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  Pregnancy ,Diabetes and Birth
 

 
 



The most fascinating aspects of diabetes for the clinicians and academicians are the interactions of disturbed carbohydrate tolerance occurring for the first time during pregnancy termed Gestational Diabetes (GDM) and conception in persons with already established diabetes (viz. Impaired Glucose Tolerance, overt diabetes mellitus (type 2), MODY, type 1 diabetes mellitus, and other types) going through pregnancy with diabetes. This latter condition is also called Pre Gestational (or) Pre Conceptional Diabetes. (PGDM).

The main reasons for identifying Diabetes in Pregnancy are

  • To prevent over weight babies (Macrosomia) and to deliver a normal weight, healthy baby.
  • To prevent immediate post-delivery problems like hypoglycaemia, hypocalcaemia, hyperbilirubinaeimia, increased susceptibility to infections, Respiratory distress syndrome in the new born. (RDS) etc.
  • To prevent (to the extent possible) intra uterine Foetal demise (IUFD or still birth)
  • To attempt and help prevention of future diabetes in the mother.

Our Team's work in the field of Diabetes, Pregnancy and Birth, is an on-going Project for the past 10 years, with close collaboration between the diabetology unit (headed by C.V.Krishnaswami) and the obstetric unit (headed by Prema Krishnaswami) and has resulted in certain definite understanding in the classification of Diabetic Pregnancies, nature of the Gestational diabetic state, and their ante-natal, peri and post natal management and outcomes. These were presented in detail at a largely attended full-day CME conducted by the Voluntary Health Services Diabetes Department on the subject in February 1996, at Chennai, with Prof. Dorothy R. Hollingsworth (University of California at San Diego, U.S.A.) as the International faculty. The audio/video transcription of the proceeding, are available at request.

The Voluntary Health Services Diabetes Department classification of Diabetes & Pregnancy.

Group I Pre Gestational Diabetes (PGDM) or Pre Conceptional Diabetes (PCDM)

Pre Gestational or Pre Conceptional Diabetes includes all those who have type 1 diabetes mellitus (IDDM), type 2 diabetes mellitus (NIDDM), MODY, Pancreatic Diabetes (FCPD), Impaired Glucose Tolerance (IGT), and other types of diabetes mellitus before pregnancy.

Group II (or) Overt Gestational Diabetes Mellitus (OGDM) Those diagnosed to have overt diabetes for the first time during pregnancy. The GTT (75 G) values for diagnosis of group II GDM here are

Test
Fasting
mg/dl (mmol/l)
Peak Value - Hr, 1 Hr, 1 Hr
mg/dl (mmol/l)
2 Hr value
mg/dl (mmol/l)
Blood Glucose >110 (6.1 ) >180 ( 10 ) >180 ( 10 )

Evidently some of this group may be type 2 diabetes mellitus occurring for the first time during pregnancy, presenting as GDM.

Group III or Gestational Diabetes Mellitus (GDM)

Those diagnosed to have abnormal carbohydrate tolerance on GTT (75 G load) for the first time during pregnancy but not an overt diabetic state.
The cut off values here are :

Test
Fasting
mg/dl (mmol/l)
Peak Value - Hr, 1 Hr, 1 Hr
mg/dl (mmol/l)
2 Hr value
mg/dl (mmol/l)
Blood Glucose >110 (6.1 ) >160 (8.8) 120 (6.6)

Group IV or Borderline GDM (BLGDM)

Those diagnosed to have abnormal carbohydrate tolerance on GTT (75 G load) for the first time during pregnancy but the abnormality is confined to

  • one value only in the GTT (i.e.) Fasting or Peak or 2 hr value
                                or
  • the blood glucose values are within 10 mg/dl below the defined cut off values given in the group III status.

The diagnostic criteria for group IV are :

Fasting
Peak Value - Hr, 1 Hr, 1 Hr
2 Hr value
a) > 110 < 160 < 120
b) < 110 > 160 < 120
c) < 110 < 160 >120
d) > 100 > 150 >110

DIABETES, PREGNANCY, BIRTH STUDY (1994)

Result of OGTT

Total cases in the study
Non-Diabetics
Diabetic Pregnancies
732 (100%)
546 (74.6%)
186 (25.40%)
No.
%
Group I(IDDM-5)
12
1.64
Group II(Overt DM of Pregnancy)
18
2.50
Group IIIGestational Diabetes (GDM)
105
14.30
Group IVPre Gestational Diabetes(Pre GDM)
51
6.96
Diabetic PregnanciesTotal
25.4
Non-diabetics
546
74.48
Default
1
0.12
Total
733
100

Risk Factors for GDM in Pregnant Women (Indications for doing Glucose Tolerance Test GTT)
DIABETES, PREGNANCY BIRTH STUDY (1994)
Dietary Plan and Nutrition Recommendations in Pregnant Women with Diabetes
Physical Exercise in Type I (or) IDDM Pregnancy
Physical Exercise in Type II (or) NIDDM & GDM Pregnancies
Future of GDM Mothers

 


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