For which of the following conditions screening for GDM is not required –
Correct Answer: Previous pre-eclampsia
Description: Ans. is 'd' i.e., Previous preeclampsia Gestational diabetes mellitus It is defined as carbohydrate intolerance of varying severity with onset or first recognition during pregnancy. Pregnancy is a form of stress that can cause latent diabetes to manifest just as do surgical operations or acute infections.In most of these cases the carbohydrate intolerance will revert by the end of puerperium but this manifestation may be the first indication of diabetes yet to come.More than half of the women with gestational diabetes will develop frank diabetes within the next 20 years.Screening and diagnosis for gestational diabetes mellitusHistorical risk factors suggestive of gestational diabetes have been known for a long timeUnexplained still birth, macrosomia. preterm birth Unexplained still birth, macrosomia and preterm birth have been consistently found to be significantly increased in both gestational and progestational diabetic pregnancies.H/O gestational diabetes in previous pregnancyH/O gestational diabetes in previous pregnancy or diabetes in a first degree relative also increase the risk of gestational diabetes mellitus in subsequent pregnancies.Congenital malformationsCongenital malformations are associated with true diabetes. Congenital malformations are increased much more in known diabetics for obvious reasons because true gestational diabetes usually manifests in the second half of pregnancy by which time fetal organogenesis is nearly complete.The incidence of gestational diabetes can be stratified and shows good correlation with risk factors which can be utilized to characterize women into low average and high risk of developing gestational diabetes. Low risk categoryHigh risk category* <25 years of age* Markedly obese* Normal baby weight* H/o diabetes in first degree relative* No family history of diabetes * Previous abnormal glucose tolerance test* No history of abnormal glucose metabolism* Previous large baby >4 kg* No history of poor obstetric outcome* Previous bad obstetric history unexplained still birth or congenital malformed babies* Not members of an ethnic/racial group with a high prevalence of diabetes* Those with persistent glycosuria There has been a debate whether screening for diabetes should be universal or selective based on risk factors, or whether it is required at allAlthough there is ample evidence to demonstrate increased pregnancy and neonatal complications with increasing maternal glycemic levels there is not enough quality data to ascertain the impact of screening on maternal and neonatal health outcomes.In such a scenario the best policy seems to be is to offer selective screening based on race, personal and obstetric risk factors and the background prevalence of type 2 diabetics in the community.Also knowThe screening for gestational diabetes mellitus is routinely done at 24-28 weeks of pregnancy.Best screening test is 50 g glucose challenge test.
Category:
Gynaecology & Obstetrics
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