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Complications of gestational diabetes mellitus.
Maternal complications
It is thought to occur 2-3 times more frequently in women with glucose in urine. It should be diagnosed early and managed by antibiotics
It is exaggerated complication of bacteremia that results when women with bacteremia is not treated properly.
Development or worsening of diabetic retinopathy during pregnancy depends on duration of diabetes .pregnancy enhances the progress because it worsens the glucose intolerance. In ignored case, proliferative retinitis and macular edema may ensue.
They seem to be more common in diabetic women, particularly as term approaches but worsening proteinuria may occur without evidence of preeclampsia and eclampsia.
When ketoacidosis occur, it presents as an emergency and prompt correction of metabolic acidosis or maternal death.
It is more common in pregnant women with diabetes.
There is greatly increased risk for having preterm labor in pregnant women; therefore tocolytic drugs are used along with intravenous infusion of insulin.
Due to glycosuria, candidiasis of vagina and vulva may develop. Superimposed bacterial infection may worsen the picture.
It is common complication. it is related to fetal and placental size and to poor control of diabetes, rather than severity of diabetes.
Due to enlarge baby, vaginal delivery is difficult and always requires episiotomy .if fails then do C-Section.
Fetal complications:
There are about 4 times more common with neural tube defects and cardiac abnormalities predominantly.
Unsatisfactory metabolic environment usually leads to obstructed labor or shoulder dystocia.
Prevention:
All of the above mentioned complications can be prevented by maintaining a normoglycemic state i.e. glucose level below 6mmol /liter fasting below 8 mmol /l postprandial.
Diet control
Daily carbohydrates intake must not exceed 150gm.
Insulin
Most of the patient can be satisfactorily controlled by twice daily injections of a combination of short and intermediate action insulin.
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