1. Antenatal care in Hyperglycemia in Pregnancy
DR NAINA MIGLANI
CONSULTANT
Dayawati hospital

2. Antenatal care Maternal surveillance Fetal surveillance
Blood sugar control
Watch for complications due to hyperglycemia
Fetal surveillance
Fetal well being
Appropriate growth
Congenital anomalies

3. Counselling
Reassure
Reassure &

4. Antenatal check up First visitHb
Urine routine exam
ABORH
VDRL
HIV
HbsAg
Anti HCV
S.TSH
Urine c/s
HbA1c
Antenatal investigations
End organ evaluation
Fundus examination
Renal function tests
Urine for proteins
If prexisting diabetes or diagnosed in early pregnancy or DIPSI ≥ 200 mg/dl

5. Counselling
If HbA1c > 8% in first trimester, increased possibility of congenital malformations
If HbA1c > 9.5% in first trimester, 22% risk of congenital malformations
If presence of end organ disease, more chances of fetal compromise and not so favourable outcome of pregnancy

6. Antenatal Check up Every visit
Hemoglobin
Urine routine exam
Blood pressure
Fundal height
Clinically evaluate for hydramnios
Blood sugar testing every 2 weeks on her own by glucometer and by venous blood sample
Diet counselling
Exercises
Insulin if required and patient is educated to administer insulin herself

7. Antenatal care Routine Iron and calcium supplements
Tetanus immunization
Counsel for possibility of preterm labour
If preterm labour
Admit
Tocolysis with nifedepine or magsulf
Sympathomimmetics to be avoided
Corticosteroids
Important to be regular for antenatal checkup
Explain how to monitor blood sugars

8. Fetal surveillance
Accurate Dating by ultrasonography in first trimester
USG at weeks for congenital anomalies
Fetal echocardiography in women with preexisting diabetes, diabetes diagnosed in early pregnancy
USG in 3 rd trimester for fetal growth evaluation
Daily fetal movement count

9. Danger signs Blood sugars
Fasting > 95 mg/dl
Postprandial 2 hrs > 120 mg/dl
Any sugars <70 mg/dl
Symptoms of hypoglycemia like sweating, syncopal attacks
Pain abdomen, leaking or bleeding pv
Reduced fetal movements
Admit if any above or compromised maternal and fetal surveillance

10. Featl surveillance Women with previous stillbirth
Associated preeclampsia
Requiring insulin
Preexisting diabetes
Twice weekly NST and doppler assessment as and when required

11. Planning delivery

12. When to deliver?
GDM well controlled on diet to be followed till 41 weeks
GDM on insulin – pregnancy terminated at weeks by induction of labour
Earlier termination of pregnancy if associated hypertension or compromised fetal testing
Antenatal corticosteroids to be administered if delivery< 34 weeks- careful blood sugar monitoring

13. How to deliver? Aim for vaginal delivery
LSCS for obstetric indications
Fetal weight >4kg consider elective cesarean section

14. Intrapartum care No definite protocol
Gestational diabetics in labour do not require insulin and only blood sugar monitoring
Omit morning dose of insulin if elective cesarean section
Night doses as usual
In induction of labour, omit the dose when in active labour
Blood sugar monitoring at regular intervals and insulin accordingly

15. Intrapartum care Fetal heart to be closely monitored in labour
More chances of prolonged labour
More instrumental delivery
Watch for
Shoulder dystocia
Birth injuries
PPH