GDM

Syamila: Salam Dr..if the patient's BSP is well controlled, then why the baby is still big?

Dr Shaiful Ehsan: Waalaikumsalam...
What is the HBA1c, mothers OGTT, diagnosed since when, BMI and family history of DM?

 All these have factors...which I will explain later...
Please reply...tq


Syamila: HBA1c-6.5%
MOGTT-5.5 and 8.9 mmol/L
Diagnosed at 24w POA
BMI-25.6 kg/m2
No family history of DM..

 Liza: Nurse ada kata sebab ibu minum susu yg manis boleh dpt big baby. Eg Anmum. Huhu

 Dr Shaiful Ehsan: What is the risk factors for her ogtt indications?

 M Syamila: Increse weight gain. Dr..actually, suspicious big baby..so they plan for ELSCS.. why not they try svd first?

 Liza: Ada kaitan tak dr susu yg ibu minum dengan saiz baby ?

 Dr Shaiful Ehsan: From her biodatas...I can tell that she is true GDM...not overt DM...
Thus the target HBA1c should be lower...even less than 5.8..
The higher the HBA1c...the higher the risk....
Her HBA1c is 6.5...which means not parallel with her BSP....

BSP patient can lie...as they need to come to KK or KD...and they can prepare few days before BSP done...

 Abd Halim: Which means... shes just not compliant to medication or something went wrong before the BSP.

 Dr Shaiful Ehsan: But HBA1c cant lie... She is not compliance to her diet....
Bila lepas BSP buat dah happy...makan tak control....
Sehari sebelum BSP cepat2 tahan makan balik....mcm tu lah...

 Most patients try to cheat us..
Thats why we rely on HBA1c...

Another factors include earlier GDM diagnosis, level OGTT more than 7/11, strong family history of DM and obesity (metabolic syndrome)...

All these factors favors overt DM which will give risk of big baby if not controlled enough with diet or medications...

Dr Shaiful Ehsan: Regarding issue...WHY not SVD 1st? I need to know what is the estimated fetal weight on palpation and TAS?

Dr Shaiful Ehsan: Nurliza, regarding minum susu =
Most mother tend to drink susu during pregnancy...if it is consume excessively....the CHO will be excessive and leads to excess sugar and fat...

Actually, it is okey for the mother not to take milk powder...as long as she take good calcium intake from daily foods.....

 That is why dietitian referral and education is important at point of diagnosis GDM...
 Dr Shaiful Ehsan: Syamila, EFWT??

Syamila: sorry dr..based on my palpation i think 3.4-3.6kg.. i forget to see the bht of the pt..i just ask her regarding her baby weight, which she just mention "baby saya besar..'

Dr Shaiful Ehsan: If 3.4 to 3.6 i would agree for SVD trial 1st with close monitoring in labor room...
Any delay in progress...definitely caesar...

Nevertheless...what is the mother's HT?Height?

 Syamila: 145cm..

Dr Shaiful Ehsan: Oops...definitely caeasar my dear...she had risk of cephalopelvic disproportion CPD...

 CPD + Suspicious big baby = preferably caesar

What is the HT level suspicious for CPD?

 Syamila: dr..what is the indication for earlier GDM diagnosis? is it in the 1st trimester?

Dr Shaiful Ehsan: Q:What is the HT level suspicious for CPD? I need answer....

  Syamila: tak ingat dr.....
 Dr Shaiful Ehsan: 145 and less...

 Dr Shaiful Ehsan: If she had normal estimated fetal weight can proceed with SVD ( but risk of CPD already there)...
But suspected big baby & short stature / CPD is = caesar...

Indication for early OGTT are those risk factors for GDM except age...
Need to done earlier eg at 12 -14 weeks...

Early diagnosis = earlier control & treatment...

Syamila: okay..thank you dr..



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 Alif Hussaini: Salam dr, is it typical for women with DM complicating pregnancy to be warded during the first trimester? Tq

Dr Shaiful Ehsan: Waalaikumsalam alif, DM complicating pregnancy usually NOT require admission unless she need to be taught and start insulin which she had no experience and we need to adjsut the dose by monitoring her dxt closely in ward....