GDM

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Gestational Diabetes (GD) Malliga sundareshan.S Demonstrator/Tutor College of Medical Lab Technology MTPG&RIHS PUDUCHERRY

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INTRODUCTION GD - Any degree of glucose intolerance with onset or first recognition during pregnancy. Diagnosis is given when a woman, who has never had diabetes before, gets diabetes or has high blood sugar, when she is pregnant Most common health problems for pregnant women

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Epidemiology Gestational diabetes and impaired glucose tolerance (IGT) in pregnancy affects 5% of all pregnancies and both have been associated with pregnancy complications Affects both mother and foetus

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Risk factors Risk assessment Low-risk status requires no glucose testing, but this category is limited to those women meeting all of the following characteristics: Age <25 years. Weight normal before pregnancy . Member of an ethnic group with a low prevalence of gestational Diabetes mellitus . No known diabetes in first-degree relatives . No history of abnormal glucose tolerance . No history of poor obstetric outcome

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High risk of gestational diabetes Marked obesity. Known history of gestational diabetes mellitus. Strong family history of diabetes . Caution

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Pathophysiology Changes in metabolism. Insulin - ineffective in glucose transport into the cells. Cells devoid of glucose(energy).  problems. The placenta is a system of vessels that passes nutrients, blood, and water from mother to fetus. The placenta secretes certain hormones that may prevent insulin from working the way that it should. When this condition happens, it is referred to as insulin resistance

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Pathophysiology cont…. In order to keep metabolism normal during pregnancy, the body has to secrete three times more insulin than normal to offset the hormones made by the placenta. For most women, the body’s extra insulin is enough to keep their blood sugar levels in the healthy range. But, for about 5% of pregnant women, even the extra insulin is not enough to keep blood sugar levels normal. These women end up with high blood sugar or gestational diabetes at around the 20 th to 24 th week of pregnancy

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Screening and diagnosis Tests for gestational diabetes 1) Non-challenge blood glucose tests a)Fasting blood glucose test b)2-hour postprandial (after a meal)‏ glucose test c)Random glucose test 2)Screening glucose challenge test 3) Oral glucose tolerance test (OGTT)‏

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Fasting and 2 hours postprandial venous plasma sugar during pregnancy. Border line indicates glucose tolerance test. 125-200 mg/dl 100-125 mg/dl Diabetic >200 mg/dl. >125 mg/dl Not diabetic <145mg/dl. <100 mg/dl Result 2 hrs postprandial Fasting

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Glucose Challenge Test Screening test for GDM: 50g oral glucose challenge, may be performed in the fed or in fasting state (More Sensitive). A plasma value above ≥140 mg/dl one hour after is commonly used as a threshold for performing a 3-hour OGTT. If initial screening is negative , repeat testing is performed at 24 to 28 weeks.

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Oral glucose tolerance test Prerequisites : Normal diet for 3 days before the test. No diuretics 10 days before. At least 10 hours fast. Person should avoid smoking & alcohol. Test is done in the morning at rest. Give 75 gm of glucose in 250 ml water Criteria for glucose tolerance test: The maximum blood glucose values during pregnancy: fasting 90 mg/ dl, 1 hour 165 mg/dl, 2 hours 145 mg/dl, 3 hours 125 mg/dl. If any 2 or more of these values are elevated, the patient is considered to have an impaired glucose tolerance.

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Complications of GDM IN CHILD 1,Growth abnormalities -Macrosomia 2,Chemical imbalance -Hypoglycemia -Jaundice -Hypocalcemia 3,Cardiac problems 4,Prone for diabetes in future

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IN MOTHER Increased risk of developing type 2 diabetes in future

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Monitoring Glycosylated haemoglobin (Hb A1)‏ It is normally accounts for 5-7% of the total haemoglobin mass. A value over 9% indicates poor diabetes control in the previous 4-8 weeks. If this is detected early in pregnancy , there is a high risk of congenital anomalies. If this is detected in late pregnancy it indicates increased incidence of macrosomia and neonatal morbidity and mortality. Daily self-monitoring of blood glucose (SMBG ) Urine glucose monitoring

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Treatment Plan for GDM Knowing your blood sugar (glucose) level and keeping it under control Eating a healthy diet, as outlined by your health care provider Maintaining a healthy weight gain Keeping daily records of your diet, physical activity, and glucose levels Taking insulin and/or other medications as prescribed