Gestational diabetes (or gestational diabetes mellitus, GDM)

When a woman is not diagnosed of diabetes but exhibits high blood pressure level during pregnancy, it is often the condition of gestational diabetes.

1. Classification
   • Pre-gestational Diabetes either type I o r type II
   • Gestational diabetes: diabetes that develops during pregnancy
2. Complications of Diabetes in pregnancy

• Maternal
• Polyhydroamnios: from fetal polyuria
• Nephropathy: common in pregestational diabetes, increasing the risk of preeclampsia
• Retinopathy: occurs after several years of pregestational diabetes, often deteriorates during pregnancy
• Diabetes ketoacidosis: May occur at lower glucose concentration
• Fetus
• Fetal demise: increased spontaneous miscarrage and fetal death in utero
• Respiratory distress syndrome
• Macrosomia(>4000-4500 g)
• Fetal hypoglycemia
• Hyperbilirubinemia
• Polycythemia
• Hypocalcemia

3. Screening glucose challenge test
   • All patient screened between 24 and 28 weeks.
   • With 75gm high concentration sugar water and keep fasting before test 4-6 hours.
   • 2 hours(75gm) Oral glucose tolerance test

• Time	National Diabetes Data Group(mg/dl)
  fasting	92
  1	180
  2	153

4. Intra-partum management

• Nutritional counseling differs individually and it varies with patients’ weight and height.
• fasting glucose levels should be under 105 mg/dl. or 2-hr post-meal sugar level should be under 120mg/dl, if not, pharmacologic treatment was suggested(insulin administration)
• Fetal evaluation
• fetal activity assessment, NST(non-stress test: a 20-minutes-test of fetal movement and fetal heart beat relation) beginning at 32-34 wks
• Ultrasound : first time at 18-20 weeks, and the second time is at 30-32 weeks
• Insulin treatment: It is usually recommended that oral hypoglycemic agents be discontinued once pregnancy is diagnosed
• Exercises like swimming and bicycle riding are highly recommended; however, riding bicycles is inappropriate toward the last stage of the pregnancy, simple walk is recommended.

5. During labor care

• Maintain euglycemia(normal sugar level) during labor
• Sugar control with Insulin drip and check sugar every hour in labor

6. Postpartum management

• Home glucose monitoring
• Diet instruction
• Prevention of hemorrhage and infection
• Regular postpartum blood sugar trace, and sugar test within 6 wks of delivery
• Breastfeeding encouraged