Decision making in hyperglycaemia seen in pregnancy
- Author:
Kavitha Nagandla
;
Sivalingam Nalliah
- Publication Type:Review
- Keywords:
betes;
Pragnancy;
Medical NutritionTherapy;
Insulin
- MeSH:
Diabetes Mellitus
- From:International e-Journal of Science, Medicine and Education
2014;8(1):8-18
- CountryMalaysia
- Language:English
-
Abstract:
Delay in childbearing, family history of type
2 diabetes mellitus and obesity in childbearing years
increases a possibility of glucose intolerance or overt
diabetes in pregnancy which may remain unrecognised
unless an oral glucose tolerance test is done.
The International Association of Diabetes and
Pregnancy Study Group (IADPSG, 2010) recommended
the detection and diagnosis of hyperglycaemic disorders
in pregnancy at two stages of pregnancy, the first stage
looking for ‘overt diabetes’ in early pregnancy based
on risk factors like age, past history of gestational
diabetes and obesity and the second stage where
‘gestational diabetes’ at 24-28 weeks with 75 g oral
glucose tolerance test. Although the one step approach
with 75 g of glucose offers operational convenience
in diagnosing gestational diabetes, there are concerns
raised by the National Institute of Health in the recent
consensus statement, supporting the two step approach
(50-g, 1-hour loading test screening 100-g, 3-hour oral
glucose tolerance test) as the recommended approach
for detecting gestational diabetes. Medical nutrition
therapy (MNT) with well-designed meal plan and
appropriate exercise achieves normoglycemia without
inducing ketonemia and weight loss in most pregnant
women with glucose intolerance. Rapidly acting insulin
analogues, such as insulin lispro and aspart are safe in
pregnancy and improve postprandial glycemic control in
women with pre-gestational diabetes. The long acting
analogues (Insulin detemir and glargine) though proven
to be safe in pregnancy, do not confer added advantage
if normoglycemia is achieved with intermediate insulin
(NPH). Current evidence indicates the safe use of
glyburide and metformin in the management of Type
2 diabetes and gestational diabetes as other options.
However, it is prudent to communicate to the women
that there is no data available on the long-term health
of the offspring and the safety of these oral hypoglycemic
drugs are limited to the prenatal period
- Full text:P020150528352870452844.pdf
