622 www.japi.org © JAPI • VOL. 54 • AUGUST 2006 JAPI - DIPSI Guidelines Gestational Diabetes Mellitus – Guidelines* V Seshiah, AK Das, Balaji V, Shashank R Joshi, MN Parikh, Sunil Gupta For Diabetes In Pregnancy Study Group (DIPSI)+ tuning of glycemic level during pregnancy is possible due to the compensatory hyperinsulinaemia, as the normal pregnancy is characterized by insulin resistance. A pregnant woman who is not able to increase her insulin secretion to overcome the insulin resistance that occurs even during normal pregnancy develops gestational diabetes. The metabolic goals of pregnancy are 1) in early pregnancy to develop anabolic stores to meet metabolic demands in late pregnancy and 2) in late pregnancy to provide fuels for fetal growth and energy needs. - Dr Patrick Catalano Gestational Diabetes Mellitus (GDM) is defined as ‘carbohydrate intolerance with recognition or onset during pregnancy’, irrespective of the treatment with diet or insulin. The importance of GDM is that two generations are at risk of developing diabetes in the future. Women with a history of GDM are at increased risk of future diabetes, predominately type 2 diabetes, as are their children 1 GDM occurs when the woman’s beta cell function is not able to overcome the antagonism created by the anti-insulin hormones of pregnancy and the increased fuel consumption required to provide for the growing fetomaternal unit. - Dr Alberto de Leiva INTRODUCTION T he maternal metabolic adaptation is to maintain the mean fasting plasma glucose of 74.5 ± 11 mg/dl and the post prandial peak of 108.7 ± 16.9mg/dl. 1 This fine +DIPSI GDM Guidelines Committee Chairman : Prof V Seshiah (President : Diabetes In Pregnancy Study group India) Members : Dr A K Das, Dr Balaji V, Dr Shashank R Joshi, Dr MN Parikh, Dr Sunil Gupta DIPSI National Meeting Experts: Dr Anil S Bhoraskar, Dr Anjalakshi C, Dr Aparna Agarwal, Dr Balaraman V T, Dr Bharti Kalra, Dr Bhavatharini A, Dr Cynthia Alexander, Dr Dorendra Singh I, Dr Hariharan R S, Dr Himangi Lubree, Dr Jitendra Singh, Dr Jothi S Parthasarathy, Dr Krishnaveni G V, Dr Kumaravel V, Dr. Lakshminarayanan S, Dr Lilly John, Dr Madhini V, Dr Madhuri S Balaji, Dr Mala Chettri, Dr Marina Packiaraj, Dr Mary John, Dr Mayur Patel, Dr Mirudhubashini G, Dr Mohan V, Dr Munichoodappa C, Dr Nalini Shah, Dr Panneerselvam A, Dr Paulose KP, Dr Padma Menon, Dr Pratiba D, Dr Rajan S K, Dr Rajendran N, Dr Rakesh M Parikh, Dr Ramachandran A, Dr Rao PV, Dr Rastogi S S, Dr Sahay B K, Dr Samar Banerjee, Dr Sanjay Kalra, Dr Saraswathy K, Dr Shailaja Kale, Dr Sharad Pendsey, Dr Shyam Mukundan, Dr Siddharth N Shah, Dr Smita P Bhavsar, Dr Sridhar C B, Dr Sundaram A, Dr Suresh S, Dr Vitull K Gupta, Dr Yajnik C S International Faculty : Dr Alberto de Leiva, Dr Lois Jovanovic, Dr Patrick Catalano, Dr Sylvie Hauguel *Based on the deliberations of the First National Conference of Diabetes In Pregnancy Study Group India at Chennai, February 11 and 12, 2006. Abstract The Diabetes In Pregnancy Study group India (DIPSI) is reporting practice guidelines for GDM in the Indian environment. Due to high prevalence, screening is essential for all Indian pregnant women. DIPSI recommends that as a pregnant woman walks into the antenatal clinic in the fasting state, she has to be given a 75g oral glucose load and at 2 hrs a venous blood sample is collected for estimating plasma glucose. This one step procedure of challenging women with 75 gm glucose and diagnosing GDM is simple, economical and feasible. Screening is recommended between 24 and 28 weeks of gestation and the diagnostic criteria of ADA are applicable. A team approach is ideal for managing women with GDM. The team would usually comprise an obstetrician, diabetes physician, a diabetes educator, dietitian, midwife and pediatrician. Intensive monitoring, diet and insulin is the corner stone of GDM management. Oral agents or analogues though used are still controversial. Until there is evidence to absolutely prove that ignoring maternal hyperglycemia when the fetal growth patterns appear normal on the ultrasonogram, it is prudent to achieve and maintain normoglycemia in every pregnancy complicated by gestational diabetes. The maternal health and fetal outcome depends upon the care by the committed team of diabetologists, obstetricians and neonatologists. A short term intensive care gives a long term pay off in the primary prevention of obesity, IGT and diabetes in the offspring, as the preventive medicine starts before birth. ©