Previous diagnosis of GDM, IGT and history of PCO are risk factors for Gestational Diabetes Mellitus-Carolina Ursing

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 JPMA launches its special issue on Diabetes and Pregnancy

Previous diagnosis of GDM, IGT and history of
PCO are risk factors for Gestational
Diabetes Mellitus-Carolina Ursing

Managing GDM is a teamwork and these patients
should be dealt with jointly in post-delivery period

KARACHI: Previous diagnosis of Gestational Diabetes Mellitus, Impaired Glucose Tolerance and history of polycystic ovary syndrome are some of the risk factors for development of GDM. This was stated by Dr. Carolina Ursing a noted endocrinologist from Karolinska Institute, Stockholm Sweden. She was speaking on Gestational Diabetes Mellitus: Increasing awareness among Obstetricians and Family Physicians, Diagnosis and Monitoring at the formal launch meeting of a special issue of Journal of Pakistan Medical Association on Pregnancy and Diabetes at PMA House on September 24th 2016. The meeting was well attended by obstetricians & gynecologists, some family physicians besides office bearers of PMA.

Hyperglycemia, she said, was first recognized during pregnancy. While managing these patient we have tight control of blood glucose and work with our patients and educate them. Every women, Dr. Carolina Ursing opined should be screened for diabetes. She then talked about post-partum glucose tolerance, metabolic stress, long term risk of obesity and diabetes in children, neonatal metabolic complications, risk of intra uterine death, and impact of gestational hyperglycemia on maternal and child health besides fetal programming. Malnourished and under nutrition mothers can have diabetes. Not only that but under nourished mothers will also have under nourished fetal and small baby.

Speaking about the prevalence of GDM, Dr. Carolina Ursing said that it varies depending on cut off criteria. In UAE the prevalence of GDM is 37.7%.She then talked about the guidelines of American Diabetes Association, WHO and IDF for GDM screening. Speaking about treatment of GDM she mentioned that HbA1c should be less than 5 and fasting blood glucose should be <90-99mgdl and it should remain 85-135, until delivery.  This can be achieved by diet, physical activity, metformin and use of Insulin. One can use rapid acting insulin, pre mixed insulin, basal insulin and intermediate acting insulin. Until delivery the blood glucose of mother is equal to blood glucose of the fetus. Insulin, she remarked, does not cross placenta. As regards risk factors for GDM it includes age more than twenty five years, family history of diabetes or member of a group having previous high Type 2 Diabetes. Pre pregnancy weight is associated with risk of Type 2 Diabetes Mellitus. She further stated that every 4-5 Kg increase in weight increases the risk of GDM by two fold. Patients should be advised to continue breast feeding, change life style, use healthy diet and have some physical activity. Ethnicity Dr. Carolina Ursing said was a non-modifiable risk factor. As regards prevention, she emphasized on dietary instructions, loss of 7% of body weight, thirty minute exercise five days a week and metformin should be taken as an addition and encourage these patients to breast feed.

Replying to questions during the discussion Dr. Carolina Ursing said that Glebenclamide is safe but there is not very strong evidence that there is no teratogenic effect. Fasting blood glucose is not possible in GDM. Prof. Sadiqa Jafary, Dr. Sadiah Ahsan Pal and Dr.Musarat Riaz also briefly spoke on the occasion and emphasized the fact that GDM management is a team work and these patients should be jointly managed particularly in post-delivery period.

Earlier Prof. Idrees Adhi opined that most of the patients with diabetes should be referred to ophthalmologists for checkup. For diabetic retinopathy apart from laser treatment, various drugs are now injected but one has to be extremely careful as with some of these drugs, safety issue is not fully resolved. Intra viteral steroids have a role if laser treatment is not effective, he added.

Dr. Fatema Jawad Chief Editor of JPMA in her welcome address thanked the guest speaker and the authors of the special issue on Diabetes and Pregnancy. Our objective was to gather professionals from, SAARC counties and jointly find a solution. This issue, she said, has thirty three articles of which Indian authors have contributed thirteen, Pakistani authors ten and three are from Bangladesh.

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