Gestational Diabetes

It is a state of increased sugar level which generally normalizes after childbirth. This occurs due to increased sugar level during pregnancy which is due to decreased insulin production or insulin resistance. Incidence 10% of the population is affected by GDM and it is increasing due to advanced maternal age and sedentary lifestyle. Why does it occur- During pregnancy, an organ called placenta is formed which provides food and oxygen to the baby from the mother. This also produces certain hormones which prevent the action of Insulin on sugar. This increases the sugar level in pregnant patient's blood. Our pancreas produces insulin, but as the sugar during pregnancy is already high the amount of insulin produced is not enough to metabolize sugar resulting in increased sugar level. Risk factors for GDM

• PCOS-Polycystic ovarian disease
• Obese patient with BMI more than 30
• Previous history of having diabetes during pregnancy.
• History of diabetes in a family
• Having the previous baby of more than 4 kg
• History of sudden still birth or IUFD.
• An elderly primi
• Ethnic-origin east Asian

Screening- During pregnancy visit, the doctor asks about the history and any risk-factor, if any risk factor During pregnancy visit, the doctor asks about the history and any risk-factor, if any risk factor then glucose challenge test with 75 gm Glucon-D is done. Or GCT is done routinely at 24-28 weeks. Then glucose challenge test with 75 gm Glucon-D is done. Or GCT is done routinely at 24-28 weeks. Symptoms

• Increased thirst
• Increased urination
• Weakness
• Increased appetite

Sign-During check up there is increased girth of the abdomen. Sonographic Findings

• Abdominal circumference is more than gestational age in growth scan at 28 weeks
• Amniotic fluid is more than 20.

Effects on mother

• Breathing difficulty due to increased girth
• Repeated vaginal infection
• High blood pressure
• Sometimes retinal detachment due to small vessel damage

Effects on baby

• Macrosomia or big baby
• Difficult shoulder delivery during birth
• Inside uterus death of a baby (IUFD)
• Post-delivery hypoglycemia of baby management
• If GCT at 28 weeks more than 140 or above>

Strict sugar monitoring by glucometer. The patient is asked to follow a strict low sugar diet. Good exercise and walking. Sonography is repeated to see fluid and growth of baby and size of a baby. If sugar is under control, the same diet and exercise are continued or else tablet like metphormin is added to lower the sugar level or else sometimes insulin must be added. Time of delivery: Mostly between 38-40 weeks as sugar tends to increase after. Between 38-40 weeks induction of labor is offered. If baby size is too big then C-section is planned. Birth difficulty:

• Prolonged labor
• Shoulder dystocia (shoulder can get stuck)
• Perineal laceration

Post-delivery care: Baby's kept in neonatal care unit and sugar monitored regularly for 24 hours. If sugar is normal baby is shifted to the mother. Baby sometimes may have respiratory distress. Baby's more prone to develop jaundice. These babies are more prone to have diabetes, so breastfeeding is very important. For mother's the sugar is checked for 24 hours. Then after discharge sugar is checked after 6 weeks and then every 6 months. These mothers are more prone to have diabetes after 15 to 20 years. So once diagnosed by gestational diabetes patient should follow a strict discipline and visit a Gynec, physician and dietitian.