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Diabetes
detected prior to pregnancy (Group I)
Diabetes
detected during pregnancy (Group II to Group IV)
(or) Gestational diabetes mellitus
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GDM
- myth or reality?
Is it necessary and worth while
to screen large numbers of pregnant women for GDM?
Yes : Helps in identifying
pregnancies with higher risk for complications like PIH, Hydramnios,
Macrosomia (Big Babies), and IUFD (still birth in the womb).
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Identify the indications
for OGTT.
Use uniform 75G glucose load for OGTT
Diagnostic criteria for GDM to be made uniform by consensus on a
region wise basis.
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Management
of diabetes during pregnancy divided into two broad groups:
Those
requiring Insulin
Group
I
IDDM
or type 1
NIDDM or type 2 controlled on OHA ± insulin and a
small percentage of type 2 diabetes mellitus controlled with diet
/ exercise and
IGTand
about 10% of Group II cases.
Those
who do not require insulin
All cases of Group III and Group IV (GDM & BLGDM) and majority (90%)
of Group II cases.
*To use only Human Insulin during Pregnancy.
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Control
Criteria for Diabetes Pregnancy
There is a good case for using Pyridoxine (Vit.B6) in GDM (Group II to
IV) to improve the carbohydrate tolerance; further planned studies
would be beneficial. The target blood glucose values, HbA1c, Serum
Fructosamire, frequency of blood testing, need for home blood glucose
monitoring in IDDM and other exceptionally difficult and high risk
pregnancies, all these could be rationalized based on scientific
evidence, clinical experience and pragmatic strategies, applicable
in day-to-day practice for obtaining maximum qualitative and quantitative
benefit could be .
Targets for
control of Diabetes in Pregnancy:
1. Fasting:
< 110 mg /dl (6.1 mmol /L)
2. Post-Prandial: 140 mg / dl
(7.7 mmol / L).
3. HbA1C: 6.5 - 7.5%.
4. Serum Fructosamine:
< 3.0 mmol / L.
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Maternal
and foetal complications associated with diabetes and pregnancy
Higher
incidence of PIH (2.2%) and Hydramnios
(3.2%), Macrosomia, Peri/Neo Natal morbidity in the new
born not different to well managed
Diabetes
with Pregnancies & GDM -
Though Group I IDDM cases will pose difficult problems.
Congenital
anomalies in children - higher in Group I (IDDM and IRDM
cases) but not in Group II to IV GDM cases, as compared with non-diabetic
pregnancies.
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Slightly
higher LSCS rate in diabetes pregnancy mainly due to obstetric (maternal
/ foetal) indications and not due to diabetes. The risk of IUFD especially
in IDDM pregnancy and previous BOH has to be constantly borne
in mind and monitored very closely during term.
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Nutrition in pregnancy needs special counselling
and regular monitoring.
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Intensive neonatal care is mandatory for infants
of diabetic mothers (IDM) in Group I - particularly in IDDM and
some IRDM cases.
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The confusion over
diagnosis, management and understanding of diabetes, pregnancy, and
birth should be removed by a planned attempt with
a) National
b) Regional and
c) International working groups and consensus process, which should
have defined aims, objectives and goals and an implementation programme
within a preset time frame (three to five years). |
