Types of Diabetes in pregnancy:

• Gestational diabetes mellitus (GDM)
• Pregestational diabetes 

Gestational diabetes mellitus (GDM)

GDM management:

Diet

• Ensure sufficient intake of micronutrients and macronutrients.

•  Intake of low- glycaemic-index carbohydrates divided over several meals and snacks daily
• Provide appropriate level of gestational weight gain

Physical activity

• Light exercise, such as walking, swimming, cycling
• Regimen appropriate for pregnancy

Regular monitoring of blood glucose:  Glycemic targets

• Pre-prandial            : ≤ 5.3 mmol/L, and
• 1-h post-prandial   : ≤7.8 mmol/L or
• 2-h post-prandial    : ≤6.4 mmol/L

Pharmacotherapy: If the glycaemic goals are not attained within 1–2 weeks of initiating dietary changes and physical activity (MIG)

• Metformin
• Insulin is the gold- standard treatment
• Glibenclamide

Treatment after delivery

• Continue lifestyle interventions
• Encourage breastfeeding
•  Pharmacotherapy can be stopped immediately after delivery
•  Blood glucose monitoring:
  • FBS at 6 weeks postpartum
  • HbA1c annually to screen for the development of diabetes mellitus.

Delivery of baby of GDM mother

Timing of delivery:

• Managed with lifestyle therapy and without any pregnancy complications: Delivery at term
• Pharmacologically treated case: Around 38 weeks

Intrapartum glycemic management:

• Usual dose of intermediate acting insulin given at bedtime
• Morning dose withheld
• Star I/V infusion  of normal saline
• Once active labor starts/ BG <3.9 mmol/L → fluid changed to 5% DA @ 100 – 250 ml/hr
• BG level checked hourly: target between 4 –7 mmol/L
• When BG level  >7.8 mmol/L → regular insulin given by I/V infusion

Neonatal complications:

• Respiratory distress syndrome
• Hypoglycemia: 
  • Diagnosis: Blood glucose <2 mmol/L, regardless of gestational age
  • Treatment: 10% dextrose in water by bottle within 1 hour
• Hypocalcemia (<7 mg/dl)
• Hyperbilirubinemia (Bilirubin >15 mg/dl)
• Erythrocytosis (Central hematocrit >70%)

Adverse outcome of hyperglycemia in pregnancy