Diabetes in

Pregnancy
KKIA Sebisak
 Diabetes is all about insulin level
and sugar levels and what you put
inside your body
Agenda
Introduction
Screening
Complications
Management
 Introduction
Gestational Pre-existing
DM DM
Diabetes Mellitus diagnosed before pregnancy
Any degree of glucose intolerance which is first Overt DM is suspected in the presence of at least one
detected during pregnancy of the following:
≥
FPG 7.0 mmol/L or Random plasma glucose (RPG)
≥ 11.1 mmol/L.
 Pathophysiology

DIABETOGENIC STATE HUMAN PLACENTAL LACTOGEN INSULIN

-produces by synciotrophoblast -maternal pancreas increase the
-Maternal metabolism is production of insulin to maintain
altered to ensure -promotes lipolysis
-FFA increase insulin resistance, stable carbohydrate metabolism
appropriate supply of -insulin cannot overcome the
glucose to foetus circulatory glucose increase to
meet foetal demand effect of counter regulatory
-anti-insulin hormones hormone
SCREENING
WHO?
HOW?
WHEN?
 WHO & WHEN
Women age ≥25 with no other risk factor: at 24-28 weeks of gestation
Women at risk to develop GDM**: at booking/as early as possible
 HOW?
75g oral glucose
tolerance test

OGTT Results
Fasting plasma glucose (FPG): ≥5.1 mmol/L
or
2-hours postprandial (2-HPP) ≥7.8 mmol/L
 COMPLICATIONS

Macrosomia Pre- eclampsia

Sudden IUD Pyelonephritis
Shoulder dystocia Polyhdramnios
Congenital anomalies Preterm delivery
Abortion Operative delivery
Hypoglycemia Hypoglycemia
Birth injuries Diabetic vasculopathy

Foetal/Neonatal Maternal
MANAGEMENT
Preconception Care
Discussion on timeline for pregnancy
planning
Lifestyle advice (diet, physical activities,
smoking cessation and optimal body weight)
Folic acid supplementation
Appropriate contraception
Full medication review (discontinue
potentially teratogenic medications)
Retinal and renal screening
Relevant blood investigations
 Checklist
Diagnosis : Preexisting DM/GDM
Counselling on diagnosis & complications from uncontrolled glucose
Counselling on symptoms of hyper- & hypo-glycaemia
Dietician referral
Treatment : Diet control/Metformin/Insulin
Own glucometer
7BSP
For preexisting DM/GDM diagnosed in early pregnancy :
a. Baseline creatinine
b. Baseline Hba1c
c. Opthalmology referral
d. Detailed scan refferal
e. Cardiovasculopathy/nephropathy/retinopathy/neuropathy
Self monitoring blood glucose
Provide each woman with 7BSP monitoring chart
Advise women to take meal regularly (breakfast, lunch and dinner)

BREAKFAST LUNCH DINNER BED

DATE
PRE POST PRE POST PRE POST PRE

DAY 1 X X

DAY 2

X X

DAY 3



X X X

Target readings :
Pre-prandial & pre-bed : 4.0 -5.3 mmol/L
Post- prandial : 4.0 - 6.7 mmol/L
 General
Management
Weight Management
Recommended weight gain during pregnancy :

Prepregnancy Mean rates of weight gain

Total weight gain
BMI (kg/week)

Underweight
12.5-18kg 0.5kg/week
(<18.5)

Normal
11.5-16kg 0.4kg/week
(18.5-24.9)

Overweight
7.0-11.5kg 0.3kg/week
(25.0-29.9)

Obese (>30) 5.0-9.0kg 0.2kg/week

Timing & Mode of Delivery
In pregnant women with pre-existing diabetes with:
no complications, deliver between 37+0 and 38+6 weeks
maternal or fetal complications, deliver before 37+0 weeks
In women with GDM:
on diet alone with no complications, deliver before 40+0 weeks
on oral antidiabetic agents or insulin, deliver between 37+0 and
38+0 weeks
with maternal or fetal complications, deliver before 37+0 weeks
• Mode of delivery should be individualised, taking into
consideration the estimated fetal weight and obstetric factors.
Postpartum
Insulin requirements drop immediately after delivery by 60-75%
Most women with GDM should be able to discontinue their insulin
therapy immediately after delivery
For GDM women whose blood glucose normalised immediately
after delivery :
For MOGTT at 6 weeks postpartum
Early MOGTT during next pregnancy
For annual screening of diabetes and lifestyle modifications
Thank you!
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