This document discusses gestational diabetes, including its pathophysiology, epidemiology, complications, and management. Some key points: - Gestational diabetes occurs in 3-10% of pregnancies and is the most common medical complication. It increases risks of complications for both mother and baby. - Complications for the baby include macrosomia, hypoglycemia, hypocalcemia, hypomagnesium, and congenital malformations. - Management involves tight glycemic control both during pregnancy and in neonatal care of the baby. Babies may require IV glucose therapy if hypoglycemic. Close monitoring of glucose and other biomarkers is important for both mother and baby outcomes.

1. Prepared By: Dr. Shaju Edavana

2.  Introduction
 Pathophysiology
 Epidemiology
 Complications
 Management

3.  Diabetes - most common medical
complication of pregnancy
 Still an increased risk of complications

4.  Any abnormal intolerance that begins or is
first recognized during pregnancy using
glucose tolerance test
 Using 100 mg glucose load
 Two or more of the plasma glucose
concentration must be met for the diagnosis.

5.  Insulin level inhibit the maturational effect of
control on the lungs (RDS)
Gestational age Pathophysiology
Before 9 weeks Malformation
Before 20 weeks fetal islet cells are incapable of responding
hyperglycemia leading to IUGR.
After 20 weeks Fetus responds to hyperglycemia with
pancreatic beta cell hyperplasia and insulin
levels.

6. Seen in 3-10 % of pregnancies
In Kuwait incidence of Diabetes is high
23 % of population are diabetic-
35% type 1 and 65% type 2

7.  Major congenital malformations are found in
5-9 % of affected infants
Affected Group Mortality Rates
Still birth and perinatal 5 times more than general
population
Neonates 15 times
Infants 3 times

8.  Fetal macrosomia
 Fetal congenital malformation
 Impaired fetal growth
 Pulmonary disease
 Metabolic and electrolyte abnormalities
 Haematological problems
 Cardiovascular abnormalities
 Congenital malformations

9.  Large for gestational age
 Birth weight more than 90th percentile or
above 4000 gm
 More likely to have hyperbilirubinemia,
hypogycemia and acidosis
 Birth injury, shoulder dystocia
 Brachial plexus palsy and Subdural
haemorrhage
 Facial palsy

10.  Impaired Fetal growth (associated with ‘Too
tight control’ )
 Maternal vascular disease
is the common cause of
impaired fetal growth

11.  Poor glycaemic control
 Associated with high risk of UTI and
maternal preeclampsia

12.  Increased number of Respiratory Distress
Syndrome
 More incidence of TTN, PPHN and
pneumothorax
 In contrast, Fetal lung maturation may occur
in diabetic pregnancies complicated by
vasculopathy

13.  Blood glucose level less than 2.6 mmol/L
 Caused by hyper insulinemia due to hyperplacia of Fetal
pancreatic beta cells
 Neonate develops hypoglycaemia - continuous supply of
glucose is stopped after birth
 Strict glycaemic control decreases but does not abolish the risk
 Symptoms –
• Jitteriness
• Irritability
• Poor feeding
• Weak cry
• Hypotonia
• Seizure

14.  Definition → total serum calcium < 1.8 mmol/L
or ionized calcium < 1 mmol/L
 Caused by lower PTH level
 Symptoms → jitteriness or seizures

15.  Definition → serum magnesium
concentration less than 0.75 mmol/L
 Mechanism is increased urinary loss
secondary to diabetes
 Prematurity may be a contributing factor
 Hypocalcaemia may not respond to
treatment until the hypomagnesaemia is
corrected.

16.  65% of all IDMs demonstrate abnormalities of
iron metabolism at birth
 Iron deficiency increases an infants risks for
neuro-developmental abnormalities

17.  Haematocrit more than 65%
 Plethoric appearance, sluggish capillary refill
or respiratory distress
 Excess red blood cells precursors lead to
hyperbilirubinemia or thrombocytopenia.

18.  Hypertrophic cardiomyopathy with intra
ventricular hypertrophy may occur in 50% of IDM
 Infants are often asymptomatic, but 5 to 10%
have respiratory distress or sign of heart failure
 Symptomatic infants typically recover after 2-3
weeks of supportive care
 VSD
 TGA
 PDA

19.  Caudal Regression Syndrome → structural
defects of caudal region → 200 times more
frequent
 Severe form is known as Sirenomelia or Mermaid
Syndrome
 Risk of Spinabifida →20 times higher
 Anencephaly → 13 times
 Microcephaly, holoprosencephaly

20.  Renal → hydronephrosis, renal agnesis,
ureteral duplication
 GI → duodenal or anorectal atresia, Small
Left Colon Syndrome (presents as transient
inability to pass meconium, lower bowel
obstruction)

21.  Unilateral micro-opthalmia
 Bilateral Microtia
 Cleft Palate
 Micro Penis
 Unilateral Cryptorchidism
 Bilateral Radial Hypoplasia
 Unilateral Polydactyly
 Bifid Tongue
 Single Umbilical Artery

22.  Investigation
1. CBC
2. RBS
3. ABG
4. Calcium
5. Magnesium
6. Chest X-ray
7. Abdominal X-ray
8. Echo
9. Barium Enema

23.  Periconception control
 HbA1C – maintain 7% -tight glycemic control
and avoid pre-eclampsia

24.  Intervention is required if:
1. plasma value < 36 mg/dL or 2 mmol/L
2. infant develop symptoms
3. glucose level does not increase after feeding
 Target glucose level 45 mg/dL or 2.5 mmol/L
 Profound hypoglycaemia requires IV therapy
with hydrocortisone

25.  Immediate IV therapy with 2-4 ml/Kg in
symptomatic infants
 Maintain continuous infusion of 6-8 mg/Kg/min
 If the follow-up glucose level remains low,
dextrose infusion increase by 2 mg/kg/min
 Maintain 80-100 ml/kg/day
 If infant requires dextrose concentration more
than 12.5% insert central line

26.  Early breast feeding- colustrum as well as
breast milk provides generous concentration
of glucose
 Monitor plasma glucose routinely
 Adequate enteral feeding
 Cardiologic screening
 Excellent prognosis