OG12.3 | Diabetes in Pregnancy — Summary & Reflection

KEY TAKEAWAYS

Diabetes in pregnancy is classified as gestational diabetes mellitus (GDM — onset/first recognition in pregnancy) or pre-gestational diabetes (PGDM — T1DM or T2DM diagnosed before pregnancy). Pregnancy induces progressive insulin resistance via diabetogenic placental hormones (hPL, progesterone, PGH, cortisol); GDM develops when beta-cell reserve is insufficient to compensate. Two distinct screening protocols exist — DO NOT merge them: the DIPSI protocol (India, FOGSI-endorsed) administers 75 g glucose NON-fasting with a single 2-h cut-off of ≥140 mg/dL; the IADPSG/WHO-2013 protocol administers 75 g glucose in the FASTING state and diagnoses GDM if ANY ONE of three thresholds is met: fasting ≥92, 1-h ≥180, or 2-h ≥153 mg/dL. Foetal hyperinsulinaemia (in response to maternal hyperglycaemia crossing the placenta) is the mechanism for macrosomia, neonatal hypoglycaemia, RDS, and polycythaemia. Congenital anomalies occur mainly in PGDM due to hyperglycaemia during organogenesis (weeks 3–8). Management: dietary modification first, then metformin or insulin (insulin preferred in PGDM); intrapartum glucose target 4–7 mmol/L; postpartum 75 g OGTT reclassification at 6–12 weeks in all GDM women.

REFLECT

Return to Priya's case from the opening scenario: a woman with a previous macrosomic infant, BMI 28, family history of T2DM, and a fasting glucose of 94 mg/dL at 14 weeks. The fasting glucose of 94 mg/dL is just below the IADPSG fasting cut-off of 92 mg/dL — wait, it EXCEEDS 92 mg/dL. She already meets the IADPSG fasting criterion for GDM at booking. How would you manage her now versus a woman diagnosed at 26 weeks? What conversations would you have about her long-term risk of T2DM? And at a systems level: why does India experience such a high prevalence of GDM, and what dietary and health-system interventions could reduce the burden? Reflect on how the knowledge you have gained in this module translates into both a clinical action plan for Priya and a population-health perspective on gestational diabetes.