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GESTATIONAL DIABETES MELLITUS

  • Diabetic  mother during pregnancy has higher chances of developing diabetic ketoacidosis after prolong fast than a normal pregnant lady.
  • In early pregnancy, insulin requirement is reduced & there are more chances of hypoglycemia that too in the early morning hours so a late night snack is always advisable while insulin requirement is increased by 2-3 folds in late pregnancy.
  • A tight control of diabetes is very essential during whole of pregnancy for the normal development of baby in womb as chances of developing congenital anomalies are very high.
  • oral hypoglycemic agents are contraindicated during pregnancy & only insulin injections are to be used to control diabetes other than exercise& diet control.
  • Smoking during pregnancy can cause low birth weight , increased risk for respiratory infections, reactive airways disease & sudden infant death syndrome.
  • ideally the premeal whole blood glucose should be < 95 mg%, 1 hr postprandial glucose < 140% and 2 hr postprandial glucose < 120 mg%. so pre meal & post meal blood glucose measurement should be regularly done.
  • Later development of obesity & metabolic syndrome is more common in infants born to diabetic mothers.
  • Incidence of childhood type-2 diabetes is 10 fold higher in offfsprings born to diabetic mothers & this incidence was 70% at age 25 – 29 years.
  • Post partum( after delivery )period require maintenance of glycemic control, diet, exercise, weight loss, blood pressure management, breast feeding, contraception & post partum thyroiditis.
  • A weight loss program consisting of diet & exerciseimproves insulin sensitivity 7 prevents development of type-2 diabetes.
  • women with a history of gestational diabetes mellitus who breast feed, appear to have lower incidence of developing type-2 diabetes. Breast feeding also appears to decrease the risk of infant obesity & impaired glucose tolerance.
  • All oral contraceptives are safe provided the serum triglyceride levels are normal & hypertension  if present is properly controlled. The women should not be at increased risk for thrombo-embolic disease also.
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