Description
Gestational Diabetes Mellitus (GDM) is one of the most common medical complications of pregnancy, with significant implications for both mother and baby. This webinar will cover current guidelines on screening and diagnosis of GDM, including timing and recommended tests. Evidence-based management strategies, focusing on lifestyle modification, glucose monitoring, and pharmacological treatment, will be discussed. Participants will gain practical insights into optimizing glycemic control during pregnancy. The session will also highlight maternal and fetal outcomes and the importance of postpartum follow-up.
Summary Listen
- Gestational Diabetes Mellitus (GDM) is a dysglycemia first recognized in pregnancy, encompassing new-onset type 1 or type 2 diabetes, and pre-existing pre-diabetes. It poses short-term and long-term risks to both mother and fetus. Obstetric complications include preterm delivery, hypertensive disorders, and cesarean sections. Neonatal complications include macrosomia and other problems. It is also a precursor to type 2 diabetes, metabolic syndrome, and cardiovascular diseases in both mother and child.
- Early GDM, diagnosed before 20 weeks of gestation, accounts for 30-70% of total GDM cases, while late GDM is diagnosed after 20 weeks. Macrosomia is defined as birth weight exceeding 4 kg, and Large for Gestational Age (LGA) refers to infants with a gestational age exceeding the 90th percentile. Global statistics reveal that one in six live births is affected by GDM, with almost half of cases occurring under the age of 30. India has a significant prevalence, with figures varying from 16% to 32.9% across different regions.
- The exact causes of GDM remain unknown, but factors include gestational weight gain, maternal obesity, socio-economic factors, maternal and fetal genetics, pre-existing glucose intolerance, and ethnicity. In normal pregnancy, beta cells compensate for decreased insulin sensitivity by increasing in size and function. In GDM, this compensation is inadequate, leading to increased blood glucose concentration.
- Different subtypes of GDM exist, including late gestational diabetes insulin resistant, late gestational diabetes insulin deficient, and early gestational diabetes, which is a combination of both. Early GDM can lead to miscarriage and impaired placentation, while late GDM affects organ development. Early glucose dysregulation also impacts placental and organ development, potentially leading to unfavorable fetal outcomes.
- The placenta acts as a link between the maternal and fetal environments, and glucose dysregulation affects its development. Fetal insulin, which starts after the 12th week, influences the development of various fetal organs. Maternal diabetic environment in the first trimester can affect neural, heart, pancreas, liver, and kidney development.
- Diagnosis can be performed using a single-test or multi-test procedure. The single-test procedure, such as the Dipsi guideline recommends a 75-gram oral glucose tolerance test (OGTT) at the first antenatal visit, repeating the test at 24-28 weeks. Multi-test procedures include one-step and two-step strategies. OGT is the gold standard for GDM diagnosis.
- Management involves diet and lifestyle education, glucose self-monitoring, and pharmacotherapy. The Dipsi workflow involves starting with medical nutrition therapy and physical exercise, followed by monitoring two-hour post-prandial glucose. Diet plans should be designed by a registered dietitian, following the healthy plate method and considering individual calorie needs based on BMI.
- Physical activity should include aerobic and resistance exercises, with moderate intensity and a frequency of at least five days a week. Insulin is the first-line pharmacotherapy, with metformin as an alternative. Glucose monitoring involves self-monitored blood glucose (SMBG) at least three to four times a day and continuous glucose monitoring (CGM) is also an option. The goal is tight glycemic control, with fasting sugar between 80-90 mg/dL and post-prandial glucose between 110-120 mg/dL.
- Obstetric care includes early visits for accurate dating and risk factor identification, along with individualized surveillance and management. Fetal monitoring involves detailed scans at 18-20 weeks and subsequent monitoring of abdominal circumference and estimated fetal weight. Postpartum care includes repeat oral glucose tolerance testing, ideally within the first six years to detect potential type 2 diabetes. The care should not be just for the management of sugar in the pregnancy it should start in early life and then continues on.
Sample Certificate
About the Speakers
Dr. Vinaykumar Mukhekar
Diabetes & Obesity Medicine Specialist, Advanced Diabetes & Weight Loss Clinic, Navi Mumbai
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