistent gylcosuria

RISK FACTORS - Hereditary
Gold standard

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


Fetal Complications

* Macrosomia - weight > 90th percentile for a given gestational age.
o Shoulder dystocia
o Dystocia

Congenital malformations
Neonatal Hypoglycemia
Newborns also at greater risk for...
Maternal Risks

TREATMENT
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

Gestational Diaberes Mellitus.ppt