MBChB, MRCOG
FHKAM(OG), FHKCOG
Subspecialist in Fetal Maternal Medicine
2 parts:
Preexisting DM and
pregnancy
Gestational diabetes
Diabetes in pregnancy
IDDM NIDDM
(Type1) (Type2)
Pre-existing diabetes True GDM
Preexisting diabetes in pregnancy
Type 1 DM ( IDDM)
Type 2 DM (NIDDM)
Preexisting DM in pregnancy
(2) Fetal
1. increase risk of congenital abnormalities
sacral agenesis, congenital heart disease,
neural tube defects
Hba1c level Risk
normal not increased
<8% 5%
>10% 25 %
Preexisting DM in Pregnancy
Aim
Cat C drug
Not well studied systemically
Monitoring
Definition
Carbohydate intolerance of variable
severity first recognised during the
present pregnancy.
This includes women with preexisting
but previously unrecognised diabetes
Gestational diabetes
No consensus for 4
decades!
Gestational diabetes
Should all pregnant women be screened or
only those with risk factors?
Is it safe to screen all?
Which screening test and which diagnostic
test are the most reliable?
Which cut-off values should we use?
What are the risk for mothers and babies
and can treatment improve outcome?
What are the connection between
gestational diabetes and type 2 DM?
Is it physiological or pathological ?
Gestational diabetes
Screening
Fasting / random glucose/ glucose
challenge test(50gm)
Diagnosis
Glucose challenge test
(75gm/100gm ?)
Gestational diabetes
Diagnosis
WHO criteria 1998,
75 gm glucose
fasting 2 hr (mmol/L)
Incidence
2-9%
more common in Asian and Indian
women
In developed countries, increasing
trend because of epidemic of obesity
Gestational diabetes
Management
Management similar as preexisting
DM
Need for glucose monitoring
Start with Diet control
Commence insulin for poor control
Delivery plan individualised
Gestational diabetes