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Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries.<br>For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources.<br>The total value of the WDF project portfolio reached USD 377 million, excluding WDF’s own advocacy and strategic platforms.<br>The WDF mission:
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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
After delivery – the infant • Watch for signs of hypoglycemia • Check blood glucose – heel prick • Within 1st hour after delivery • After each of 1st4 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
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
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
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
Post partum period • Encourage mother to achieve healthy weight. • Healthy eating • Adequate intake to sustain breast feeding • Regular activity
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
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
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
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
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
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.
