Post Partum

1
Post Partum
2
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

3
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
4
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
5
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

6
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
7
Post partum period

• Encourage mother to achieve healthy weight.
• Healthy eating
• Adequate intake to sustain breast feeding
• Regular activity

8
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

9
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

10
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
11
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
12
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
13
References

• Gunderson EP. Breastfeeding after gestational
  diabetes pregnancy. Diabetes Care. 200730(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
  200654622-28.