Uncontrolled GDM

Case: 28/M/F, G3P2 at 28W P.O.A admitted in view of uncontrolled blood sugar level. Diagnosed as GDM at 26W P.O.A. Previous pregnancy also complicated with GDM and macrosomic baby requiring LSCS. Positive family history of DM on maternal side.

Questions

a) Complication of GDM

b) Indication for MOGTT

c) Management to this patient

Complication of GDM

Maternal

a) Hypertension, ↑ incidence of pre-eclampsia (if a/w nephropathy)

b) ↑ incidence of infection – UTI, vulvovaginitis etc

c) Polyhydramnios

d) Pre-term labour

e) Coronary artery disease

f) Thromboembolic disease

g) Risk of caesarean delivery

Fetus

1. Early pregnancy

a) Spontaneous abortion

b) Congenital anomalies → 40% of perinatal death in diabetic pregnancies

c) Cardiac defects

d) Neural tube defects

e) Renal anomalies

f) Caudalregression synd (rare)

2. Later pregnancy

a) Macrosomia

b) Polyhydramnios

c) IUGR (intrauterine growth restriction)

d) Unexplained Intrauterine death. May be secondary to:

Chronic hypoxia

Polycythemia

Lactic acidemia

Ketoacidosis

Neonate

a) Congenital abnormalities

b) Shoulder dystocia, birth asphyxia & traumatic birth

c) Hypoglycemia – fetal islet cell hyperplasia

d) Jaundice

e)Respiratory distress syndrome – hyperinsulinaemia diminished surfactant production

f) Hypocalcaemia and hypomagnesaemia

Indication for MOGTT

1) Significant glycosuria on 2 or more occasions during pregnancy

2) Maternal obesity (i.e. maternal weight >80 kg or BMI >27 at booking)

3) Family history of diabetes in first-degree relatives

4) Previous big baby (weighing >4 kg)

5) Women >35 years old

6) Previous unexplained stillbirths, recurrent abortions, birth defects

7) Previous history of gestational diabetes

8) Polyhydramnios in current pregnancy

9) Big baby in current pregnancy

10) Congenital abN

Management for this patient

My point of view: This patient was diagnosed as GDM at 26W of pregnancy. Now is her 28W of pregnancy and her blood sugar level is uncontrolled. Obviously DM diet is not working. Therefore, I see the role of giving insulin injection to her.

Therefore for this current admission, BSP should be done after giving insulin injection to look for the blood sugar level and further adjustment of insulin dosage.

Pregnancy shouldn’t be allowed beyond 38W due to risk of unexplained IUD.