Your SlideShare is downloading. ×
Diabetes In Pregnancy
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Diabetes In Pregnancy

2,444

Published on

gestational diabetes

gestational diabetes

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
2,444
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
66
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. Diabetes in Pregnancy
  • 2. Diabetes in Pregnancy
    • Epidemiology
    • Classification
    • Pathophysiology
    • Morbidity
      • Fetal
      • Maternal
    • Diagnosis
    • Treatment and Management
    • References
  • 3. Epidemiology
    • 4-6% of pregnancies in the U.S are complicated by DM, accounting for 50-150 thousand babies per year.
      • 88% GDM, 8% Type II DM, 4% Type 1 DM
    • Prevalence also varies by race
      • 1.5-2% in Caucasians, 5-8% in Hispanic, Asian and African Americans, and up to 15% in some SW Native American groups.
  • 4. Classification
  • 5. Pathophysiology
    • Normal pregnancy is characterized by:
      • Mild fasting hypoglycemia
      • Postprandial hyperglycemia
      • Hyperinsulinemia
    • Due to peripheral insulin resistance which ensures an adequate supply of glucose for the baby.
  • 6. Pathophysiology
    • Human Placental Lactogen (HPL)
      • Produced by syncytiotrophoblasts of placenta.
      • Acts to promote lipolysis  increased FFA and to decrease maternal glucose uptake and gluconeogenesis. “Anti-insulin”
    • Estrogen and Progesterone
      • Interfere with insulin-glucose relationship.
    • Insulinase
      • Placental product that may play a minor role.
  • 7. A Vicious Cycle???
  • 8. Fetal Morbidity
    • Miscarriages
      • Frequency directly related to degree of maternal glycemic control.
      • Up to 44% with poorly controlled DM (HbA 1 C >12).
    • Preterm Delivery
      • Increase in both spontaneous and indicated preterm labor (<35 wks).
  • 9. Fetal Morbidity
    • Birth Defects
      • 1-2% risk among the general population.
      • 4-8 fold increased risk among preexisting diabetics.
      • Most common defects are CNS and CV, but also an increase in renal and GI abnormalities.
      • Up to a 600 fold increase in caudal regression syndrome.
  • 10. Fetal Morbidity
    • Macrosomia
      • Defined as birthweight above 90 th % or >4000 grams.
      • Occurs in 15-45% of diabetic pregnancies, a 4-fold increase over normal.
      • Carries many morbidities including birth trauma, RDS, neonatal jaundice and severe hypoglycemia.
  • 11. Fetal Morbidity
    • Growth Restriction
      • Although we typically associate maternal DM with macrosomia, growth restriction is fairly common among Type 1 diabetic mothers.
      • Best predictor is presence of maternal vascular disease.
  • 12. Fetal Morbidity
  • 13. Fetal Morbidity
    • Polycythemia
      • Hyperglycemia stimulates fetal erythropoeitin production.
      • Can lead to tissue ischemia and infarction.
    • Hypoglycemia
      • Think of as an “overshoot” mechanism.
      • Baby is used to having lots of maternal glucose so it makes lots of insulin. When born, maternal glucose is no longer available but insulin remains high  hypoglycemia.
      • Can lead to seizures, coma and brain damage.
  • 14. Fetal Morbidity
    • Postnatal hyperbilirubinemia
      • Occurs in appox. 25%, double that of normal.
      • Thought to be due in large part to polycythemia.
    • Respiratory distress syndrome
      • 5-6 fold increased frequency.
      • May be due to a delay in lung maturation or simply due to the increased frequency of preterm deliveries.
  • 15. Fetal Morbidity
    • Polyhydramnios
      • Amniotic fluid volume >2000 mL.
      • Occurs in 10% of diabetics.
      • Increased risk of placental abruption and preterm labor.
  • 16. Maternal Morbidity
    • Increased risk of DKA due to increasingly resistant DM.
    • Increased incidence of UTI due to glucose-rich urine and urinary stasis.
      • Glucosuria is a normal finding of pregnancy but may be much higher in diabetics.
    • Diabetic retinopathy
    • Diabetic nephropathy
  • 17. Maternal Morbidity
    • Diabetic neuropathy
    • Preeclampsia
      • 2-fold increase
  • 18. Diagnosis
    • Glucose Challenge Test (24-28 wks)
      • 50 gram glucose load with blood level 1 hour later.
      • Does NOT require fasting state.
      • Normal finding is <140 mg/dl.
      • If >140, need to do a 3 hour glucose tolerance test.
  • 19. Diagnosis
    • Glucose Tolerance Test
      • Draw a fasting glucose level (normal<95).
      • Give 100 gram glucose load with glucose levels drawn after 1, 2 and 3 hours.
      • Normal levels vary widely depending on who you ask but should be in the following ranges:
        • 1 hr:<180 2 hr:<155 3 hr:<140
      • 2 or more abnormal values = GDM.
  • 20. Treatment and Management
    • Obviously the main goal is to maintain good glycemic control.
      • Typically controlled with insulin but oral hypoglycemic agents like glyburide are also showing promise.
  • 21. Treatment and Management
    • Obstetrical management
      • Serial US to trend fetal growth, AFI and fetal anatomy
      • Fetal well-being monitored with kick counts, NSTs, BPPs
    • Postpartum, 95% of GDM mothers return to normal glucose tolerance, and require no further insulin.
      • Glucose tolerance screen 2-4 mo. postpartum to detect those that remain diabetic.
  • 22. References
    • www.acog.org
    • Current Obstetric & Gynecologic Diagnosis & Treatment (2003)
    • Williams Obstetrics (2005)
  • 23.  

×