Gestational Diabetes From Screening to Management

Bashir Taha SalihMD Germany, FRCOG UKConsultant & Chief Obstetric MedicineCorniche Hospital Abu DhabiKuwait April 27th 2014

Gestational Diabetes

ContentsIntroduction

Physiology

Whats new in GDM ?

In Screening

In Management

Conclusion

Introduction GDM increases the risk of complications for both mother and fetus during pregnancy, childbirth and beyond increased risk of Type 2 diabetes

International Association of Diabetes and Pregnancy Study Groups, Diabetes Care March 2010 vol. 33 no. 3 676-682

Introduction Current evidence suggests early detection and management of gestational diabetes:

Improves outcomes for both mother and baby

More cost effective by preventing the complications

International Association of Diabetes and Pregnancy Study Groups, Diabetes Care March 2010 vol. 33 no. 3 676-682

National Collaborating Centre for Women's and Children's Health. Diabetes in Pregnancy: Management of Diabetes and Its Complications from Preconception to the Postnatal Period. London, U.K., RCOG Press, 2008

DefinitionGestational Diabetes Mellitus (GDM) is one of the most common medical disorders in pregnancy and is defined as any degree of glucose intolerance with onset or first recognition during pregnancy

American Diabetes Association. Diagnosis and classification of diabetes mellitus (Position Statement). Diabetes Care 2009;32(Suppl. 1):S62S67

Diabetes in pregnancy and risk of complicationsPre-existing diabetes in pregnancy is associated with high rates of complications:Fetal/neonatalCongenital malformationsPerinatal mortalityExcess fetal growthTraumatic deliveryNeonatal hypoglycaemiaHyperbilirubinaemiaDiabetic fetopathyMaternalPregnancy-induced hypertension/pre-eclampsiaPolyhydramnios/large for gestational ageOperative delivery

Dunne et al. Diabetes Care 2009;32:12056

6Diabetes in pregnancy and risk of complicationsConfidential Enquiry into Maternal and Child Health (CEMACH): Pregnancy in Women with Type 1 and Type 2 Diabetes in 200203, England, Wales and Northern Ireland. London: CEMACH; 2005OutcomePregnant women with type 1 or type 2 diabetesNational data (background population) Rate ratioPre-term delivery 37%7.3%5Birth weight 90th percentile52%10%5.2Shoulder dystocia 7.9% 3%2.6Erbs palsy4.5/1000 0.42/100011Neonatal unit admission56% 10%5.6Term admission for special care 33%10%3.3

7Blood glucose control is linked with outcomes in diabetic pregnancyDiabetes Control and Complications Trial. Am J Obstet Gynecol 1996;174(4):134353

8Speaker notesThe Diabetes Control and Complications Trial was a multicentre controlled clinical trial that compared intensive with conventional therapy in insulin-dependent diabetes mellitus. Intensive therapy, with the aim of achieving normal glycemic control, was initiated in women originally assigned to conventional therapy who actively sought to become pregnant or who became pregnant.

The above graph shows median HbA1c for DCCT pregnancies in intensive treatment group for pregnancies with normal and abnormal outcomes. Overall the median HbA1c was higher in women who had abnormal outcomes (p=0.05). *At 3 months before conception and at month 5 there were significant differences in median HbA1c levels for the pregnancies with normal outcomes versus those with abnormal outcomes.

Glycaemic thresholds for prevention of diabetic fetopathy complications?Langer. Diabetes Reviews 1996;4:210LGA, large for gestational ageComplicationMean blood glucosemmol/Lmg/dLSpontaneous abortion