Pathogenesis and Complications of Gestational Diabetes Mellitus (GDM)

Brajesh LahriFinal Professional MBBSAll India Institute of Medical Sciences (AIIMS),Bhopal

Gestational Diabetes Mellitus (GDM)…Why and How ?

Definition

Gestational Diabetes Mellitus (GDM) refers to cases with abnormal carbohydrate tolerance which have onset or are first detected to have abnormal glucose tolerance during the pregnancy.

Risk Factors for GDMPositive family history of Diabetes (Parents or Sibling)

Having a previous birth of an overweight baby of 4kg or more

Persistent Glycosuria

Age over 30 years

Obesity

History of Unexplained perinatal loss

Presence of polyhydramnios or vaginal candidiasis in present pregnancy

Pathogenesis of GDM

Why to detect early and treat GDM ?

An Overview of effects of Diabetes on PregnancyEffects of

Diabetes on Pregnancy

Maternal

During Pregnancy

During LabourDuring

Puerperium

Foetal

Congenital Malformations

Neonatal Complications

Effects on Mother

During Pregnancy :

Abortion

Pre term Labour (May be secondary to infection or polyhydramnios)

Increased risk of Infections (specially Urinary Tract Infections)

Maternal Distress (Due to oversized foetus and polyhydramnios)

Diabetic Retinopathy

Diabetic Nephropathy

Ketoacidosis

During Labour :Prolongation of Labour (Due to big baby)

Perineal Injuries (Due to big baby)

Shoulder Dystocia (Due to disproportionate growth)

Post Partum Hemorrhage

During Puerperium : Puerperal Sepsis

Lactation Failure

Effects on Foetus

Foetal Macrosomia : Most common foetal hazard (30-40% are affected)

Congenital Malformations

Usually not related to Gestational Diabetes mellitus as it presents in second and third trimester.

These teratogenic effects are related to severity of Diabetes affecting organogenesis ,in the first

trimester.

CNS Defects : Neural tube defects, Anencephaly, Microcephaly, Sacral agenesis

Cardiac Defects : VSD, ASD, Coarctation of aorta, Transposition of great vessels,Cardiomegaly

Renal Defects : Renal agenesis, Hydronephrosis, Ureteral duplication

Gastrointestinal : Duodenal Atresia, Anorectal Atresia

Neonatal Complications Hypoglycemia

Respiratory Distress Syndrome

Hyperbilirubinaemia

Polycythemia

Hypocalcemia

Hypomagnesaemia

Cardiomyopathy

The Overall Perinatal mortality rate is increased 2-3 times. The neonatal deaths are principally due to hypoglycemia, respiratory distress syndrome, polycythemia and jaundice.

Thank You !!!