Management of renal glycosuria: •Frequent urine testing to detect asymptomatic bacteriuria.
•To take several small meals per day.
•Staying alert for signs and symptoms of preterm labor. •Dietary counseling.
Management of gestational diabetes mellitus:
Diet:
Around 30-32kcal/kg per day for non obese women and 25kcal/day for obese women.
Among that 50-60% complex carbohydrates, <30% fat and proteins 25g/1000 kcal, in 3 meals & 1or2 snacks.
Should be monitored with weekly test for ketonuria.
Maintain FBS <105mg/dl and 2hrs PP value <120mg/dl.
Exercise:
Helps to improve cardio respiratory fitness and to avoid insulin therapy.
Self monitoring: Patient is instructed to self determine blood sugar levels by glucometer, 3-4 times per day both before and after meals to asses for the need of insulin therapy.
Oral hypoglycemic agents:
Should not be used in pregnant patients as they may induce severe prolonged fetal hyperinsulinemia and neonatal hypoglycemia
Management of low risk patients: Low risk GDM patients with adequate control of blood sugars and no abnormalities require no ante partum surviellance before 40 weeks.
They are monitored with kick counts and vibro acoustic stimulation at each office visit. They are allowed to develop spontaneous labor and to deliver at term.
Once the patient reaches 40 wks, evaluate the cervical ripeness, the amniotic fluid, the fetal size and wellbeing.
If normal, continue for one more week, but should be delivered once they reach 41 weeks.
In case of persistent elevation of FBS: Around 5-10 units of IAI - NPH is started at bed time and modified according to response.
Persistent elevation of PPBS:
Around 10 -15 units of IAI - NPH before breakfast or a mixture of 2/3rds IAI NPH and 1/3 rd SAI regular before breakfast or a small dose of regular insulin 10 units before meals.
Management of high risk patients: Fetal surveillance started at 34 weeks of gestation.
Weekly or biweekly non stress test(NST), biophysical profile should be done.
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Patient should be delivered at 38-40 weeks.
Labor should be induced as soon as the cervix is ripe and fetal lung is mature.
No insulin is required during labor owing to the fasting status.
Blood sugar estimated every 2 hours.
Glucose levels maintained between70-120mg/dl.
Postpartum care:
Insulin requirements remain low after delivery.
Blood glucose determined 2-4 times per day.
Persistent hyperglycemia-anti diabetic therapy resumed.
FPG and PPBG are done 4-6 weeks postpartum, to be certain that the abnormality has disappeared. Repeat GTT done after delivery in GDM women who had elevated fasting glucose levels 95mg/dl or who were diagnosed with GDM before 24 wks of gestation.
Indications for elective cesarean section:
Macrosomia >4kg of expected fetal weight.
Uncontrolled diabetes.
Bad obstetric history.
Demonstrable fetal compromise as in severe IUGR, abnormal NST, biophysical profile.
•To take several small meals per day.
•Staying alert for signs and symptoms of preterm labor. •Dietary counseling.
Management of gestational diabetes mellitus:
Diet:
Around 30-32kcal/kg per day for non obese women and 25kcal/day for obese women.
Among that 50-60% complex carbohydrates, <30% fat and proteins 25g/1000 kcal, in 3 meals & 1or2 snacks.
Should be monitored with weekly test for ketonuria.
Maintain FBS <105mg/dl and 2hrs PP value <120mg/dl.
Exercise:
Helps to improve cardio respiratory fitness and to avoid insulin therapy.
Self monitoring: Patient is instructed to self determine blood sugar levels by glucometer, 3-4 times per day both before and after meals to asses for the need of insulin therapy.
Oral hypoglycemic agents:
Should not be used in pregnant patients as they may induce severe prolonged fetal hyperinsulinemia and neonatal hypoglycemia
Management of low risk patients: Low risk GDM patients with adequate control of blood sugars and no abnormalities require no ante partum surviellance before 40 weeks.
They are monitored with kick counts and vibro acoustic stimulation at each office visit. They are allowed to develop spontaneous labor and to deliver at term.
Once the patient reaches 40 wks, evaluate the cervical ripeness, the amniotic fluid, the fetal size and wellbeing.
If normal, continue for one more week, but should be delivered once they reach 41 weeks.
In case of persistent elevation of FBS: Around 5-10 units of IAI - NPH is started at bed time and modified according to response.
Persistent elevation of PPBS:
Around 10 -15 units of IAI - NPH before breakfast or a mixture of 2/3rds IAI NPH and 1/3 rd SAI regular before breakfast or a small dose of regular insulin 10 units before meals.
Management of high risk patients: Fetal surveillance started at 34 weeks of gestation.
Weekly or biweekly non stress test(NST), biophysical profile should be done.
.jpg)
Patient should be delivered at 38-40 weeks.
Labor should be induced as soon as the cervix is ripe and fetal lung is mature.
No insulin is required during labor owing to the fasting status.
Blood sugar estimated every 2 hours.
Glucose levels maintained between70-120mg/dl.
Postpartum care:
Insulin requirements remain low after delivery.
Blood glucose determined 2-4 times per day.
Persistent hyperglycemia-anti diabetic therapy resumed.
FPG and PPBG are done 4-6 weeks postpartum, to be certain that the abnormality has disappeared. Repeat GTT done after delivery in GDM women who had elevated fasting glucose levels 95mg/dl or who were diagnosed with GDM before 24 wks of gestation.
Indications for elective cesarean section:
Macrosomia >4kg of expected fetal weight.
Uncontrolled diabetes.
Bad obstetric history.
Demonstrable fetal compromise as in severe IUGR, abnormal NST, biophysical profile.
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