Today we're going to talk about one of the most common complications of pregnancy
called gestational diabetes.
Gestational diabetes or GDM for short,
is defined as impaired glucose tolerance that's first recognized during pregnancy.
So, put another way that means someone who develops diabetes during pregnancy
when normally everything was fine.
Now, I want to share with you some facts about diabetes.
When we think about the whole world and all the pregnant persons in the world,
about 1 in 10 of them will have pregnancies that are associated with diabetes.
Breaking that down even more, about 90% of those patients with diabetes will have gestational diabetes,
so the diabetes that's just developed during pregnancy.
The other 10% will have preexisting disease, so type 1 or type 2 diabetes.
It's really important that gestational diabetes is both diagnosed
and treated adequately during pregnancy,
because if we failed to do that,
that can lead to pretty significant complications for both the pregnant person and the baby,
and not just during the pregnancy.
What we know, is about 50% of the clients who have gestational diabetes
will go on to develop type 2 diabetes within 10 years.
And for the baby, 60% of them may develop obesity and also develop type 2 diabetes.
However, if the diabetes is well-controlled,
the outcomes for clients with gestational diabetes can be almost the same as clients
who don't have gestational diabetes.
So next I want to show you a table that we use called the White's Classification table.
Now this was developed by Pricilla White,
who really looked at the effect of gestational diabetes on pregnancy.
So this helps us to organize what's going on with the diabetes
and it also gives us the nomenclature when we're writing our reports to explain it.
So let's go through this table.
So we have two classes of gestational diabetes, Type A1 and Type A2.
Now we can look at the onset, both of them are gestational, meaning it happens during pregnancy,
it was not preexisting.
Now this is where we get a little bit more detail.
We can look at the fasting and two hour postprandial blood sugars.
So fasting, remember that's the blood sugar we get first thing in the morning
before we eat or before we do anything like that.
So if the fasting blood sugar on average is less than a 105,
that would classify that type of diabetes is Type A1.
If, however, the fasting blood sugar is above 105 that would be classified as a2.
Now let's look at the two hour postprandial.
Now post prandial means after we eat,
so two hours after we eat, what is that blood sugar look like?
If it's less than a 120, which would be great, then that again will be classified as A1,
or if it's more than a 120, then that would be A2.
So this refers to gestational onset diabetes.
Now, let's look at the very last column. So how is the diabetes controlled?
Again we're still talking about gestational onset, so the therapy, is it diet-controlled?
Are we able to keep the blood sugar within normal limits just by using nutritional changes,
or does the client need insulin? Alright?
So when you see type a1or Type A2 in the chart, you now know what that is.
Now let's look at preexisting diabetes, we can also classify that.
So now you'll see class Type's B, C, D, F, R, and H. And that corresponds with the age of onset,
so you can see on this axis over the age of 20, 10-19,
or maybe diabetes that shows up at any point, as a classification.
We can also think about duration, how long have they had the diabetes?
So if you think about it, we know the longer you have diabetes,
the more sequelae or consequences or complications you're going to have,
that's going to be important in the management.
Speaking of complications, we can look at the level of vascular disease
and also classify the diabetes by that.
So you can see with Type's B and C, there's no vascular disease so far so they're still pretty healthy,
but the further we get on the classification scale, you see the more damage.
So we have retinopathy all the way to heart disease.