GDM & HEALTH CARE PROFESSIONALS GDM & HEALTH CARE PROFESSIONALS

WHAT IS GESTATIONAL DIABETES?

Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with first recognition during pregnancy

WHEN AND WHOM TO SCREEN?

All women should be screened for GDM at the first antenatal visit, if they are not found to have GDM, they should be rescreened between 24-28 weeks gestation, women at higher risk of GDM should be tested early. High-risk women are:

• Elevated blood glucose level
• Belonging to Asian, African, Middle Eastern, Indian subcontinent, and Pacific islander region.
• Family history of diabetes
• Previous macrocosmic baby ( baby weight > 4500g or >90th centile)
• Obese women BMI (Body mass index) >25kg/m2
• Women with Polycystic ovary syndrome.
• Women use medications like antipsychotics, corticosteroids.

HOW GDM IS DIAGNOSED?

GDM diagnostic criteria remains controversial, according to ADA (American diabetes association) following tests/criteria use to confirm GD

Diagnosis of GDM with a 75-g oral glucose load

Duration	mg/dl	mmol/l
Fasting	95	5.3
1-h	180	10.0
2-h	155	8.6

Two or more of the venous plasma concentrations must be met or exceeded for a positive diagnosis. The test should be done in the morning after an overnight fast of between 8 and 14 h and after at least 3 days of unrestricted diet (≥ 150 g carbohydrate per day) and unlimited physical activity. The subject should remain seated and should not smoke throughout the test.

What is MNT?

MNT (medical nutrition therapy) all women with GDM should be counselled by a registered dietitian, for adequate intake of calories and nutrition on individualized bases.

Physical activity?

Moderate physical activity (such as walking) provided no contraindication, shown to have good effects on maternal blood glucose control.

How GDM managed during labour?

GDM is not a contraindication for vaginal delivery provided there is an obstetrical indication. Planning insulin management during delivery in important part of care, with goal to avoid maternal hypoglycemia, while preventing maternal hyperglycemia.

Insulin?

Intensive insulin therapy with basal-bolus therapy or some time continuous subcutaneous insulin infusion (csii) is recommended ton achieve glycemic control. Basal cover is via NPH or insulin analogue detemir /glargine, while bolus cover via regular insulin or insulin analogue lispro, aspart.

Which oral antidiabetic medication can be use safely in GDM?

Although not preferred but Metformin and Glyburide can be use in GDM.

How frequently SMBG done in GDM?

It is recommended that SMBG should be performed four (4) to seven (7) times per day, a before breakfast and one or two hours after each meal, and as there are chances of night time low sugar level in some women so it is also recommend to check sugar at night before sleep.

GDM targets for women without preexisting type 1 or 2 diabetes	Targets for women with preexisting type 1 or 2 who become pregnant.
Prepandial:≤ 95 mg/dL	Premeal, bedtime, overnight glucose: 60-99 mg/dL
1-hr postmeal: ≤140 mg/dL	Peak postprandial glucose: 100-129 mg/dL
2-hr postmeal: ≤120 mg/dL	A1C: <6.0%