27 June, 2010

Gestational / pregnancy induced Diabetes

Gestational diabetes generally resolves once the baby is born. Based on different studies, the chances of developing GDM in a second pregnancy are between 30 and 84%, depending on ethnic background. A second pregnancy within 1 year of the previous pregnancy has a high rate of recurrence.

Women diagnosed with gestational diabetes have an increased risk of developing diabetes mellitus in the future.
The risk is highest in women who needed insulin treatment,
Had antibodies associated with diabetes (such as antibodies against glutamate decarboxylase, islet cell antibodies and/or insulinoma antigen-2),
Women with more than two previous pregnancies,
Women who were obese.

Women requiring insulin to manage gestational diabetes have a 50% risk of developing diabetes within the next five years.
The risk appears to be highest in the first 5 years, reaching a plateau thereafter.

Children of women with GDM have an increased risk for childhood and adult obesity and an increased risk of glucose intolerance and type 2 diabetes later in life.
This risk relates to increased maternal glucose values.It is currently unclear how much genetic susceptibility and environmental factors each contribute to this risk, and if treatment of GDM can influence this outcome.


  1. Padae, saddest part.. my major case was DM in exam.. got screwed in glycosylated hb and ketoacidosis... is probably gonna b the difference of pass or fail for me, this case.. lets see

  2. Interestingly in GDM the blood glucose targets are less than the normal people(FBS-<90mg%, PPBS-<120mg%),the reason being, its not only the blood sugars but also the insulin resistance has to be brought down, and doses of insulin will help(metformin may be considered too). We may even suggest little insulin to pts whose blood sugars are WNL and urine showing sugar + if she has H/O BOH, As it is obvious that the blood sugar has crossed the limit at some point of time.
    One more important point is that the PPBS is 1 hr after food in GDM.

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  4. As an alternative to insulin, Glyburide has been safely administered to pregnant patients with Gestational Diabetes. This is a less invasive modality of treatment, which improves patient compliance.
    Glyburide has no fetal side effects.
    It should however be remembered that those not responsive to Glyburide in addition to dietary modification in 2 weeks time, or those with Pre Gestational Diabetes have to be switched back to Split Dose Insulin Regimens.
    The use of metformin in pregnant patients lacks adequate data, however it is ok to continue a patient who has Pre gestational Diabetes and is well controlled on the drug on metformin when pregnant.
    The one hour PPBS value in pregnant patients should be less than 140 mg/dl and the two hour should be less than 120 mg/dl.

    Patients with Gestational Diabetes have a higher risk of developing Type 2 Diabetes, and they MUST be screened with a 75mg 2 hour Oral Glucose Challenge Test, 6 weeks post partum.

  5. Dear Ali.
    I agree with you. Here is the indian perspective.
    glibenclamide ( glyburide) is a category C drug as per FDA. It is not yet been approved in india for use in pregnancy due to lack of indian data.
    Even in the case of Metformin many docs are scared to use metformin during pregnancy. most of the teritiary care hospitals use metformin in the first trimester.


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