Glucose intolerance recognized for the first time during pregnancy.

                                                                        Dr. Mitalee Barman

CAUSES:
Placental hormones, human placental lactogen and placental growth hormone, which are meant  to shunt nutrients to the fetus, cause worsening of insulin resistance during the late 2nd trimester

Mothers are unable to produce enough insulin to overcome the overwhelming resistance to maintain normal blood glucose levels.

DIAGNOSTIC CRITERIA

All pregnant women should undergo a 2 hour 75 gm- oral glucose tolerance test between the 24th and 28th week of pregnancy.

Fasting – 92 mg/dl 

1 hr       - 180 mg/dl

2 hr       - 153 mg/dl

Gestational diabetes mellitus is diagnosed if any 2 values are equal to, meet, or exceed the values given above.

FOLLOW UP: 

• Every 3 weeks till 28 weeks of pregnancy
• Every 2 weeks from 29 weeks to 34 weeks of pregnancy
• Every week from 35 wks to term
• Every 2 weeks from 29 weeks to term, if not on insulin. 

AFTER DELIVERY    

RISK FACTORS FOR TYPE 2 DIABETES MELLITUS FOLLOWING GESTATIONAL DIABETES MELLITUS

Unmodifiable risk factors                                                          Modifiable risk factors

Ethnicity                                                                                         Obesity

Age                                                                                                  Future weight gain 

Family history

Degree of hyperglycemia in pregnancy

SCREENING:

6-12 weeks after delivery, a follow up of 75 gm oral glucose tolerance test (GTT) should be performed to determine the women’s risk of developing diabetes and her status. If found normal , GTT should be repeated after 6 months and then after each year.

PREVENTION:

           Women who have had gestational diabetes mellitus are at a heightened risk for type 2 diabetes mellitus and so the best advice is:

• A LOW FAT DIET

• AVOIDANCE OF OBESITY   

• REGULAR EXERCISE.