Diabetes mellitus is a group of diseases characterized by the deficiency or insensitivity or both, to insulin leading to the exposure of organs to excessive blood glucose. Gestational diabetes can be defined as any degree of glucose intolerance{poor handling of glucose}first diagnosed in pregnancy. It complicates about 4-6% of all pregnancies.

Complications

If not properly treated gestational diabetes leads to:

-recurrent spontaneous abortions

-Infections like urinary tract infection, candidal vaginitis

-a serious complication called eclampsia which results in convulsions and death of both baby and mother.

-too much fluid in the uterus{hydraminos}

-pre-term labor

-ketoacidosis

-excessively big babies {macrosomia} leading to trauma during delivery and increasing chances of caesarian section.

Risk Factors For Developing Gestational Diabetes

a}age-women older than 25years are more prone than younger women

b}excessive weight, obesity and women with body mass index greater than 25 are more prone

c}women that having been giving birth to big babies or babies born with malformations

d}previous history of stillbirths

e}previous history of gestational diabetes.

Women that are high risk cases are screened twice in pregnancy

1-At first medical contact in pregnancy

2-In the second trimester {26-36 weeks of pregnancy}

Diagnostic criteria for Gestational Diabetes

-fasting blood sugar=or> 126mg/dl {7.0mmol/l}

-random blood sugar=or> 200mg/dl {11.0mmol/l}

Management

There are 3 key factors in managing gestational diabetes:

a} Good glycaemic control -blood sugar levels should be kept within normal range, control is achieved by use of insulin

b} Excellent monitoring of blood glucose levels

c} Early delivery is the standard ,pregnancy MUST not be allowed to go beyond 37 completed weeks.

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