This document discusses gestational diabetes mellitus (GDM). It defines GDM as carbohydrate intolerance that begins or is first recognized during pregnancy, usually in the second or third trimester. The document outlines the physiological changes in pregnancy that can contribute to GDM, including increased insulin resistance caused by hormones like estrogen and progesterone. It also lists predisposing factors for GDM and discusses Priscilla White's classification system for GDM and diabetes in pregnancy. This classification distinguishes between gestational diabetes and pre-existing diabetes and further stratifies them based on risks and management needs. The document concludes by defining overt or pre-existing diabetes diagnosed during pregnancy.

1. GESTATIONAL
DIABETES
MELLITUS
Nishitha A

2. Objectives
• Definition
• Physiological Changes during Pregnancy
• Pre-disposing factors
• Classification
• Overt Diabetes

3. GDM
• Carbohydrate Intolerance of variable severity
with onset or first recognition during the first
pregnancy
• Presents usually in the 2nd or 3rd trimester
• More appropriately called Pregnancy induced
Glucose tolerance

4. Metabolic Changes
• Insulin secretion - hypertrophy and
hyperplasia of β-cells of pancreas.
• Sensitivity of Insulin receptors is
• Plasma insulin level is - presence of contra-
insulin factors
• Ensures continuous supply of glucose to the
foetus.

5. Metabolic changes
• Contra- insulin factors:
1. Oestrogen
2. Progesterone
3. Human Placental Lactogen (hPL)
4. Cortisol
5. Prolactin
6. Free Fatty acids
7. Increased tissue resistance

7. Effects of hyperinsulinemia
• During Maternal Fasting – hypoglycemia,
hypoinsulinemia, hyperlipidemia,
hyperketonemia
• Lipolysis – fatty acids formation –
Gluconeogenesis – fuel supply to foetus
• Plasma glucagon - Unchanged

8. Effects of hyperinsulinemia
Overall :
• Maternal fasting hypoglycemia
• Postprandial hyperglycemia
• Hyperinsulinemia
• OGTT – abnormal pattern
• Glycosuria – 50% of normal pregnant women

10. Pre-disposing factors
• Positive family history
• Previous stillbirth with Pancreatic islet
hyperplasia
• Previous overweight baby – 4kg or more
• Polyhydramnios

11. Pre-disposing Factors
• Recurrent vaginal candidiasis
• Age > 30 years
• Obesity
• Ethnic group
• Polycystic Ovary Syndrome
• Smoking

14. Classisfication of GDM
• Priscilla White’s Classification is used
• Mainly used for statistical correlation of
different types of pregnant diabetics.
• Vasculopathy – predisposes to risk of
complications like IUD, IUGR, Pre-eclampsia
and ketoacidosis

15. White’s Classification
• Distinguishes b/w gestational diabetes (Type A)
and pre-gestational diabetes (Type B - Type T)
• Further subdivided according to their associated
risks and management.
• Gestational diabetes is classified as: Type A1 &
Type A2
• An early age of onset or long-standing disease
comes with greater risks, hence the first three
subtypes (Type B,C,D).

16. White’s Classisfication
Class Onset Fasting Plasma
Glucose
2 hour postprandial Treatment
A1
A2
Gestational
diabetes
Any age A1: Glucose
<105mg/dl
A2 : >105mg/dl
<120mg/dl
>120mg/dl
Diet
Insulin
Class Age of Onset Duration
(years)
Vascular disease Treatment
B
C
D
F
H
R
RF
T
>20 years
10-19 years
<10 years
Any
Any
Any
Any
Any
<10 years
10-19 years
>20 years
Any
Any
Any
Any
Any
None
None
Benign retinopathy
Nephropathy
Coronary artery disease
Proliferative retinopathy
Retinopathy & Nephropathy
Prior Renal Transplant
Insulin
Insulin
Insulin
Insulin
Insulin
Insulin
Insulin
Insulin

17. Overt Diabetes
• A patient with symptoms of diabetes mellitus
(i.e polyuria, polydipsia, weight loss) and
random plasma glucose concentration of
200mg/ dL or more is considered Overt
Diabetic
• May be pre-existing or detected for the first
time during pregnancy

18. Bibliography
• D.C. Dutta Textbook of Obstetrics – 7th edition
• Mudaliar & Menon
• www.google.com

19. Thank You