Gestational diabetes mellitus

New-onset hypertension after 20 weeks of gestation with proteinuria or end-organ dysfunction, driven by abnormal placental spiral artery remodeling and widespread endothelial dysfunction. Eclampsia is preeclampsia complicated by seizures; magnesium sulfate treats and prevents seizures, and prompt delivery is the only definitive cure for both.

Gestational hypertension is new hypertension after 20 weeks of pregnancy without proteinuria or other features of preeclampsia. It requires close surveillance because a substantial proportion progresses to preeclampsia; management is blood pressure control with pregnancy-safe agents and timely delivery near term.

Chronic hypertension in pregnancy is hypertension predating pregnancy or diagnosed before 20 weeks. It raises the risk of superimposed preeclampsia, growth restriction, and abruption, so management is blood pressure control with pregnancy-safe agents, low-dose aspirin prophylaxis, close surveillance, and switching off teratogenic drugs preconception.

Pregestational diabetes is type 1 or type 2 diabetes mellitus present before conception, affecting about 1 to 2 percent of pregnancies. The diagnosis rests on a preexisting diagnosis or first-trimester glucose values meeting standard diabetes criteria. First-line treatment is insulin, titrated to a fasting glucose below 95 mg per deciliter, because it does not cross the placenta.

Insulin therapy replaces or supplements endogenous insulin to control hyperglycemia, and is lifelong and mandatory in type 1 diabetes because of absolute beta-cell failure, while in type 2 diabetes it is added when oral and noninjectable agents fail to reach glycemic goals. First-line therapy is a basal-bolus regimen started at 0.4-1.0 units/kg/day in type 1 diabetes, or basal insulin glargine 10 units/day (or 0.1-0.2 units/kg/day) in type 2 diabetes, titrated to a fasting glucose target.

Type 2 diabetes is hyperglycemia from insulin resistance with progressive relative insulin deficiency, diagnosed by a hemoglobin A1c of 6.5% or higher, a fasting glucose of 126 mg/dL or higher, or a 2-hour oral glucose tolerance test value of 200 mg/dL or higher. First-line treatment is lifestyle modification plus metformin, with an SGLT2 inhibitor or GLP-1 receptor agonist added early for patients with atherosclerotic disease, kidney disease, or heart failure.

Hypoglycemia is a plasma glucose below 70 mg/dL, most often a complication of insulin or sulfonylurea therapy for diabetes, and in a person without diabetes it requires a Whipple triad-based evaluation for insulinoma or another endogenous cause. An alert patient is treated with 15 to 20 g of fast-acting oral carbohydrate, while a patient unable to swallow safely receives intramuscular glucagon 1 mg or intravenous dextrose 50% 25 g.

Routine prenatal care is the scheduled, gestational-age-anchored protocol of visits, counseling, and screening tests that confirms dating, stratifies risk, and detects treatable complications before they harm mother or fetus. The visit interval (every 4 weeks to 28 weeks, every 2 weeks to 36 weeks, weekly thereafter) carries a fixed sequence of labs, ultrasounds, and prophylaxis, so any abnormal result at a given gestational age has its own defined next step rather than an open-ended workup.