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Diabetes detected prior to pregnancy (Group I)
Diabetes detected during pregnancy (Group II to Group IV)
(or) Gestational diabetes mellitus

GDM - myth or reality?

Is it necessary and worth while to screen large numbers of pregnant women for GDM?

Yes : Helps in identifying pregnancies with higher risk for complications like PIH, Hydramnios, Macrosomia (Big Babies), and IUFD (still birth in the womb).

Identify the indications for OGTT.

Use uniform 75G glucose load for OGTT
Diagnostic criteria for GDM to be made uniform by consensus on a region wise basis.

Management of diabetes during pregnancy divided into two broad groups:

Those requiring Insulin

Group I
IDDM or type 1
NIDDM or type 2
controlled on OHA insulin and a small percentage of type 2 diabetes mellitus controlled with diet / exercise and

IGTand

about 10% of Group II cases.

Those who do not require insulin

All cases of Group III and Group IV (GDM & BLGDM) and majority (90%) of Group II cases.
*To use only Human Insulin during Pregnancy.

Control Criteria for Diabetes Pregnancy There is a good case for using Pyridoxine (Vit.B6) in GDM (Group II to IV) to improve the carbohydrate tolerance; further planned studies would be beneficial. The target blood glucose values, HbA1c, Serum Fructosamire, frequency of blood testing, need for home blood glucose monitoring in IDDM and other exceptionally difficult and high risk pregnancies, all these could be rationalized based on scientific evidence, clinical experience and pragmatic strategies, applicable in day-to-day practice for obtaining maximum qualitative and quantitative benefit could be .

Targets for control of Diabetes in Pregnancy:

1. Fasting: < 110 mg /dl (6.1 mmol /L)
2. Post-Prandial: 140 mg / dl (7.7 mmol / L).
3. HbA1C: 6.5 - 7.5%.
4. Serum Fructosamine: < 3.0 mmol / L.

Maternal and foetal complications associated with diabetes and pregnancy

Higher incidence of PIH (2.2%) and Hydramnios (3.2%), Macrosomia, Peri/Neo Natal morbidity in the new born not different to well managed

Diabetes with Pregnancies & GDM - Though Group I IDDM cases will pose difficult problems.

Congenital anomalies in children - higher in Group I (IDDM and IRDM cases) but not in Group II to IV GDM cases, as compared with non-diabetic pregnancies.

Slightly higher LSCS rate in diabetes pregnancy mainly due to obstetric (maternal / foetal) indications and not due to diabetes. The risk of IUFD especially in IDDM pregnancy and previous BOH has to be constantly borne in mind and monitored very closely during term.

Nutrition in pregnancy needs special counselling and regular monitoring.

Intensive neonatal care is mandatory for infants of diabetic mothers (IDM) in Group I - particularly in IDDM and some IRDM cases.

The confusion over diagnosis, management and understanding of diabetes, pregnancy, and birth should be removed by a planned attempt with
a) National
b) Regional and
c) International working groups and consensus process, which should have defined aims, objectives and goals and an implementation programme within a preset time frame (three to five years).


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