Diabetes in Pregnancy - MedG

🩺 Understanding Diabetes in Pregnancy

Welcome to this focused review on hyperglycemia during pregnancy. Whether pre-existing or gestational in onset, diabetes presents significant risks to both mother and fetus.

This resource breaks down the essentials of Pregestational Diabetes and Gestational Diabetes, covering clinical features, management strategies, complications, and diagnostic criteria—including the Glucose Tolerance Test (GTT).

Let’s ensure the best outcomes through early detection, proper monitoring, and targeted interventions.

PREGESTATIONAL DIABETES

Patient: 34-year-old G2P1 at 6 weeks GA with family history of T2DM

Management:

• HbA1c for diagnosis
• Folate supplements
• Glucose control: Diet, exercise, oral agents, insulin
• Frequent follow-up
• Monitor fetal growth
• Regular antenatal testing

Complications:

• Fetus/neonate: Congenital anomalies, polyhydramnios, macrosomia, FGR, shoulder dystocia, birth injury, RDS, hypoglycemia, hyperbilirubinemia, childhood obesity
• Gestational carrier: DKA (T1DM), HHS (T2DM), retinopathy, nephropathy, preeclampsia
• Birth: Miscarriage, preterm delivery, cesarean delivery

HYF: Screen for T2DM in the 1st trimester in high-risk patients. Glucose control is critical in organogenesis (0–8 weeks GA).

GESTATIONAL DIABETES (GDM)

Patient: 38-year-old G2P1 at 25 weeks GA with prior GDM

Management:

• 3-hour GTT for diagnosis
• Glucose control: Diet, exercise, oral agents (glyburide, metformin), insulin
• Frequent follow-up
• Monitor fetal growth
• Regular antenatal testing if medication used
• Postpartum T2DM screening at 6 weeks

Complications:

• Fetus/neonate: Polyhydramnios, macrosomia, stillbirth, RDS, hypoglycemia, hyperbilirubinemia, childhood obesity
• Gestational carrier: Preeclampsia, hypertension, T2DM risk
• Birth: Cesarean delivery

HYF: Screen for GDM at 24–28 weeks GA. Placental hormones cause insulin resistance. Prior GDM increases recurrence risk.

Glucose Tolerance Test (GTT) for Gestational Diabetes Screening

3-hour 100 g GTT	2-hour 75 g GTT
≥2 of the following values diagnostic of GDM:	≥1 of the following values diagnostic of GDM:
Fasting: >95	Fasting: >92
1 hour: >180	1 hour: >180
2 hours: >155	2 hours: >153
3 hours: >140	N/A