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DiabetesComplicating pregnancies      Presentation to Maskwacis– November 2012     Dr Ellen Toth     University of     Alb...
The epidemic      Population growth      Case findingPregnancy:Diabetes          Diabetesbegetsdiabetes                   ...
Plan for this talk   Introduction   How does diabetes complicate    pregancy?   What can be done? (Standing Strong)    ...
Pregnancy     Diabetes begets        diabetes?                       Pregnancy, Maskwacis, 2012
Plan for this talk   Introduction   How does diabetes complicate    pregancy?   What can be done? (Standing Strong)    ...
Pregnancy and          Diabetes Pre-existing diabetesOR gestational diabetes both canhave (epigenetic) consequences   Th...
Glucose crosses placenta, Insulin does not                             Pregnancy, Maskwacis, 2012
Developmental trajectory                Sensitive                phase                             Epigenetic             ...
The Barker Hypothesis  Also shown for cancer, diabetes, chronic lung disease                                              ...
Prevalence of Gestational Diabetes: A:  Pimas, B: Norway, C: African Americans, D: New York State                         ...
Consequences of poorly, uncontrolled orundiagnosed diabetes in pregnancy   Early miscarriages   Large babies (and birth ...
Definitions   Pre-existing diabetes: Type 1 or Type 2    before conception       Type 2 can (often) be undiagnosed   Ge...
Definitions   Diabetes before pregnancy   Diabetes in early pregnancy   Diabetes in late pregnancy                     ...
What to do? Know whether you havediabetes or not Plan your pregnancy Screening       Before pregnancy       In early ...
Gestational Diabetes---RiskFactors   Overweight   Family history of diabetes   Over 25 years old   Previously delivere...
Gestational Diabetes---Risk    Factors   Overweight   Family history of diabetes   Over 25 years old   Previously deli...
Gestational Diabetes   Diabetes during pregnancy.   Causes: Hormones that help the    baby develop can affect your    ow...
Questions?         Pregnancy, Maskwacis, 2012
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Diabetes Complicating Pregnancies: Presentation to Maskwacis Health Services, November 2012

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BRAID Research, University of Alberta
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Diabetes Complicating Pregnancies: Presentation to Maskwacis Health Services, November 2012

  1. 1. DiabetesComplicating pregnancies Presentation to Maskwacis– November 2012 Dr Ellen Toth University of Alberta Diabetes Specialist Pregnancy, Maskwacis, 2012
  2. 2. The epidemic Population growth Case findingPregnancy:Diabetes Diabetesbegetsdiabetes Behaviours Genetics Environment Modified from Engelgau
  3. 3. Plan for this talk Introduction How does diabetes complicate pregancy? What can be done? (Standing Strong) Pregnancy, Maskwacis, 2012
  4. 4. Pregnancy Diabetes begets diabetes? Pregnancy, Maskwacis, 2012
  5. 5. Plan for this talk Introduction How does diabetes complicate pregancy? What can be done? (Standing Strong) Pregnancy, Maskwacis, 2012
  6. 6. Pregnancy and Diabetes Pre-existing diabetesOR gestational diabetes both canhave (epigenetic) consequences The baby gets the increased glucose (and other good or bad nutrition) from the mother This affects the baby’s pancreas: with lifelong consequences Pregnancy, Maskwacis, 2012
  7. 7. Glucose crosses placenta, Insulin does not Pregnancy, Maskwacis, 2012
  8. 8. Developmental trajectory Sensitive phase Epigenetic adaptation:Genetic modification of genesdevlopment Environmental resulting in different influences: phenotypes nutrition etc Pregnancy, Maskwacis, 2012
  9. 9. The Barker Hypothesis Also shown for cancer, diabetes, chronic lung disease Pregnancy, Maskwacis, 2012
  10. 10. Prevalence of Gestational Diabetes: A:  Pimas, B: Norway, C: African Americans, D: New York State Pregnancy, Maskwacis, 2012
  11. 11. Consequences of poorly, uncontrolled orundiagnosed diabetes in pregnancy Early miscarriages Large babies (and birth complications) Congenital defects: heart, spine, cleft palate, “prune belly”, hydrocephalus Still births Childhood obesity Diabetes Pregnancy, Maskwacis, 2012
  12. 12. Definitions Pre-existing diabetes: Type 1 or Type 2 before conception  Type 2 can (often) be undiagnosed Gestational diabetes: Type 1 or Type 2 first “recognised” during pregnancy  Either undiagnosed Type 2 (Overt)  Or predictor of Type 2  Very rarely Type 1 Pregnancy, Maskwacis, 2012
  13. 13. Definitions Diabetes before pregnancy Diabetes in early pregnancy Diabetes in late pregnancy Pregnancy, Maskwacis, 2012
  14. 14. What to do? Know whether you havediabetes or not Plan your pregnancy Screening  Before pregnancy  In early pregnancy  (Universal screening recommended at 24- 28 weeks EXCEPT if increased risk factors) Pregnancy, Maskwacis, 2012
  15. 15. Gestational Diabetes---RiskFactors Overweight Family history of diabetes Over 25 years old Previously delivered a large baby Being of non-white heritage (ethnic groups) Pregnant with more than one baby Pregnancy, Maskwacis, 2012
  16. 16. Gestational Diabetes---Risk Factors Overweight Family history of diabetes Over 25 years old Previously delivered a large baby Being of non-white heritage (ethnic groups) Pregnant with more than one baby Pregnancy, Maskwacis, 2012
  17. 17. Gestational Diabetes Diabetes during pregnancy. Causes: Hormones that help the baby develop can affect your own insulins ability to handle sugar. This is a type of insulin resistance. Both mother and child are at a higher risk of developing type 2 diabetes later in life. Pregnancy, Maskwacis, 2012
  18. 18. Questions? Pregnancy, Maskwacis, 2012

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