pathogenesis and complications of gestational diabetes mellitus
TRANSCRIPT
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 !!!