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Gestational Diabetes Mellitus

Dunn, Garner, Buckingham, Ostrander, Smith, Woodward


Objectives
Know two problems GDM can cause to mother

Know two problems GDM can cause to baby

Be able to list three ways to manage GDM

Have a practical understanding of the pathophysiology


Pathophysiology
Normally, a mother eats a meal and her blood glucose increases. Beta cells within the
pancreas produce insulin which is then secreted into the bloodstream. Insulin binds to
target cells and allows them to take up glucose from the blood.

During a normal pregnancy target cells become slightly more resistant to insulin to
allow more blood sugar to get to the placenta and the fetus and facilitate fetal growth.

In a GDM pregnancy the mother’s cells become highly resistant to insulin. Leading to
little blood sugar absorption in her cells and hyperglycemia. The infants pancreas then
takes over and the infant will undergo quicker than desired growth leading to high birth
weights and various other problems.
Diagnosis
You may be at risk for it if you
Had it before
are overweight
have diabetes in your family
are older than 25
are Hispanic-American, African-American, Native American, South or East Asian, or Pacific Islander.

Oral glucose tolerance test


Involves monitoring of plasma glucose levels 2 hours after ingestion of a challenge dose of glucose to assess insulin
secretion and the body's ability to metabolize glucose. Plasma glucose levels peak at 160 to 180 mg/dL within 1 hour after
the patient receives an oral glucose test dose then return to fasting levels or lower within 3 hours.

Other tests to check the progress of the diabetes and health of mom and baby are: fetal ultrasound, home blood sugar
checks, nonstress test, and A1c.
Effects on Baby
● Neonatal macrosomia (large body)

● Hypoglycemia

● Hyperbilirubinemia

● Delayed fetal lung maturity

● Increased incidence of congenital anomalies

● Defects of the heart, neural tube, sacral agenesis

● Stillbirth
Effects on Mother
● Hydramnios

● Preeclampsia-eclampsia

● Ketoacidosis

● Dystocia

● Monilial vaginal infections and UTIs

● Worsened retinopathy
Management
Primary goal is to maintain blood sugar levels

Target Goals
● 95mg/dl morning, 140 mg/dl 1 hr after meal and 120 mg/dl 2 hr after meal

Nonpharmacological
● Diet: includes vegetables, fruit, and whole grains. Cut out fats and refined carbohydrates.
● Exercise

Pharmacological
● Insulin (short and long acting)
● Metformin
Monitoring Fetus
● 32 week gestation increase to Bi weekly NST

● 37-39 week gestation Amniocentesis


A Quiz
Get in groups

Get ready

Rules
● Must write out the correct answer.
● First group who raises their hand with the correct answer gets 2 points.
● All other groups with correct answer get 1 point.
Question 0
Practice round

Who is, most obviously, the coolest person in this room?

Answer: Cedar
Question 1
Pathophysiology

What causes GDM?

Answer: Hormones from placenta


Question 2
Pathophysiology

With GDM, what causes the infant to develop high birth weight
and other problems?

Answer: infant’s pancreas


Question 3
Diagnosis
Name two risk factors for GDM.

Answers:
Had it before
overweight
have diabetes in your family
older than 25
are Hispanic-American, African-American, Native American, South or East
Asian, or Pacific Islander
Question 4
Effects on baby
Name two problems that a baby can develop with a mother who
has GDM.

Answers:
Neonatal macrosomia (large body)
Hypoglycemia
Hyperbilirubinemia
Delayed fetal lung maturity
Increased incidence of congenital anomalies
Defects of the heart, neural tube, sacral agenesis
Stillbirth
Question 5
Effects on mother
Name two problems a mother with GDM can develop.

Answer:
Hydramnios
Preeclampsia-eclampsia
Ketoacidosis
Dystocia
Monilial vaginal infections and UTIs
Worsened retinopathy
Question 6
Management
What is the primary goal in managing GDM?

Answer: Maintain blood sugar levels


Question 7
Management
List one pharmacologic and one nonpharmacologic method of
management.

Answer:
Non: Diet, Exercise
Pharm: Insulin, Metformin
Thanks