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Gestational Diabetes

Gestational Diabetes

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Published by Riezky Febriyanti
etiology , diagnostic criteria, prognosis, management
etiology , diagnostic criteria, prognosis, management

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Categories:Types, School Work
Published by: Riezky Febriyanti on Dec 12, 2012
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12/12/2012

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1
GESTATIONAL DIABETES
What is gestational diabetes?
 
Is a condition in which women without previously diagnosed diabetes exhibit high blood glucoselevels during pregnancy.
 
"Gestational" diabetes implies that this disorder is induced by pregnancy, perhaps due toexaggerated physiological changes in glucose metabolism
 
is formally defined as "any degree of glucose intolerance with onset or first recognition duringpregnancy"
 
Its medical name is gestational diabetes mellitus or GDM
 
different with OVERT DIABETES
 – 
patients known to have diabetes even before pregnancy
 
prevalence may range from 1 to 14% of all pregnancies, and more than 200.000 cases annually
What causes gestational diabetes?
No specific cause has been identified, but it is believed that the hormones produced during pregnancyreduce a woman's sensitivity to insulin, resulting in high blood sugar levels.
Why do some women develop gestational diabetes?
Our body normally makes a hormone called insulin that moves glucose out of the blood and into the cellsof the body. Women with gestational diabetes develop resistance to insulin and cannot move glucose intothe cells. This causes the blood sugar level remain too highAlmost all women have some degree of impaired glucose intolerance during pregnancy as a result of hormonal changes that occur during pregnancy. That means that their blood sugar may be higher thannormal, but not high enough to have diabetes. During the later part of pregnancy (the third trimester),these hormonal changes place pregnant woman at risk for gestational diabetes.The placenta is a system of vessels that passes nutrients, blood, and water from mother to fetus. Theplacenta makes certain hormones that may prevent insulin from working the way that it should. When thiscondition happens, it is referred to as insulin resistance. In order to keep metabolism normal duringpregnancy, the body has to make three times more insulin than normal to offset the hormones made bythe placenta.Fo
r 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 levelsnormal. These women end up with high blood sugar or gestational diabetes at around the 20th to 24thweek of pregnancy
Who’s at risk for gestational diabetes?
 
 
A previous diagnosis of gestational diabetes or prediabetes, impaired glucose tolerance, orimpaired fasting glycaemia [H]
 
A family history revealing a first degree relative with type 2 diabetes [H]
 
Maternal age - a woman's risk factor increases the older she is (especially if older than 35 years of age)
 
Ethnic background (those with higher risk factors include African-Americans, North Americannative peoples and Hispanics)
 
Being overweight, obese or severely [H]
 
Previous pregnancy which resulted in a child with a high birth weight (>90th centile, or >4000g)[H]
 
2
 
Previous poor obstetric history
 
Diagnosis of polycystic ovarian syndrome [H]
 
Presence of glycosuria [H]
How to know if pregnant woman have diabetes mellitus?
Frequently women with gestational diabetes exhibit no symptoms, so women who are at very high risk should undergo testing as soon as possible. All pregnant women should be screened for gestationaldiabetes at 24-28 weeks gestation, including those with negative test result in the first trimester (low risk).
Diagnosis criteria for Gestational diabetes
Perform blood glucose testing at 24-28 weeks using one of the followingOne-step protocol: 75gr, 2hr Oral Glucose Tolerance Test on all women, normally :Fasting <95 mg/dL (5,3 mmol/L)1 hour <180 mg/dL (10 mmol/L)2 hour <155 mg/dL (8,6 mmol/L)3 hour <140 mg/dL (7,8 mmol/L)Two-step protocol: 50gr, 1hr plasma glucose on all women: if test done in fasting state, threshold is >130mg/dL (>7,2mmol/L); if test done in fed state, threshold is >140 mg/dL (>7,8mmol/L). Then test with 100gr 3hr, in fasting state:Fasting <95 mg/dL (5,3 mmol/L)1 hour <180 mg/dL (10 mmol/L)2 hour <155 mg/dL (8,6 mmol/L)3 hour <140 mg/dL (7,8 mmol/L)If one value is abnormal or exceed any of these threshold, repeat test in 4 weeks.One abnormal value on 3hr GGT can increased risk for fetal
macrosomia
.
 
3
Potential risk of unrelated gestational diabetes
1.
 
Maternal complication
 
Increased risk for caesarean delivery
 
Higher risk of preeclampsia
 
Diabetic ketoacidosis
 
Coronary artery disease
 
Diabetic Nephropathy
 
Retinopathy2.
 
Fetal complication
 
Large for gestational age (macrosomia)
 
Macrosomia in turn increase the risk of instrumental deliveries (e.g. forceps, ventouse, andcaesarean section)
 
Problems during vaginal delivery (such as shoulder dystocia)
 
Stillbirth
 
Neonates are also at an increased risk of low blood glucose (hypoglycemia), jaundice, highred blood cell mass (polycythemia) and low blood calcium (hypocalcemia) and magnesium(lypomagnesemia)

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