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Post Partum

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Objectives

Discuss the immediate care of the infant


Discuss the importance of breast feeding
Discuss follow up screening of the mother
Discuss risk of IGT or diabetes in future
Discuss follow up education for mother

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After delivery the infant

Watch for signs of hypoglycemia


Check blood glucose heel prick
Within 1st hour after delivery
After each of 1st 4 feeds

Less than 2.6 mmol/L or 44 mg/dl defined as


hypoglycemia
Treatment of hypoglycemia
Topfeeding/glucose in water/ IV dextrose

Seshiah, Balaji, 2006


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After delivery the infant

Usual care
Vital signs
Apgar scores
Pre-warmed incubator
Start breast feeding within 30 minutes for better latching
Watch for jaundice check bilirubin
If macrosomic, check calcium and magnesium on day 2

Seshiah, Balaji, 2006


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After delivery - mother

Exogenous insulin not required after placenta is


delivered
Blood glucose usually returns to normal
Check fasting within 48 hours to rule out type 1 or
type 2 diabetes

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Breast feeding

Encourage for all


Protects infant from over or undernutrition
during early childhood
May lower risk of
Obesity
Hypertension
Cardiovascular disease
Diabetes

Gunderson, 2007
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Post partum period

Encourage mother to achieve healthy weight.


Healthy eating
Adequate intake to sustain breast feeding
Regular activity

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Future pregnancies

Should be planned
Education regarding birth control is needed
Encourage achieving healthy weight prior to
conceiving again
Check blood glucose levels well ahead of
conception allowing time to normalize if necessary

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Contraception

Any method of contraception can be safely used in


a woman with history of GDM
Intrauterine devices are commonly used

Progesterone-only oral contraceptives are the best


choice within the first 6 weeks post partum
They have the lowest risk of thrombosis
Preferred during breastfeeding

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Glucose tolerance testing

Should be done 6-12 weeks post partum


Fasting glucose testing is not sufficient to
identify all who have IGT or type 2 diabetes
Only 34% of women with IGT or type 2 had elevated
fasting glucose levels
44% of those with type 2 had fasting less than 5.5
mmol/L (100 mg/dL)

OGTT should be done

Metzger, Buchanan, Coustan et al. 2007


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CVD risk

Women with GDM may have many of


characteristics of metabolic syndrome
Hypertension, dyslipidemia, obesity, IGT should all
be evaluated and treated

Metzger, Buchanan, Coustan et al. 2007


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Postpartum education is key

OGTT at 6-12 weeks


Managing risk factors
Obesity
Hypertension
Dyslipidemia
Birth control
Preconception screening
Annual screening for diabetes 35-60% risk of
type 2 within 10 years

Metzger, Buchanan, Coustan et al. 2007


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References
Gunderson EP. Breastfeeding after gestational diabetes pregnancy. Diabetes Care. 2007;30(suppl 2):S161-168.

Metzger BE, Buchanan TA, Coustan DR, De Leiva A, Hadden DR, Hod M. Summary and recommendations of
the fifth international workshop-conference on gestational diabetes mellitus, Diabetes Care. 2007; 30(suppl
2):S251-260.

Seshiah V, Balaji V, et al. Gestational Diabetes Mellitus Guidelines. J Assoc Physic of India 2006;54:622-28.

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