SlideShare a Scribd company logo
1 of 19
Download to read offline
GESTATIONAL DIABETES
MELLITUS – SCREENING
PRESENTEB BY:-
ROHAN THOMAS ROY
CRRI
DEPT. OF OBSTETRICS AND GYNECOLOGY
OUTLINE:-
 DEFINITION
 IMPORTANCE
 PREGNANCY – A DIABETOGENIC STATE
 WHEN DOES GESTATIONAL DIABETES DEVELOP?
 WHEN SHOULD WE DO SCREENING?
 WHAT ARE THE SCREENING TESTS?
DEFINITION:-
 Gestational diabetes is defined as carbohydrate intolerance of variable severity with
onset or first recognition during pregnancy (American College of Obstetricians
and Gynecologists, 2013).
 Therefore, it may include women with pre – existing but previously
unrecognized diabetes.
 Since it occurs in the later half of pregnancy, it doesn’t have any effect on
organogenesis.
 The main problem with gestational diabetes is macrosomia which usually reverts
to normal following delivery.
IMPORTANCE
 Use of the term gestational diabetes has been encouraged to communicate
the need for increased surveillance and to stimulate women to seek further
testing postpartum.
 The most important perinatal correlate is excessive fetal growth, which may
result in both maternal and fetal birth trauma.
 The likelihood of fetal death with appropriately treated gestational diabetes
is not different from that in the general population.
 Importantly, more than half of women with gestational diabetes ultimately
develop overt diabetes in the ensuing 20 years
WHY PREGNANCY IS A DIABETOGENIC
STATE?
 Pregnancy is a state of physiological Insulin Resistance especially in the second half.
 Estrogen, Progesterone and Human Placental Lactogen act as insulin antagonists
causing insulin resistance.
 HPL LIPOLYSIS FREE FATY ACIDS INSULIN RESISTANCE
 Plasma Cortisol also increase leading to Insulin Resistance.
 As a result pancreas produce more insulin and plasma glucose levels fall.
 Pregnancy is characterized by fasting hypoglycemia and postprandial hyperglycemia.
 In the fasting state there is hypoglycemia, decreased amino acids, and
increased triglycerides breaking down into free fatty acids and ketone
bodies.
 When fasting is prolonged, these all are exaggerated and ketosis
appears.
 This pregnancy – induced switch in fuels from glucose to lipids has
been described as accelerated starvation.
WHEN DOES GESTATIONAL DIABETES
DEVELOP?
 GDM develops when a stage is reached, when the pancreas despite the
increased insulin production cannot counter the insulin resistance caused by
the pregnancy hormones.
 GDM usually occurs in women with poor pancreatic reserve and insulin
resistance such as those with polycystic ovary syndrome or a family history of
diabetes.
 It usually appears after 24 weeks of pregnancy.
SCREENING OF GESTATIONAL DIABETES
 There are two ways of screening UNIVERSAL SCREENING
SELECTIVE SCREENING
 In Universal screening all women are screened, while in selective screening
only those women who have the risk factors are screened.
 They are:-
HISTORY CLINICAL
Age > 30 Obesity
Previous GDM Polyhydraminos
Family H/O diabetes Repeated Infections
Previous macrosomic baby Macrosomia
Bad obstetric history Glycosuria
Polycystic ovary syndrome
Fifth International Workshop-Conference on Gestational Diabetes:
Recommended Screening Strategy Based on Risk Assessment for Detecting
Gestational Diabetes (GDM)
 GDM risk assessment: should be ascertained at the first prenatal visit.
 Low Risk: Blood glucose testing not routinely required if all the following
are present:
(i) Member of an ethnic group with a low prevalence of GDM
(ii) No known diabetes in first-degree relatives
(iii) Age < 25 years
(iv) Weight normal before pregnancy
(v) Weight normal at birth
(vi) No history of abnormal glucose metabolism
(vii) No history of poor obstetrical outcome
 Average Risk: Perform screening test between 24 to 28 weeks using either:
Two-step procedure: 50-g oral glucose challenge test (GCT), followed by a
A diagnostic100-g OGTT for those meeting the threshold value in the GCT.
One-step procedure: diagnostic 100-g OGTT performed on all subjects.
 High Risk: Perform screening test as soon as possible, using the
procedures described above, if one or more of these factors are
present:
(i) Severe obesity
(ii) Strong family history of type 2 diabetes
(iii) Previous history of GDM, impaired glucose metabolism, or glycosuria
(iv) If GDM is not diagnosed, screening should be repeated at 24 to 28
weeks’ gestation or at any time symptoms or signs suggest
hyperglycemia
Gestational Diabetes Mellitus -
Screening Guidelines
Diabetes risk assessment
Average to
low risk
Screen at 24
to 28 weeks
gestation
Positive for
GDM
Negative for
GDM
Postpartum
Screen for
diabetes at 6-
12 weeks1,2
Lifelong
screening for
diabetes every
3 years3
Prediabetes
Diabetes
Normoglycemia
Treat3
TREAT
THRESHOLD VALUES FOR DIAGNOSING
GDM
Plasma glucose Glucose concentration
Threshold
Above threshold
(%)
cumulative
mmol/L mg/dl
Fasting 5.1 92 5.6
1 hour OGTT 10.0 180 14.0
2 hour OGTT 8.5 153 16.1
One or more of these values must be equaled or exceeded for the diagnosis of
gestational diabetes.
THE SCREENING TESTS….
 There are two approaches:-
1. SINGLE STEP APPROACH
2. TWO STEP APPROACH
 This Single Step Approach was greatly influenced by results of the
Hypoglycemia and Pregnancy Outcomes (HAPO) Study. Although the ADA
adopted this new scheme, the American College of Obstetricians and
Gynecologists (2013) declined to endorse the single 75-gram oral glucose
tolerance test.
 Instead, the College continues to recommend a two-step approach to
screen and diagnose gestational diabetes.
SINGLE STEP APPROACH
 Here the patient is given 75g of oral glucose without prior 50g glucose
challenge test.
 The test should be performed in the morning after an overnight fast of at
least 8 hr but not more than 14 hr and after at least 3 days of unrestricted
diet (≥ 150 g/d) and physical activity.
 Fasting and 2hr values are estimated.
TWO STEP APPROACH
 The recommended two-step approach begins with either universal or risk-
based selective screening using a 50-g, 1-hour oral glucose challenge test.
 This 50-g screening test is followed by a diagnostic 100-g, 3-hour oral glucose
tolerance test (OGTT) if screening results meet or exceed a predetermined
plasma glucose concentration.
 The plasma glucose level is measured 1 hour after a 50-g oral glucose load
without regard to the time of day or time of last meal.
 The American College of Obstetricians and Gynecologists (2013) recommends
using either 135 or 140 mg/dL as the 50-g screen threshold.
 In the 100g OGTT, the woman should have been on an unrestricted diet for
the previous 3 days and fasting overnight.
 The fasting, 1 hour, 2 hour and 3 hour values are estimated.
GDM Diagnostic Criteria for OGTT Testing
75-g 2-hour† 100-g 3-hour*
Fasting plasma glucose
(FPG)
92 mg/dL (5.1 mmol/L)2 95 mg/dL (5.3 mmol/L)2
1-hour post-challenge
glucose
180 mg/dL (10.0 mmol/L)2 180 mg/dL (10.0 mmol/L)2
2-hour post-challenge
glucose
153 mg/dL (8.5 mmol/L2 155 mg/dL (8.6 mmol/L)2
3-hour post-challenge
glucose
140 mg/dL (7.8 mmol/L)2
†A positive diagnosis requires that test results satisfy any one of these criteria
*A positive diagnosis requires that ≥2 thresholds are met or exceeded
SESHIAH TEST
 The pregnant women should be given 75g oral glucose irrespective of
whether she is fasting or not.
 Irrespective of the time of her last meal.
 The 2 hour plasma glucose level is estimated.
 If the value is more than or equal to 140 mg/dl, its diagnostic of GDM.
 Performing the procedure in the non fasting state is rational, as
glucose concentration are affected little by the time since the last
meal in a normal glucose tolerant woman, where as it will, in a
woman with gestational diabetes.
 After a meal, a normal glucose tolerant woman would be able to maintain
euglycaemia despite glucose challenge due to brisk and adequate insulin
response, whereas, a woman with GDM who has impaired insulin secretion,
her glycemic level increases with a meal and with glucose challenge, the
glycaemic excursion exaggerates further.
 This cascading effect is advantageous as this would not result in false positive
diagnosis of GDM.
 Advantages:-
1. Pregnant woman need not be fasting
2. Causes least disturbance in a pregnant woman’s routine activities.
3. Serves as both screening and diagnostic procedure.
THIS SINGLE STEP PROCEDURE HAS BEEN APPROVED BY MINISTRY OF
HEALTH, GOVERNMENT OF INDIA AND ALSO RECOMMENDED BY WHO.
GESTATIONAL DIABETES MELLITUS SCREENING

More Related Content

What's hot

REDUCED FETAL MOVEMENTS - HOW TO PROCEED BY DR SHASHWAT JANI
REDUCED FETAL MOVEMENTS - HOW TO PROCEED BY DR SHASHWAT JANIREDUCED FETAL MOVEMENTS - HOW TO PROCEED BY DR SHASHWAT JANI
REDUCED FETAL MOVEMENTS - HOW TO PROCEED BY DR SHASHWAT JANIDR SHASHWAT JANI
 
Cervical incompetence
Cervical incompetenceCervical incompetence
Cervical incompetenceNikita Sharma
 
Follow up of vesicular mole
Follow up of vesicular moleFollow up of vesicular mole
Follow up of vesicular moleVishnu Ambareesh
 
Deep transverse arrest
Deep transverse arrestDeep transverse arrest
Deep transverse arrestpriya saxena
 
Fibroid complicating pregnancy
Fibroid complicating pregnancyFibroid complicating pregnancy
Fibroid complicating pregnancyMilan Kharel
 
Fetal growth restriction
Fetal growth restrictionFetal growth restriction
Fetal growth restrictionKirtan Vyas
 
MANAGEMENT OF GESTATIONAL DIABETES MELLITUS BY DR SHASHWAT JANI
MANAGEMENT OF GESTATIONAL DIABETES MELLITUS BY DR SHASHWAT JANIMANAGEMENT OF GESTATIONAL DIABETES MELLITUS BY DR SHASHWAT JANI
MANAGEMENT OF GESTATIONAL DIABETES MELLITUS BY DR SHASHWAT JANIDR SHASHWAT JANI
 
Abnormal Uterine Bleeding by Dr Kemi Dele
Abnormal Uterine Bleeding by Dr Kemi DeleAbnormal Uterine Bleeding by Dr Kemi Dele
Abnormal Uterine Bleeding by Dr Kemi DeleKemi Dele-Ijagbulu
 
Carbohydrate metabolism in pregnancy
Carbohydrate metabolism in pregnancyCarbohydrate metabolism in pregnancy
Carbohydrate metabolism in pregnancysaisucheethra
 
Thyroid diseases in pregnancy
Thyroid diseases in pregnancyThyroid diseases in pregnancy
Thyroid diseases in pregnancyikramdr01
 
Rh negative pregnancy
Rh negative pregnancyRh negative pregnancy
Rh negative pregnancyobgymgmcri
 

What's hot (20)

REDUCED FETAL MOVEMENTS - HOW TO PROCEED BY DR SHASHWAT JANI
REDUCED FETAL MOVEMENTS - HOW TO PROCEED BY DR SHASHWAT JANIREDUCED FETAL MOVEMENTS - HOW TO PROCEED BY DR SHASHWAT JANI
REDUCED FETAL MOVEMENTS - HOW TO PROCEED BY DR SHASHWAT JANI
 
Cervical incompetence
Cervical incompetenceCervical incompetence
Cervical incompetence
 
Follow up of vesicular mole
Follow up of vesicular moleFollow up of vesicular mole
Follow up of vesicular mole
 
Deep transverse arrest
Deep transverse arrestDeep transverse arrest
Deep transverse arrest
 
Cardiac disease in pregnancy
Cardiac disease in pregnancyCardiac disease in pregnancy
Cardiac disease in pregnancy
 
Fibroid complicating pregnancy
Fibroid complicating pregnancyFibroid complicating pregnancy
Fibroid complicating pregnancy
 
Molar pregnancy
Molar pregnancyMolar pregnancy
Molar pregnancy
 
Fetal growth restriction
Fetal growth restrictionFetal growth restriction
Fetal growth restriction
 
MANAGEMENT OF GESTATIONAL DIABETES MELLITUS BY DR SHASHWAT JANI
MANAGEMENT OF GESTATIONAL DIABETES MELLITUS BY DR SHASHWAT JANIMANAGEMENT OF GESTATIONAL DIABETES MELLITUS BY DR SHASHWAT JANI
MANAGEMENT OF GESTATIONAL DIABETES MELLITUS BY DR SHASHWAT JANI
 
adenomyosis
adenomyosisadenomyosis
adenomyosis
 
Abnormal uterine bleeding
Abnormal  uterine bleedingAbnormal  uterine bleeding
Abnormal uterine bleeding
 
WHO labour guide.pdf
WHO labour guide.pdfWHO labour guide.pdf
WHO labour guide.pdf
 
Abnormal Uterine Bleeding by Dr Kemi Dele
Abnormal Uterine Bleeding by Dr Kemi DeleAbnormal Uterine Bleeding by Dr Kemi Dele
Abnormal Uterine Bleeding by Dr Kemi Dele
 
Carbohydrate metabolism in pregnancy
Carbohydrate metabolism in pregnancyCarbohydrate metabolism in pregnancy
Carbohydrate metabolism in pregnancy
 
Postdate pregnancy
Postdate pregnancyPostdate pregnancy
Postdate pregnancy
 
management of placenta previa
management of placenta previamanagement of placenta previa
management of placenta previa
 
Shoulder dystocia
Shoulder dystociaShoulder dystocia
Shoulder dystocia
 
Thyroid diseases in pregnancy
Thyroid diseases in pregnancyThyroid diseases in pregnancy
Thyroid diseases in pregnancy
 
Rh negative pregnancy
Rh negative pregnancyRh negative pregnancy
Rh negative pregnancy
 
Molar pregnancy
Molar pregnancyMolar pregnancy
Molar pregnancy
 

Viewers also liked

Philippine CPG on Diagnosis & Screening for Gestational Diabetes
Philippine CPG on Diagnosis & Screening for Gestational DiabetesPhilippine CPG on Diagnosis & Screening for Gestational Diabetes
Philippine CPG on Diagnosis & Screening for Gestational DiabetesIris Thiele Isip-Tan
 
Diabetes dalam kehamilan
Diabetes dalam kehamilanDiabetes dalam kehamilan
Diabetes dalam kehamilanamel015
 
Medical Complications In Pregnancy
Medical Complications In PregnancyMedical Complications In Pregnancy
Medical Complications In PregnancyDJ CrissCross
 
Universal screening for gestational diabetes by DIPSI test by Dr.Preksha
Universal screening for gestational diabetes by DIPSI test by Dr.PrekshaUniversal screening for gestational diabetes by DIPSI test by Dr.Preksha
Universal screening for gestational diabetes by DIPSI test by Dr.PrekshaDr. Preksha Jain
 
DM in pregnancy 5 points
DM in pregnancy 5 pointsDM in pregnancy 5 points
DM in pregnancy 5 pointsHanifullah Khan
 
Diabetes during Pregnancy - Risk Factors, Detection, & Treatment
Diabetes during Pregnancy - Risk Factors, Detection, & TreatmentDiabetes during Pregnancy - Risk Factors, Detection, & Treatment
Diabetes during Pregnancy - Risk Factors, Detection, & TreatmentAshutosh Pandit
 
Diabetes in pregnancy segamat 2012
Diabetes in pregnancy segamat 2012Diabetes in pregnancy segamat 2012
Diabetes in pregnancy segamat 2012Dr Zharifhussein
 
Diabetes and pregnancy - Endocrine society guidelines 2013
Diabetes and pregnancy - Endocrine society guidelines 2013Diabetes and pregnancy - Endocrine society guidelines 2013
Diabetes and pregnancy - Endocrine society guidelines 2013Jagjit Khosla
 
Gestational diabetes mellitus
Gestational diabetes mellitusGestational diabetes mellitus
Gestational diabetes mellitusNabelle Rabbitson
 
Diabetes mellitus in pregnancy
Diabetes mellitus in pregnancyDiabetes mellitus in pregnancy
Diabetes mellitus in pregnancyPrativa Dhakal
 

Viewers also liked (17)

Philippine CPG on Diagnosis & Screening for Gestational Diabetes
Philippine CPG on Diagnosis & Screening for Gestational DiabetesPhilippine CPG on Diagnosis & Screening for Gestational Diabetes
Philippine CPG on Diagnosis & Screening for Gestational Diabetes
 
Diabetes dalam kehamilan
Diabetes dalam kehamilanDiabetes dalam kehamilan
Diabetes dalam kehamilan
 
Medical Complications In Pregnancy
Medical Complications In PregnancyMedical Complications In Pregnancy
Medical Complications In Pregnancy
 
Diabetes in Pregnancy
Diabetes in PregnancyDiabetes in Pregnancy
Diabetes in Pregnancy
 
Gestational Diabetes Mellitus
Gestational Diabetes MellitusGestational Diabetes Mellitus
Gestational Diabetes Mellitus
 
Universal screening for gestational diabetes by DIPSI test by Dr.Preksha
Universal screening for gestational diabetes by DIPSI test by Dr.PrekshaUniversal screening for gestational diabetes by DIPSI test by Dr.Preksha
Universal screening for gestational diabetes by DIPSI test by Dr.Preksha
 
DM in pregnancy 5 points
DM in pregnancy 5 pointsDM in pregnancy 5 points
DM in pregnancy 5 points
 
Diabetes in Pregnancy
Diabetes in PregnancyDiabetes in Pregnancy
Diabetes in Pregnancy
 
Diabetes during Pregnancy - Risk Factors, Detection, & Treatment
Diabetes during Pregnancy - Risk Factors, Detection, & TreatmentDiabetes during Pregnancy - Risk Factors, Detection, & Treatment
Diabetes during Pregnancy - Risk Factors, Detection, & Treatment
 
Diabetes in pregnancy segamat 2012
Diabetes in pregnancy segamat 2012Diabetes in pregnancy segamat 2012
Diabetes in pregnancy segamat 2012
 
Diabetes and pregnancy - Endocrine society guidelines 2013
Diabetes and pregnancy - Endocrine society guidelines 2013Diabetes and pregnancy - Endocrine society guidelines 2013
Diabetes and pregnancy - Endocrine society guidelines 2013
 
Gestational diabetes mellitus
Gestational diabetes mellitusGestational diabetes mellitus
Gestational diabetes mellitus
 
Apple's brand personality
Apple's brand personalityApple's brand personality
Apple's brand personality
 
Gestational Diabetes.
Gestational Diabetes.Gestational Diabetes.
Gestational Diabetes.
 
Diabetes In Pregnancy
Diabetes In PregnancyDiabetes In Pregnancy
Diabetes In Pregnancy
 
Diabetes mellitus in pregnancy
Diabetes mellitus in pregnancyDiabetes mellitus in pregnancy
Diabetes mellitus in pregnancy
 
GESTATIONAL DIABETES
GESTATIONAL DIABETESGESTATIONAL DIABETES
GESTATIONAL DIABETES
 

Similar to GESTATIONAL DIABETES MELLITUS SCREENING

Gestational diabetes mellitus
Gestational diabetes mellitusGestational diabetes mellitus
Gestational diabetes mellitusJasmi Manu
 
Gestational Diabetes Mellitus.pptx
Gestational Diabetes Mellitus.pptxGestational Diabetes Mellitus.pptx
Gestational Diabetes Mellitus.pptxsusanta12
 
Introduction to Gestational Diabetes Mellitus
Introduction to Gestational Diabetes MellitusIntroduction to Gestational Diabetes Mellitus
Introduction to Gestational Diabetes MellitusSumi Singh
 
Diabetes in pregnancy : medical management
Diabetes in pregnancy : medical managementDiabetes in pregnancy : medical management
Diabetes in pregnancy : medical managementRadwa Rasheedy
 
GDM.pptx
GDM.pptxGDM.pptx
GDM.pptxMrsP6
 
Gestational diabetes mellitus
Gestational diabetes mellitusGestational diabetes mellitus
Gestational diabetes mellitusAgasya raj
 
Screening for Diabetes in Pregnancy
Screening for Diabetes in PregnancyScreening for Diabetes in Pregnancy
Screening for Diabetes in Pregnancyhalaahmed5
 
RECENT ADVANCES IN THE MANAGEMENT OF GESTATIONAL DIABETES AND PRE-ECLAMPSIA
RECENT ADVANCES IN THE MANAGEMENT OF GESTATIONAL DIABETES AND PRE-ECLAMPSIARECENT ADVANCES IN THE MANAGEMENT OF GESTATIONAL DIABETES AND PRE-ECLAMPSIA
RECENT ADVANCES IN THE MANAGEMENT OF GESTATIONAL DIABETES AND PRE-ECLAMPSIASyedfahidali
 
Gestational diabetes mellitus
Gestational diabetes mellitusGestational diabetes mellitus
Gestational diabetes mellitusdr hina khudaidad
 
GDM .pptx
GDM .pptxGDM .pptx
GDM .pptxOBGSMC
 
Gestational diabetes mellitus
Gestational diabetes mellitusGestational diabetes mellitus
Gestational diabetes mellitusTushar Ranjan
 
Gestational diabetes
Gestational diabetesGestational diabetes
Gestational diabetesNilesh Kucha
 
Presentation 28.pptx
Presentation 28.pptxPresentation 28.pptx
Presentation 28.pptxDrTejaswini7
 

Similar to GESTATIONAL DIABETES MELLITUS SCREENING (20)

Gestational diabetes mellitus
Gestational diabetes mellitusGestational diabetes mellitus
Gestational diabetes mellitus
 
Gestational Diabetes Mellitus.pptx
Gestational Diabetes Mellitus.pptxGestational Diabetes Mellitus.pptx
Gestational Diabetes Mellitus.pptx
 
Introduction to Gestational Diabetes Mellitus
Introduction to Gestational Diabetes MellitusIntroduction to Gestational Diabetes Mellitus
Introduction to Gestational Diabetes Mellitus
 
GDM_ Dr Selim
GDM_ Dr SelimGDM_ Dr Selim
GDM_ Dr Selim
 
gdm (1).pptx
gdm (1).pptxgdm (1).pptx
gdm (1).pptx
 
GDM
GDMGDM
GDM
 
Gestational Diabetes by Dr Shahjada Selim
Gestational Diabetes by Dr Shahjada SelimGestational Diabetes by Dr Shahjada Selim
Gestational Diabetes by Dr Shahjada Selim
 
gdm (1).pptx
gdm (1).pptxgdm (1).pptx
gdm (1).pptx
 
Diabetes in pregnancy : medical management
Diabetes in pregnancy : medical managementDiabetes in pregnancy : medical management
Diabetes in pregnancy : medical management
 
GDM.pptx
GDM.pptxGDM.pptx
GDM.pptx
 
Gestational diabetes mellitus
Gestational diabetes mellitusGestational diabetes mellitus
Gestational diabetes mellitus
 
Screening for Diabetes in Pregnancy
Screening for Diabetes in PregnancyScreening for Diabetes in Pregnancy
Screening for Diabetes in Pregnancy
 
Diabetes
DiabetesDiabetes
Diabetes
 
RECENT ADVANCES IN THE MANAGEMENT OF GESTATIONAL DIABETES AND PRE-ECLAMPSIA
RECENT ADVANCES IN THE MANAGEMENT OF GESTATIONAL DIABETES AND PRE-ECLAMPSIARECENT ADVANCES IN THE MANAGEMENT OF GESTATIONAL DIABETES AND PRE-ECLAMPSIA
RECENT ADVANCES IN THE MANAGEMENT OF GESTATIONAL DIABETES AND PRE-ECLAMPSIA
 
Gestational diabetes
Gestational diabetesGestational diabetes
Gestational diabetes
 
Gestational diabetes mellitus
Gestational diabetes mellitusGestational diabetes mellitus
Gestational diabetes mellitus
 
GDM .pptx
GDM .pptxGDM .pptx
GDM .pptx
 
Gestational diabetes mellitus
Gestational diabetes mellitusGestational diabetes mellitus
Gestational diabetes mellitus
 
Gestational diabetes
Gestational diabetesGestational diabetes
Gestational diabetes
 
Presentation 28.pptx
Presentation 28.pptxPresentation 28.pptx
Presentation 28.pptx
 

Recently uploaded

"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...Sujoy Dasgupta
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)kishan singh tomar
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project reportNARMADAPETROLEUMGAS
 
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...Shubhanshu Gaurav
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxkomalt2001
 
concept of total quality management (TQM).
concept of total quality management (TQM).concept of total quality management (TQM).
concept of total quality management (TQM).kishan singh tomar
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionkrishnareddy157915
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communicationskatiequigley33
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu Medical University
 
Pregnacny, Parturition, and Lactation.pdf
Pregnacny, Parturition, and Lactation.pdfPregnacny, Parturition, and Lactation.pdf
Pregnacny, Parturition, and Lactation.pdfMedicoseAcademics
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE Mamatha Lakka
 
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...Ganesan Yogananthem
 
Female Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyFemale Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyMedicoseAcademics
 
The Importance of Mental Health: Why is Mental Health Important?
The Importance of Mental Health: Why is Mental Health Important?The Importance of Mental Health: Why is Mental Health Important?
The Importance of Mental Health: Why is Mental Health Important?Ryan Addison
 
Microbiology lecture presentation-1.pptx
Microbiology lecture presentation-1.pptxMicrobiology lecture presentation-1.pptx
Microbiology lecture presentation-1.pptxkitati1
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaSujoy Dasgupta
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.kishan singh tomar
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxNaveenkumar267201
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptPradnya Wadekar
 

Recently uploaded (20)

"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)
 
Cone beam CT: concepts and applications.pptx
Cone beam CT: concepts and applications.pptxCone beam CT: concepts and applications.pptx
Cone beam CT: concepts and applications.pptx
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project report
 
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptx
 
concept of total quality management (TQM).
concept of total quality management (TQM).concept of total quality management (TQM).
concept of total quality management (TQM).
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung function
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communications
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu
 
Pregnacny, Parturition, and Lactation.pdf
Pregnacny, Parturition, and Lactation.pdfPregnacny, Parturition, and Lactation.pdf
Pregnacny, Parturition, and Lactation.pdf
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE
 
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
 
Female Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyFemale Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before Pregnancy
 
The Importance of Mental Health: Why is Mental Health Important?
The Importance of Mental Health: Why is Mental Health Important?The Importance of Mental Health: Why is Mental Health Important?
The Importance of Mental Health: Why is Mental Health Important?
 
Microbiology lecture presentation-1.pptx
Microbiology lecture presentation-1.pptxMicrobiology lecture presentation-1.pptx
Microbiology lecture presentation-1.pptx
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.ppt
 

GESTATIONAL DIABETES MELLITUS SCREENING

  • 1. GESTATIONAL DIABETES MELLITUS – SCREENING PRESENTEB BY:- ROHAN THOMAS ROY CRRI DEPT. OF OBSTETRICS AND GYNECOLOGY
  • 2. OUTLINE:-  DEFINITION  IMPORTANCE  PREGNANCY – A DIABETOGENIC STATE  WHEN DOES GESTATIONAL DIABETES DEVELOP?  WHEN SHOULD WE DO SCREENING?  WHAT ARE THE SCREENING TESTS?
  • 3. DEFINITION:-  Gestational diabetes is defined as carbohydrate intolerance of variable severity with onset or first recognition during pregnancy (American College of Obstetricians and Gynecologists, 2013).  Therefore, it may include women with pre – existing but previously unrecognized diabetes.  Since it occurs in the later half of pregnancy, it doesn’t have any effect on organogenesis.  The main problem with gestational diabetes is macrosomia which usually reverts to normal following delivery.
  • 4. IMPORTANCE  Use of the term gestational diabetes has been encouraged to communicate the need for increased surveillance and to stimulate women to seek further testing postpartum.  The most important perinatal correlate is excessive fetal growth, which may result in both maternal and fetal birth trauma.  The likelihood of fetal death with appropriately treated gestational diabetes is not different from that in the general population.  Importantly, more than half of women with gestational diabetes ultimately develop overt diabetes in the ensuing 20 years
  • 5. WHY PREGNANCY IS A DIABETOGENIC STATE?  Pregnancy is a state of physiological Insulin Resistance especially in the second half.  Estrogen, Progesterone and Human Placental Lactogen act as insulin antagonists causing insulin resistance.  HPL LIPOLYSIS FREE FATY ACIDS INSULIN RESISTANCE  Plasma Cortisol also increase leading to Insulin Resistance.  As a result pancreas produce more insulin and plasma glucose levels fall.  Pregnancy is characterized by fasting hypoglycemia and postprandial hyperglycemia.
  • 6.  In the fasting state there is hypoglycemia, decreased amino acids, and increased triglycerides breaking down into free fatty acids and ketone bodies.  When fasting is prolonged, these all are exaggerated and ketosis appears.  This pregnancy – induced switch in fuels from glucose to lipids has been described as accelerated starvation.
  • 7. WHEN DOES GESTATIONAL DIABETES DEVELOP?  GDM develops when a stage is reached, when the pancreas despite the increased insulin production cannot counter the insulin resistance caused by the pregnancy hormones.  GDM usually occurs in women with poor pancreatic reserve and insulin resistance such as those with polycystic ovary syndrome or a family history of diabetes.  It usually appears after 24 weeks of pregnancy.
  • 8. SCREENING OF GESTATIONAL DIABETES  There are two ways of screening UNIVERSAL SCREENING SELECTIVE SCREENING  In Universal screening all women are screened, while in selective screening only those women who have the risk factors are screened.  They are:- HISTORY CLINICAL Age > 30 Obesity Previous GDM Polyhydraminos Family H/O diabetes Repeated Infections Previous macrosomic baby Macrosomia Bad obstetric history Glycosuria Polycystic ovary syndrome
  • 9. Fifth International Workshop-Conference on Gestational Diabetes: Recommended Screening Strategy Based on Risk Assessment for Detecting Gestational Diabetes (GDM)  GDM risk assessment: should be ascertained at the first prenatal visit.  Low Risk: Blood glucose testing not routinely required if all the following are present: (i) Member of an ethnic group with a low prevalence of GDM (ii) No known diabetes in first-degree relatives (iii) Age < 25 years (iv) Weight normal before pregnancy (v) Weight normal at birth (vi) No history of abnormal glucose metabolism (vii) No history of poor obstetrical outcome  Average Risk: Perform screening test between 24 to 28 weeks using either: Two-step procedure: 50-g oral glucose challenge test (GCT), followed by a
  • 10. A diagnostic100-g OGTT for those meeting the threshold value in the GCT. One-step procedure: diagnostic 100-g OGTT performed on all subjects.  High Risk: Perform screening test as soon as possible, using the procedures described above, if one or more of these factors are present: (i) Severe obesity (ii) Strong family history of type 2 diabetes (iii) Previous history of GDM, impaired glucose metabolism, or glycosuria (iv) If GDM is not diagnosed, screening should be repeated at 24 to 28 weeks’ gestation or at any time symptoms or signs suggest hyperglycemia
  • 11. Gestational Diabetes Mellitus - Screening Guidelines Diabetes risk assessment Average to low risk Screen at 24 to 28 weeks gestation Positive for GDM Negative for GDM Postpartum Screen for diabetes at 6- 12 weeks1,2 Lifelong screening for diabetes every 3 years3 Prediabetes Diabetes Normoglycemia Treat3 TREAT
  • 12. THRESHOLD VALUES FOR DIAGNOSING GDM Plasma glucose Glucose concentration Threshold Above threshold (%) cumulative mmol/L mg/dl Fasting 5.1 92 5.6 1 hour OGTT 10.0 180 14.0 2 hour OGTT 8.5 153 16.1 One or more of these values must be equaled or exceeded for the diagnosis of gestational diabetes.
  • 13. THE SCREENING TESTS….  There are two approaches:- 1. SINGLE STEP APPROACH 2. TWO STEP APPROACH  This Single Step Approach was greatly influenced by results of the Hypoglycemia and Pregnancy Outcomes (HAPO) Study. Although the ADA adopted this new scheme, the American College of Obstetricians and Gynecologists (2013) declined to endorse the single 75-gram oral glucose tolerance test.  Instead, the College continues to recommend a two-step approach to screen and diagnose gestational diabetes.
  • 14. SINGLE STEP APPROACH  Here the patient is given 75g of oral glucose without prior 50g glucose challenge test.  The test should be performed in the morning after an overnight fast of at least 8 hr but not more than 14 hr and after at least 3 days of unrestricted diet (≥ 150 g/d) and physical activity.  Fasting and 2hr values are estimated.
  • 15. TWO STEP APPROACH  The recommended two-step approach begins with either universal or risk- based selective screening using a 50-g, 1-hour oral glucose challenge test.  This 50-g screening test is followed by a diagnostic 100-g, 3-hour oral glucose tolerance test (OGTT) if screening results meet or exceed a predetermined plasma glucose concentration.  The plasma glucose level is measured 1 hour after a 50-g oral glucose load without regard to the time of day or time of last meal.  The American College of Obstetricians and Gynecologists (2013) recommends using either 135 or 140 mg/dL as the 50-g screen threshold.  In the 100g OGTT, the woman should have been on an unrestricted diet for the previous 3 days and fasting overnight.  The fasting, 1 hour, 2 hour and 3 hour values are estimated.
  • 16. GDM Diagnostic Criteria for OGTT Testing 75-g 2-hour† 100-g 3-hour* Fasting plasma glucose (FPG) 92 mg/dL (5.1 mmol/L)2 95 mg/dL (5.3 mmol/L)2 1-hour post-challenge glucose 180 mg/dL (10.0 mmol/L)2 180 mg/dL (10.0 mmol/L)2 2-hour post-challenge glucose 153 mg/dL (8.5 mmol/L2 155 mg/dL (8.6 mmol/L)2 3-hour post-challenge glucose 140 mg/dL (7.8 mmol/L)2 †A positive diagnosis requires that test results satisfy any one of these criteria *A positive diagnosis requires that ≥2 thresholds are met or exceeded
  • 17. SESHIAH TEST  The pregnant women should be given 75g oral glucose irrespective of whether she is fasting or not.  Irrespective of the time of her last meal.  The 2 hour plasma glucose level is estimated.  If the value is more than or equal to 140 mg/dl, its diagnostic of GDM.  Performing the procedure in the non fasting state is rational, as glucose concentration are affected little by the time since the last meal in a normal glucose tolerant woman, where as it will, in a woman with gestational diabetes.
  • 18.  After a meal, a normal glucose tolerant woman would be able to maintain euglycaemia despite glucose challenge due to brisk and adequate insulin response, whereas, a woman with GDM who has impaired insulin secretion, her glycemic level increases with a meal and with glucose challenge, the glycaemic excursion exaggerates further.  This cascading effect is advantageous as this would not result in false positive diagnosis of GDM.  Advantages:- 1. Pregnant woman need not be fasting 2. Causes least disturbance in a pregnant woman’s routine activities. 3. Serves as both screening and diagnostic procedure. THIS SINGLE STEP PROCEDURE HAS BEEN APPROVED BY MINISTRY OF HEALTH, GOVERNMENT OF INDIA AND ALSO RECOMMENDED BY WHO.