This document discusses gestational diabetes. It provides information on:
1. Gestational diabetes is a form of diabetes that develops during pregnancy in women who do not have diabetes otherwise. It is caused by pregnancy hormones and/or insulin deficiency.
2. While gestational diabetes usually resolves after delivery, it increases the mother's risk of developing type 2 diabetes later in life. It can also increase risks for the baby if not well controlled, such as being too large or jaundice.
3. Screening all pregnant women for gestational diabetes is recommended, as prior selective screening missed some cases. Screening and treatment can help reduce risks for both mother and baby.
This document discusses diabetes mellitus and its classification, signs, symptoms, causes, and management during pregnancy. It begins by defining diabetes and describing its four main categories. It then discusses gestational diabetes in detail, including its causes, significance, and effects on both mother and fetus. These effects include complications like macrosomia, birth defects, hypoglycemia, and others. Throughout, it provides information on managing diabetes during pregnancy to minimize risks through glycemic control and monitoring.
This document discusses gestational diabetes, including its definition, risk factors, screening and diagnostic tests, complications, management, and delivery considerations. Gestational diabetes is a type of diabetes that develops during pregnancy due to insufficient insulin production or action. It is characterized by high blood glucose and poses risks to both mother and baby if not properly managed through careful monitoring, medical nutrition therapy, exercise, and possibly insulin treatment. The goal of management is to maintain normal blood glucose levels and reduce complications.
Gestational diabetes is a type of diabetes that develops during pregnancy and usually disappears after giving birth. It occurs in 2-10% of pregnancies due to hormonal changes reducing the body's ability to use insulin. While most women have no symptoms, screening tests are done between 24-28 weeks of pregnancy to check blood sugar levels. Eating a healthy diet and exercise can help manage gestational diabetes and reduce risks to both mother and baby like high birth weight or developing diabetes later in life.
This document provides an overview of disorders of carbohydrate metabolism during pregnancy, including gestational diabetes and pre-existing diabetes. It discusses the physiological changes in carbohydrate metabolism during pregnancy, pathogenesis and clinical features of type 1 and type 2 diabetes, effects of diabetes on pregnancy outcomes, management through medical treatment, diet, and obstetric care, and considerations for pre-pregnancy counseling and care during labor and delivery. The goal of management is to achieve near normal blood glucose levels in order to reduce risks of complications for both mother and baby.
A 52-year-old woman presented with unconsciousness for 1 hour. She has a 5-year history of type 2 diabetes that was not being treated with medication. On examination, she was severely dehydrated with low blood pressure and an elevated heart rate. Her blood sugar was very high at 21 mmol/L. She was diagnosed with diabetic ketoacidosis and treated with fluid replacement and insulin. Her condition stabilized and she was discharged on oral medications for diabetes.
Gestational diabetes mellitus (GDM) is a type of diabetes that develops during pregnancy and usually resolves after giving birth. It occurs in 4% of pregnancies worldwide and prevalence varies between racial/ethnic groups. GDM results from the placenta producing hormones that cause insulin resistance in the mother. This puts the fetus at risk for complications like macrosomia and hypoglycemia. Women with GDM are also at higher risk for cesarean delivery and developing type 2 diabetes later in life. Screening and treatment of GDM can help reduce risks to both mother and baby.
This document discusses gestational diabetes mellitus (GDM). It begins by defining GDM as an endocrine disease involving faulty carbohydrate metabolism that complicates 3-5% of pregnancies. The document then discusses the pathophysiology of GDM, screening and diagnostic methods including oral glucose tolerance tests, maternal and fetal complications, and management approaches including careful antenatal supervision and control of blood sugar levels. Key goals of management are finding the optimal time and method of delivery and arranging newborn care.
You can live with diabetes if you learn how! diabetes treatmentasucoms
Diabetes is a metabolic disease where the body does not properly process glucose due to inadequate insulin production or cells not responding to insulin. There are three main types of diabetes: type 1 where the body does not produce insulin; type 2 where the body does not produce enough insulin or cells do not respond properly; and gestational diabetes which affects females during pregnancy. Treatment involves monitoring blood sugar levels, eating healthy, exercising, and potentially taking medications or insulin to control glucose levels. Keeping diabetes managed is important to prevent health complications.
This document discusses diabetes mellitus and its classification, signs, symptoms, causes, and management during pregnancy. It begins by defining diabetes and describing its four main categories. It then discusses gestational diabetes in detail, including its causes, significance, and effects on both mother and fetus. These effects include complications like macrosomia, birth defects, hypoglycemia, and others. Throughout, it provides information on managing diabetes during pregnancy to minimize risks through glycemic control and monitoring.
This document discusses gestational diabetes, including its definition, risk factors, screening and diagnostic tests, complications, management, and delivery considerations. Gestational diabetes is a type of diabetes that develops during pregnancy due to insufficient insulin production or action. It is characterized by high blood glucose and poses risks to both mother and baby if not properly managed through careful monitoring, medical nutrition therapy, exercise, and possibly insulin treatment. The goal of management is to maintain normal blood glucose levels and reduce complications.
Gestational diabetes is a type of diabetes that develops during pregnancy and usually disappears after giving birth. It occurs in 2-10% of pregnancies due to hormonal changes reducing the body's ability to use insulin. While most women have no symptoms, screening tests are done between 24-28 weeks of pregnancy to check blood sugar levels. Eating a healthy diet and exercise can help manage gestational diabetes and reduce risks to both mother and baby like high birth weight or developing diabetes later in life.
This document provides an overview of disorders of carbohydrate metabolism during pregnancy, including gestational diabetes and pre-existing diabetes. It discusses the physiological changes in carbohydrate metabolism during pregnancy, pathogenesis and clinical features of type 1 and type 2 diabetes, effects of diabetes on pregnancy outcomes, management through medical treatment, diet, and obstetric care, and considerations for pre-pregnancy counseling and care during labor and delivery. The goal of management is to achieve near normal blood glucose levels in order to reduce risks of complications for both mother and baby.
A 52-year-old woman presented with unconsciousness for 1 hour. She has a 5-year history of type 2 diabetes that was not being treated with medication. On examination, she was severely dehydrated with low blood pressure and an elevated heart rate. Her blood sugar was very high at 21 mmol/L. She was diagnosed with diabetic ketoacidosis and treated with fluid replacement and insulin. Her condition stabilized and she was discharged on oral medications for diabetes.
Gestational diabetes mellitus (GDM) is a type of diabetes that develops during pregnancy and usually resolves after giving birth. It occurs in 4% of pregnancies worldwide and prevalence varies between racial/ethnic groups. GDM results from the placenta producing hormones that cause insulin resistance in the mother. This puts the fetus at risk for complications like macrosomia and hypoglycemia. Women with GDM are also at higher risk for cesarean delivery and developing type 2 diabetes later in life. Screening and treatment of GDM can help reduce risks to both mother and baby.
This document discusses gestational diabetes mellitus (GDM). It begins by defining GDM as an endocrine disease involving faulty carbohydrate metabolism that complicates 3-5% of pregnancies. The document then discusses the pathophysiology of GDM, screening and diagnostic methods including oral glucose tolerance tests, maternal and fetal complications, and management approaches including careful antenatal supervision and control of blood sugar levels. Key goals of management are finding the optimal time and method of delivery and arranging newborn care.
You can live with diabetes if you learn how! diabetes treatmentasucoms
Diabetes is a metabolic disease where the body does not properly process glucose due to inadequate insulin production or cells not responding to insulin. There are three main types of diabetes: type 1 where the body does not produce insulin; type 2 where the body does not produce enough insulin or cells do not respond properly; and gestational diabetes which affects females during pregnancy. Treatment involves monitoring blood sugar levels, eating healthy, exercising, and potentially taking medications or insulin to control glucose levels. Keeping diabetes managed is important to prevent health complications.
Gestational diabetes is a type of diabetes that develops during pregnancy in women who have never had diabetes before. It occurs in about 5% of all pregnancies. If not treated, gestational diabetes can cause health problems for both the mother and fetus, such as delivering a large baby. Risk factors include maternal age over 25, family history of diabetes, and belonging to certain ethnic groups. Women are screened for gestational diabetes between 24-28 weeks of pregnancy through a glucose challenge test and glucose tolerance test if needed. Treatment may involve diet, exercise, blood sugar monitoring, and possibly insulin.
1) Gestational diabetes is a form of diabetes that develops during pregnancy and affects 2-3% of pregnancies. It occurs when the placenta produces hormones that block the action of insulin and cause high blood sugar levels.
2) Both gestational diabetes and pre-existing diabetes can lead to complications for the mother such as preeclampsia and infections, as well as complications for the baby like premature birth and macrosomia. Babies are also at higher risk for obesity and diabetes later in life.
3) Managing diabetes during pregnancy involves glucose monitoring, medical nutrition therapy, exercise if appropriate, and sometimes insulin to control blood sugar levels and minimize risks.
This document discusses gestational diabetes mellitus (GDM), including its definition, epidemiology, etiology, pathophysiology, risk factors, maternal and fetal complications, screening, management, and the role of exercise and physiotherapy. Some key points:
- GDM is defined as glucose intolerance that begins or is first recognized during pregnancy and puts both mother and child at risk for developing diabetes later in life.
- Risk factors include family history of diabetes, previous large baby, past pregnancy loss, age over 30, obesity.
- Increased hormones during pregnancy cause insulin resistance, leading to high blood glucose levels if not managed.
- Screening usually occurs between 24-28 weeks with an oral glucose tolerance test
This document discusses gestational diabetes mellitus (GDM), including its definition, epidemiology, etiology, pathophysiology, risk factors, maternal and fetal complications, screening, medical management, and the role of physiotherapy. Some key points:
- GDM is defined as glucose intolerance that begins or is first recognized during pregnancy and resolves after delivery.
- It occurs in 7% of pregnancies and risk increases with age over 35.
- Pregnancy causes insulin resistance which can lead to GDM if not met with adequate insulin production.
- Complications for the mother include preeclampsia and future type 2 diabetes; complications for the baby include macrosomia, hypoglycemia
Diabetes in pregnancy-overt diabetes: type I DM, type II DM,Gestational diabe...FarsanaM
This document discusses diabetes in pregnancy, including types, screening, diagnosis, management, and effects on mother and fetus. It covers gestational diabetes and pregestational diabetes types 1 and 2. Key points include increased risk of complications for both mother and baby if blood sugar is not well-controlled, and the importance of medical nutrition therapy, exercise, monitoring blood sugar levels, and insulin treatment if needed to maintain healthy blood glucose levels during pregnancy. The goals are to reduce risks and promote optimal outcomes for mother and child.
Diabetes is a common medical complication of pregnancy that can be detrimental if not properly managed. It includes pre-existing diabetes, gestational diabetes, and pre-diabetes. Strict control of blood sugar levels is important to prevent complications in both the mother and baby such as preeclampsia, macrosomia, and birth injuries. Management involves medical nutrition therapy, insulin when needed, exercise, tight glucose monitoring, and obstetric care. Close cooperation is needed between the doctor, patient, and family to help achieve successful outcomes.
This document discusses various nutrition-related conditions and interventions during pregnancy. It covers topics like hypertensive disorders, gestational diabetes, obesity, multifetal pregnancies, HIV/AIDS, eating disorders, and fetal alcohol spectrum. For each condition, it describes characteristics, potential consequences, diagnosis and treatment approaches. Nutritional recommendations are provided to support maternal and fetal health for different pregnancy complications. The goal is to provide evidence-based nutritional interventions that are safe, effective and affordable.
This document provides information about diabetes mellitus. It defines diabetes as a group of diseases characterized by high blood glucose levels due to defects in insulin production or action. It describes the normal and abnormal blood glucose ranges and symptoms of diabetes such as frequent urination. It discusses the types of diabetes including type 1, type 2, and gestational diabetes. It covers insulin action and homeostasis as well as the burden, signs and symptoms, complications, diagnosis, and management of diabetes.
1. Gestational diabetes is characterized by carbohydrate intolerance that begins or is first recognized during pregnancy. It can increase risks for both mother and baby.
2. It is diagnosed through screening tests such as a glucose challenge test and confirmed with an oral glucose tolerance test. Treatment involves diet, exercise, blood sugar monitoring, and possibly insulin.
3. Complications for the mother include preeclampsia and infections. Complications for the baby include hypoglycemia, jaundice, and respiratory distress. Strict control of blood sugar levels can help reduce risks.
This document discusses diabetes in pregnancy. It begins by introducing diabetes as a metabolic disorder characterized by hyperglycemia that can be caused by lack of insulin or insensitivity to insulin. Gestational diabetes is defined as glucose intolerance first recognized during pregnancy.
The document then discusses how pregnancy affects carbohydrate metabolism. Hormonal changes associated with pregnancy initially facilitate maternal energy storage and later divert energy to the fetus as demand increases. This can precipitate glucose intolerance or diabetes in those with limited insulin production capacity. The placenta also causes insulin resistance in the mother to make more glucose available to the fetus.
The effects of diabetes on pregnancy are then reviewed. Poorly controlled diabetes can lead to complications for both mother and
Diabetes as presented by cheruiyot sambu in kapkatet county hospital. cheruiyot sambu
Diabetes is a group of metabolic diseases where a person has high blood glucose due to either inadequate insulin production or cells not responding properly to insulin. Type 1 diabetes occurs when the pancreas does not produce insulin, while type 2 occurs when the body does not produce enough insulin or cells do not respond properly to insulin. Symptoms of diabetes include increased urination, thirst, hunger, weight loss, fatigue, and changes in mood or vision. Treatment involves physical activity, healthy diet, and potentially insulin injections or tablets. Uncontrolled diabetes can lead to complications affecting the eyes, feet, heart, kidneys and other organs.
Diabetes is a common complication of pregnancy, affecting 4-6% of pregnancies in the US. It can lead to both maternal and fetal morbidity. The main types of diabetes in pregnancy are gestational diabetes (88% of cases), type 2 diabetes (8% of cases), and type 1 diabetes (4% of cases). Diabetes in pregnancy is associated with increased risks of miscarriage, preterm delivery, birth defects, macrosomia, growth restriction, hypoglycemia, jaundice, and respiratory distress in the baby. It also increases the mother's risk of preeclampsia, diabetic ketoacidosis, and complications from existing diabetes or related conditions. Diagnosis and treatment focus on managing blood glucose
Definition
Incidence
Types
Diabetogenic effect of pregnancy
Metabolic changes during pregnancy
Risk of uncontrolled DM on pregnancy
Diagnosis and evaluation
Medical management
Nursing management
Definition of Diabetes mellitus:It is inability to metabolize glucose properly. It is a chronic systemic disease, manifesting metabolic and vascular changes affecting every organ in the body.
a. Pregestational (preexisting) diabetes
Occurs when have type 1 or type 2 diabetes before becoming pregnant.
1-Type I Insulin-dependent (IDDM) (Insulin deficient).
2-Type II Non-Insulin dependent (NIDDM) (Insulin resistant).
b. Gestational diabetes mellitus (GDM).
Occurs diabetes when becoming pregnant.
a. Pregestational (preexisting) diabetes
Occurs when have type 1 or type 2 diabetes before becoming pregnant.
1-Type I Insulin-dependent (IDDM) (Insulin deficient).
2-Type II Non-Insulin dependent (NIDDM) (Insulin resistant).
b. Gestational diabetes mellitus (GDM).
Occurs diabetes when becoming pregnant.
Diabetes may appear only during pregnancy due to :-
1-Increased levels of antiinsulinas (estrogen, progesteron, human placental lactogen, and prolactine).
2-Decreased renal threshold for glucose (glucose loss in urine).
During early stage of pregnancy: Maternal hypoglycemia.
After the fourth month: increase glucose level in the blood due to placental hormones
During labor: liability to hypoglycaemia.
After delivery: glucose level return to prepregnant state.
Gestational Diabetes
Risk Factors
Maternal age >25
Family history
Glucosuria
Prior macrosomia
Previous unexplained stillbirth
Risk of uncontrolled diabetes on pregnancy
A- Maternal effect:
On pregnancy On labor On puerperium
-Abortion - premature -puerperal sepsis
-PET labor -PPH
-Polyhydramnios - Inertia - Abnormal
-Pressure symptom - Operative lactation
-Infection delivery
-Retinopathy
Risk of uncontrolled diabetes on fetus
1- Abortion
2- Congenital anomalies
Open neural defect, CHD, renal anomaly, sacral agenesis, small left colon syndrome(Approximately 40% to
50% of infants with this disorder have diabetic mothers, almost all of whom are insulin dependent , , imperforated anus.
3- Macrosomia
Fetal hyperglycaemia causes increase insulin secretion and lead to increase fetal fat deposition
Open neural defect
sacral agenesis
Macrosomia
Macrosomia
Macrosomia
Risk of uncontrolled diabetes on fetus
4- Intrauterine fetal death due to:
Congenital malformation, ketoacedosis, hypoglycaemia, superimposed PET.
5- Neonatal hypoglycemia
After delivery, glucose concentration fail, while neonatal insulin level remain high lead to neonatal hypoglycemia (Tremors, pallor, apnea, cyanosis)
Risk of uncontrolled diabetes on fetus
7- Hyperbilirubinaemia
Due to immature liver
8- Neonatal death due to:
Congenital anomalies
This talk was delivered for postgraduates and faculty of Dr. TMA Pai Hospital, Udupi on 07 March, 2017. This talk covered pathophysiology, screening, diagnosis, complications and management of diabetes mellitus in pregnancy.
This document discusses hyperemesis gravidarum and diabetes in pregnancy. Hyperemesis gravidarum is severe nausea and vomiting during pregnancy persisting past the first trimester, affecting 0.3-1% of pregnancies. It can cause dehydration, weight loss, and electrolyte imbalances. Treatment involves IV fluids, antiemetics, and nutritional support. Diabetes in pregnancy occurs in 7% of pregnancies and increases risks for mothers and babies. Good management through glucose monitoring, identifying complications, and maintaining normal levels can help mitigate these risks. The goals are healthy glucose levels and identifying/managing any issues that arise.
This document discusses diabetes mellitus in pregnancy. It defines diabetes and discusses its prevalence and classifications. It covers gestational diabetes mellitus (GDM), risk factors for GDM, screening and diagnostic methods for GDM, and complications of diabetes in pregnancy for both mother and baby. It outlines management of diabetes in pregnancy including diet, insulin therapy, glycemic control during labor, and care of the newborn.
Diabetes mellitus is a chronic disease characterized by high blood glucose levels resulting from defects in insulin production or insulin action. There are two main types - type 1 is caused by lack of insulin and type 2 is caused by insulin resistance. Gestational diabetes occurs during pregnancy and usually resolves after delivery. Diagnosis involves fasting plasma glucose tests or oral glucose tolerance tests. Emergencies can include diabetic ketoacidosis, hyperglycemic hyperosmolar state, or hypoglycemia.
Diabetes is a disease that affects your body's ability to produce or use insulin. Insulin is a hormone. When your body turns the food you eat into energy (also called sugar or glucose), insulin is released to help transport this energy to the cells. ... There are two main types of diabetes: Type 1 and Type 2 .
This document discusses the care of infants born to diabetic mothers (IDMs). IDMs are at risk of hypoglycemia, cardiac issues like cardiomyopathy, and long-term metabolic disorders. The pediatrician's role is to monitor blood sugar, watch for complications, and ensure adequate nutrition and glucose levels. Special attention should be paid to blood sugar levels in the first 24 hours and cardiac screening through echocardiogram is also recommended. Strict maternal glycemic control during pregnancy can help reduce risks to the infant.
This document provides information on gestational diabetes mellitus (GDM), including its definition, risk factors, pathophysiology, screening methods, complications, and management. GDM is glucose intolerance that develops during pregnancy and can cause issues for both the mother and baby if not properly managed. The key aspects discussed are:
- GDM is caused by defects in insulin secretion/action leading to abnormal carbohydrate and lipid metabolism.
- Risk factors include family history of diabetes, previous large baby, and obesity.
- Screening typically occurs between 24-28 weeks using a 75g oral glucose tolerance test.
- Complications for the mother include preeclampsia and operative delivery, while risks for
Suvorexant, branded as Belsomra, is an insomnia medication that works by blocking orexin receptors in the brain. Orexin is a neuropeptide that promotes wakefulness, so blocking its receptors promotes sleep. Suvorexant is thought to exert its therapeutic effects for insomnia by inhibiting the wakefulness-promoting effects of orexin. A current study is investigating whether long-term use of suvorexant can slow the accumulation of amyloid plaques and tau tangles in the brain, which are hallmarks of Alzheimer's disease. The results so far suggest suvorexant may be able to temporarily reduce levels of these proteins.
Gestational diabetes is a type of diabetes that develops during pregnancy in women who have never had diabetes before. It occurs in about 5% of all pregnancies. If not treated, gestational diabetes can cause health problems for both the mother and fetus, such as delivering a large baby. Risk factors include maternal age over 25, family history of diabetes, and belonging to certain ethnic groups. Women are screened for gestational diabetes between 24-28 weeks of pregnancy through a glucose challenge test and glucose tolerance test if needed. Treatment may involve diet, exercise, blood sugar monitoring, and possibly insulin.
1) Gestational diabetes is a form of diabetes that develops during pregnancy and affects 2-3% of pregnancies. It occurs when the placenta produces hormones that block the action of insulin and cause high blood sugar levels.
2) Both gestational diabetes and pre-existing diabetes can lead to complications for the mother such as preeclampsia and infections, as well as complications for the baby like premature birth and macrosomia. Babies are also at higher risk for obesity and diabetes later in life.
3) Managing diabetes during pregnancy involves glucose monitoring, medical nutrition therapy, exercise if appropriate, and sometimes insulin to control blood sugar levels and minimize risks.
This document discusses gestational diabetes mellitus (GDM), including its definition, epidemiology, etiology, pathophysiology, risk factors, maternal and fetal complications, screening, management, and the role of exercise and physiotherapy. Some key points:
- GDM is defined as glucose intolerance that begins or is first recognized during pregnancy and puts both mother and child at risk for developing diabetes later in life.
- Risk factors include family history of diabetes, previous large baby, past pregnancy loss, age over 30, obesity.
- Increased hormones during pregnancy cause insulin resistance, leading to high blood glucose levels if not managed.
- Screening usually occurs between 24-28 weeks with an oral glucose tolerance test
This document discusses gestational diabetes mellitus (GDM), including its definition, epidemiology, etiology, pathophysiology, risk factors, maternal and fetal complications, screening, medical management, and the role of physiotherapy. Some key points:
- GDM is defined as glucose intolerance that begins or is first recognized during pregnancy and resolves after delivery.
- It occurs in 7% of pregnancies and risk increases with age over 35.
- Pregnancy causes insulin resistance which can lead to GDM if not met with adequate insulin production.
- Complications for the mother include preeclampsia and future type 2 diabetes; complications for the baby include macrosomia, hypoglycemia
Diabetes in pregnancy-overt diabetes: type I DM, type II DM,Gestational diabe...FarsanaM
This document discusses diabetes in pregnancy, including types, screening, diagnosis, management, and effects on mother and fetus. It covers gestational diabetes and pregestational diabetes types 1 and 2. Key points include increased risk of complications for both mother and baby if blood sugar is not well-controlled, and the importance of medical nutrition therapy, exercise, monitoring blood sugar levels, and insulin treatment if needed to maintain healthy blood glucose levels during pregnancy. The goals are to reduce risks and promote optimal outcomes for mother and child.
Diabetes is a common medical complication of pregnancy that can be detrimental if not properly managed. It includes pre-existing diabetes, gestational diabetes, and pre-diabetes. Strict control of blood sugar levels is important to prevent complications in both the mother and baby such as preeclampsia, macrosomia, and birth injuries. Management involves medical nutrition therapy, insulin when needed, exercise, tight glucose monitoring, and obstetric care. Close cooperation is needed between the doctor, patient, and family to help achieve successful outcomes.
This document discusses various nutrition-related conditions and interventions during pregnancy. It covers topics like hypertensive disorders, gestational diabetes, obesity, multifetal pregnancies, HIV/AIDS, eating disorders, and fetal alcohol spectrum. For each condition, it describes characteristics, potential consequences, diagnosis and treatment approaches. Nutritional recommendations are provided to support maternal and fetal health for different pregnancy complications. The goal is to provide evidence-based nutritional interventions that are safe, effective and affordable.
This document provides information about diabetes mellitus. It defines diabetes as a group of diseases characterized by high blood glucose levels due to defects in insulin production or action. It describes the normal and abnormal blood glucose ranges and symptoms of diabetes such as frequent urination. It discusses the types of diabetes including type 1, type 2, and gestational diabetes. It covers insulin action and homeostasis as well as the burden, signs and symptoms, complications, diagnosis, and management of diabetes.
1. Gestational diabetes is characterized by carbohydrate intolerance that begins or is first recognized during pregnancy. It can increase risks for both mother and baby.
2. It is diagnosed through screening tests such as a glucose challenge test and confirmed with an oral glucose tolerance test. Treatment involves diet, exercise, blood sugar monitoring, and possibly insulin.
3. Complications for the mother include preeclampsia and infections. Complications for the baby include hypoglycemia, jaundice, and respiratory distress. Strict control of blood sugar levels can help reduce risks.
This document discusses diabetes in pregnancy. It begins by introducing diabetes as a metabolic disorder characterized by hyperglycemia that can be caused by lack of insulin or insensitivity to insulin. Gestational diabetes is defined as glucose intolerance first recognized during pregnancy.
The document then discusses how pregnancy affects carbohydrate metabolism. Hormonal changes associated with pregnancy initially facilitate maternal energy storage and later divert energy to the fetus as demand increases. This can precipitate glucose intolerance or diabetes in those with limited insulin production capacity. The placenta also causes insulin resistance in the mother to make more glucose available to the fetus.
The effects of diabetes on pregnancy are then reviewed. Poorly controlled diabetes can lead to complications for both mother and
Diabetes as presented by cheruiyot sambu in kapkatet county hospital. cheruiyot sambu
Diabetes is a group of metabolic diseases where a person has high blood glucose due to either inadequate insulin production or cells not responding properly to insulin. Type 1 diabetes occurs when the pancreas does not produce insulin, while type 2 occurs when the body does not produce enough insulin or cells do not respond properly to insulin. Symptoms of diabetes include increased urination, thirst, hunger, weight loss, fatigue, and changes in mood or vision. Treatment involves physical activity, healthy diet, and potentially insulin injections or tablets. Uncontrolled diabetes can lead to complications affecting the eyes, feet, heart, kidneys and other organs.
Diabetes is a common complication of pregnancy, affecting 4-6% of pregnancies in the US. It can lead to both maternal and fetal morbidity. The main types of diabetes in pregnancy are gestational diabetes (88% of cases), type 2 diabetes (8% of cases), and type 1 diabetes (4% of cases). Diabetes in pregnancy is associated with increased risks of miscarriage, preterm delivery, birth defects, macrosomia, growth restriction, hypoglycemia, jaundice, and respiratory distress in the baby. It also increases the mother's risk of preeclampsia, diabetic ketoacidosis, and complications from existing diabetes or related conditions. Diagnosis and treatment focus on managing blood glucose
Definition
Incidence
Types
Diabetogenic effect of pregnancy
Metabolic changes during pregnancy
Risk of uncontrolled DM on pregnancy
Diagnosis and evaluation
Medical management
Nursing management
Definition of Diabetes mellitus:It is inability to metabolize glucose properly. It is a chronic systemic disease, manifesting metabolic and vascular changes affecting every organ in the body.
a. Pregestational (preexisting) diabetes
Occurs when have type 1 or type 2 diabetes before becoming pregnant.
1-Type I Insulin-dependent (IDDM) (Insulin deficient).
2-Type II Non-Insulin dependent (NIDDM) (Insulin resistant).
b. Gestational diabetes mellitus (GDM).
Occurs diabetes when becoming pregnant.
a. Pregestational (preexisting) diabetes
Occurs when have type 1 or type 2 diabetes before becoming pregnant.
1-Type I Insulin-dependent (IDDM) (Insulin deficient).
2-Type II Non-Insulin dependent (NIDDM) (Insulin resistant).
b. Gestational diabetes mellitus (GDM).
Occurs diabetes when becoming pregnant.
Diabetes may appear only during pregnancy due to :-
1-Increased levels of antiinsulinas (estrogen, progesteron, human placental lactogen, and prolactine).
2-Decreased renal threshold for glucose (glucose loss in urine).
During early stage of pregnancy: Maternal hypoglycemia.
After the fourth month: increase glucose level in the blood due to placental hormones
During labor: liability to hypoglycaemia.
After delivery: glucose level return to prepregnant state.
Gestational Diabetes
Risk Factors
Maternal age >25
Family history
Glucosuria
Prior macrosomia
Previous unexplained stillbirth
Risk of uncontrolled diabetes on pregnancy
A- Maternal effect:
On pregnancy On labor On puerperium
-Abortion - premature -puerperal sepsis
-PET labor -PPH
-Polyhydramnios - Inertia - Abnormal
-Pressure symptom - Operative lactation
-Infection delivery
-Retinopathy
Risk of uncontrolled diabetes on fetus
1- Abortion
2- Congenital anomalies
Open neural defect, CHD, renal anomaly, sacral agenesis, small left colon syndrome(Approximately 40% to
50% of infants with this disorder have diabetic mothers, almost all of whom are insulin dependent , , imperforated anus.
3- Macrosomia
Fetal hyperglycaemia causes increase insulin secretion and lead to increase fetal fat deposition
Open neural defect
sacral agenesis
Macrosomia
Macrosomia
Macrosomia
Risk of uncontrolled diabetes on fetus
4- Intrauterine fetal death due to:
Congenital malformation, ketoacedosis, hypoglycaemia, superimposed PET.
5- Neonatal hypoglycemia
After delivery, glucose concentration fail, while neonatal insulin level remain high lead to neonatal hypoglycemia (Tremors, pallor, apnea, cyanosis)
Risk of uncontrolled diabetes on fetus
7- Hyperbilirubinaemia
Due to immature liver
8- Neonatal death due to:
Congenital anomalies
This talk was delivered for postgraduates and faculty of Dr. TMA Pai Hospital, Udupi on 07 March, 2017. This talk covered pathophysiology, screening, diagnosis, complications and management of diabetes mellitus in pregnancy.
This document discusses hyperemesis gravidarum and diabetes in pregnancy. Hyperemesis gravidarum is severe nausea and vomiting during pregnancy persisting past the first trimester, affecting 0.3-1% of pregnancies. It can cause dehydration, weight loss, and electrolyte imbalances. Treatment involves IV fluids, antiemetics, and nutritional support. Diabetes in pregnancy occurs in 7% of pregnancies and increases risks for mothers and babies. Good management through glucose monitoring, identifying complications, and maintaining normal levels can help mitigate these risks. The goals are healthy glucose levels and identifying/managing any issues that arise.
This document discusses diabetes mellitus in pregnancy. It defines diabetes and discusses its prevalence and classifications. It covers gestational diabetes mellitus (GDM), risk factors for GDM, screening and diagnostic methods for GDM, and complications of diabetes in pregnancy for both mother and baby. It outlines management of diabetes in pregnancy including diet, insulin therapy, glycemic control during labor, and care of the newborn.
Diabetes mellitus is a chronic disease characterized by high blood glucose levels resulting from defects in insulin production or insulin action. There are two main types - type 1 is caused by lack of insulin and type 2 is caused by insulin resistance. Gestational diabetes occurs during pregnancy and usually resolves after delivery. Diagnosis involves fasting plasma glucose tests or oral glucose tolerance tests. Emergencies can include diabetic ketoacidosis, hyperglycemic hyperosmolar state, or hypoglycemia.
Diabetes is a disease that affects your body's ability to produce or use insulin. Insulin is a hormone. When your body turns the food you eat into energy (also called sugar or glucose), insulin is released to help transport this energy to the cells. ... There are two main types of diabetes: Type 1 and Type 2 .
This document discusses the care of infants born to diabetic mothers (IDMs). IDMs are at risk of hypoglycemia, cardiac issues like cardiomyopathy, and long-term metabolic disorders. The pediatrician's role is to monitor blood sugar, watch for complications, and ensure adequate nutrition and glucose levels. Special attention should be paid to blood sugar levels in the first 24 hours and cardiac screening through echocardiogram is also recommended. Strict maternal glycemic control during pregnancy can help reduce risks to the infant.
This document provides information on gestational diabetes mellitus (GDM), including its definition, risk factors, pathophysiology, screening methods, complications, and management. GDM is glucose intolerance that develops during pregnancy and can cause issues for both the mother and baby if not properly managed. The key aspects discussed are:
- GDM is caused by defects in insulin secretion/action leading to abnormal carbohydrate and lipid metabolism.
- Risk factors include family history of diabetes, previous large baby, and obesity.
- Screening typically occurs between 24-28 weeks using a 75g oral glucose tolerance test.
- Complications for the mother include preeclampsia and operative delivery, while risks for
Suvorexant, branded as Belsomra, is an insomnia medication that works by blocking orexin receptors in the brain. Orexin is a neuropeptide that promotes wakefulness, so blocking its receptors promotes sleep. Suvorexant is thought to exert its therapeutic effects for insomnia by inhibiting the wakefulness-promoting effects of orexin. A current study is investigating whether long-term use of suvorexant can slow the accumulation of amyloid plaques and tau tangles in the brain, which are hallmarks of Alzheimer's disease. The results so far suggest suvorexant may be able to temporarily reduce levels of these proteins.
The document discusses the relationship between hormones and behavior. It covers several topics:
- The endocrine system and its role in maintaining homeostasis, growth and development, and reproduction.
- Studies showing connections between sex hormones and cognitive functioning, aggression, mood, and sleep. Removing or adding hormones can impact behaviors.
- Early experiments by Berthold demonstrating changes in rooster behavior and appearance based on castration and testis transplantation.
- Conditions like Kallmann syndrome, Turner syndrome, and 5α-reductase deficiency that impact sexual development and behaviors due to hormone deficiencies or insensitivities.
- Evidence that testosterone levels relate to traits like aggression and can change based on
This document discusses hormones and their relationship to cancer development. It defines cancer and different types of tumors, and notes that over half of cancers in the US could be prevented through lifestyle changes. Tables show the most common cancers among men and women. The document discusses how hormones like estrogen can promote the growth of hormone-sensitive tumors through various mechanisms, including stimulating cell proliferation and producing genotoxic metabolites. It also discusses how hormones like insulin may increase cancer risk by influencing cell signaling pathways and metabolism.
Puberty is initiated by increases in hormones like leptin and kisspeptin which activate the hypothalamic-pituitary-gonadal axis, triggering the release of sex hormones and setting off physical changes. In females, puberty involves breast development, pubic hair growth, menarche, and ovarian and uterine maturation over 3-5 years starting around age 10. In males, it involves testicular growth, pubic hair growth, penis growth, voice deepening, and a growth spurt over 3-5 years starting around age 11. Throughout puberty, sex hormones influence brain development and increase emotional volatility and risk-taking behavior.
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The document discusses the placenta and its functions. It begins by defining the placenta and its origins from Latin. It then discusses:
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The document discusses aging and the endocrinology of aging. It notes that several hormone levels change with age: thyroid secretion decreases, the thymus gland involutes, cortisol levels decrease, and the pancreas decreases secretion of enzymes and hormones. Overall, some hormone levels like aldosterone, growth hormone, and estrogen decrease with age, while others like LH and FSH may increase, and still others like cortisol remain unchanged. These hormonal changes can lead to physical, sexual, and psychological symptoms in older individuals. The effects of declining testosterone and DHEA levels are also examined.
This document discusses hormones involved in obesity and weight regulation. It describes how leptin signals fullness, while the set point is the weight maintained without effort to gain or lose. A higher set point occurs with more eating, lowering basal metabolism. Environmental factors, genetics, stress and chemicals can influence weight homeostasis by altering hormones. Obesity is associated with reduced testosterone in men and increased cancer risk. Ghrelin signals hunger opposite to leptin. The hypothalamus regulates food intake through a set point model to maintain a constant mass.
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2. 1- Type 1 diabetes, formerly called juvenile diabetes, is usually
first diagnosed in children, teenagers, or young adults. In this
form of diabetes, the beta cells of the pancreas no longer make
insulin because the body's immune system has attacked and
destroyed them.
2-Type 2 diabetes, formerly called adult-onset diabetes, is the
most common form. People can develop it at any age, even
during childhood. This form of diabetes usually begins with
insulin resistance, a condition in which muscle, liver, and fat
cells do not use insulin properly. At first, the pancreas keeps up
with the added demand by producing more insulin. In time,
however, it loses the ability to secrete enough insulin in
response to meals.
IDDM 10%(die if no insulin),NIDDM 90%(insulin resistance)
1. is a brown to black, poorly defined, velvety
hyperpigmentation of the skin. It is usually found in
body folds
2. It typically occurs in individuals younger than age
40, may be genetically inherited, and is associated
with obesity or endocrinopathies, such as
hypothyroidism or hyperthyroidism, acromegaly,
polycystic ovary disease, insulin-resistant diabetes,
or Cushing's disease.
3. Acanthosis nigricans may also be seen with certain
medications that lead to elevated insulin levels (e.g.,
glucocorticoids, niacin, insulin, oral contraceptives,
and protease inhibitors)
3. Long term complications of diabetes (problem with micro- and macro vessels)
1. Diabetic eye(Cataracts and glaucoma, microaneurisms ).
"proliferative retinopathy". haemorrhage in the eye can lead
to blindness. New-grown fragile vessels
2. Diabetic feet
3. Diabetic kidney(30-50% of Diab patients develop kidney
disease) proteinuria
4. Diabetic heart(coronary artery disease risk 4 times
greater)
5. Chronic hyperglycemia causes increased glycation of
proteins, resulting in Advanced Glycation Endproducts
(AGEs)
6. Diabetic ketoacidosis: body uses fat as an energy source
and this results in the production of ketones that
accumulate in the body. Seen in type I DM .Infection, fever, beta
– agonists are frequent predisposing factors .Suspected with +serum
ketones and blood glucose levels above 300Fetal distress is common
7. thirst, passing large volumes of urine, feeling very tired,
nausea, vomiting and abdominal pain
13 000 new cases in children each year (USA)
CA: cancer, CF:
cystic fibrosis,
MS: multiple
sclerosis, JRA:
juvenile
rheumatoid
arthritis, MD:
muscle dystrophy
4. Insulin could be obtained from cows’ or pigs’ pancreases (used since 1922).(7-10 lb
pancreatic tissue per patient per year)Bovine insulin = 3 amino acid differences
,Porcine insulin = 1 amino acid difference .Amino acid differences stimulate allergic
responses .Human insulin also cause formation of antibodies in substantial number of
users (55%) lipoatrophy.Nevertheless human insulin is preferred .Human gene library
was screened and INS gene subcloned into a plasmid expression vector using lac
operon to promote transcription 24 aa Signal peptide leader was added to 5’ end.
secretion of insulin into culture medium instead of its retention inside inclusion
bodies(Signal leader detaches as insulin is transported across cell membrane..) A chain
synthesized in one E. coli strain .B chain synthesized in a different E. coli strain .Chains
are purified separately then joined together .Continuous culture techniques used
Expression in E. coli resulted in inclusion bodies packed full of insulin .Isolation of
insulin from inclusion bodies is timely and expensive
Humilin (Eli Lilly, 1986) – first industrially
produced human insulin
Contains a signal sequence + A,B, C sections of protein, Signal
sequence is removed after targeting to RER,Translation
continues on RER (forming proinsulin) ,Removal of 33 amino
acids at Golgi ,and S-S joining of A and B chains to form insulin
5. 5-Gestational diabetes is a condition in which a woman
without diabetes develops high blood sugar levels during
pregnancy. Although this form of diabetes usually goes
away after the baby is born, a woman who has had it is more
likely to develop type 2 diabetes later in life. Gestational
diabetes is caused by the hormones of pregnancy or by a
shortage of insulin. Out of every 100 women in the United
States, three to eight get gestational diabetes . Prevalence in
Canada:3.5 - 3.8% non-Aboriginal (but multi-ethnic)
population, 8.0 - 18.0% Aboriginal.Gestational diabetes
generally results in few symptoms in most women,
gestational diabetes causes no symptoms. Some women do
get symptoms of high blood sugar, such as increased thirst,
increased need to pass water and increased hunger however,
it does increase the risk of pre-eclampsia, depression, and
requiring a Caesarean section. Babies born to mothers with
poorly treated gestational diabetes are at increased risk of
being too large, having low blood sugar after birth, and
jaundice. If untreated, it can also result in a stillbirth. Long
term, children are at higher risk of being overweight and
developing type 2 diabetes, although these are also common
later on in pregnancy anyway.
3-In pre-diabetes, blood glucose levels are higher
than normal but not high enough to be
characterized as diabetes. However, many people
with pre-diabetes develop type 2 diabetes within
10 years. Pre-diabetes also increases the risk of
heart disease and stroke. With modest weight
loss and moderate physical activity, people with
pre-diabetes can delay or prevent type 2
diabetes.
4-Pre-gestational diabetes .Insulin dependent
.Non-insulin dependent (uncommon)
< 8.0 ?
6. Although there is no clear reason why some
women get gestational diabetes, women are
more at risk if they:have a family history of
type II (adult-onset) diabetes
are over the age of 35 are obese
have previously given birth to a large baby
have previously given birth to a baby born
with an abnormality ,have previously had a
stillbirth late in pregnancy
7. Gestational Diabetes Mellitus (GDM)
Prior “selective screening” resulted in missed
cases:
◦ Caucassians < 25 y.o.
◦ No personal or FHx of DM
◦ No prior infant with birth weight > 4 kg
Treatment of GDM reduces prenatal morbidity
Diagnosis GDM maternal anxiety ?
◦ Evidence controversial for this
Therefore all women should be screened
have previously had a stillbirth late in pregnancy
* Presence of multiple risk factors warrants earlier
screening (preconception, 1st & 2nd trimester)
Causes fetal hyperglycemia Leading to fetal
hyperinsulinaemia,Fetal hyperinsulinaemia - even short
periods (1-2hours) lead to detrimental consequences in:
fetal growth ,fetal well-being
Maternal Hyperglycemia
9. G - ADAPTATION TO PREGNANCY
In early pregnancy Estrogen and Progesterone stimulate beta cell hyperplasia and increased insulin secretion
.Glycogenolyis and peripheral utilization increase .The net result is relative hypoglycemia of mother
10.
11. Oral Glucose ToleranceTest (OGTT)
for pre-diabetics
Research has shown that the OGTT is
more sensitive than the FPG test for
diagnosing pre-diabetes, but it is less
convenient to administer. The OGTT
requires to fast for at least 8 hours before
the test. plasma glucose is measured
immediately before and 2 hours after
drinking a liquid containing 75 grams of
glucose dissolved in water. blood glucose
level is between 140 and 199 mg/dL 2
hours after drinking the liquid a form of
pre-diabetes called impaired glucose
tolerance or IGT, meaning that one is
more likely to develop type 2 diabetes
but do not have it yet. A 2-hour glucose
level of 200 mg/dL or above, confirmed
by repeating the test on another day,
means that have diabetes
12. Fetal Hyperinsulinaemia
1. Promotes storage of excess nutrients - macrosomnia
2. Increased catabolism of excess nutrients - energy usage
and fetal oxygen storage
3. Episodic fetal hypoxia catecholamines causing: -
hypertension,cardiac remodelling and hypertrophy,
Erythropoietin, RBC’s, haematocrit causing poor
circulation and hyperbilirubinaemia
4. Induction of labor for “impending” fetal macrosomia
does not reduce the rate of either injury and may
increase the rate of cesarean .Planned cesarean is
reasonable (in diabetics) with EFW > 4250 g.
5. Good to fair evidence that screening with therapy
reduces the rate of fetal macrosomia .Insufficient
evidence that screening reduces the rate of cesarean,
birth injury or neonatal morbidity and mortality)
.Screening produces many false positives Agrees that
screening with 50 g CHO with 3 hour GTT as follow-up
is acceptable
13. CHO METABOLISM 20- 24 WEEKS
Increased human placental lactogen – diabetogenic
Increased prolactin – insulin resistance
Increased cortisol – decreased glycogen storage
Stable amounts of FFA
Increased cholesterol and TG
Reduced amino acid levels
NEONATAL METABOLIC COMPLICATIONS
Hypoglycemia
Hypocalcemia
Hypothermia
Hypomagnesemia
Hyperbilirubinemia
Fetal cardiac anomalies may be complex
CNS – Spina Bifida, Anencephaly
Caudal regression syndrome
Must consider family history of other malformations that
are unrelated to DM
Nerve injury:Rate varies from 4-40% following shoulder
dystocia
Most (90%) resolve without sequelae .Can occur with
EFW < 4000 g .Can occur in utero and therefore not
preventable by cesarean
Polycythemia and hyperviscosity
Neonatal hypoglycemia
Neonatal hypocalcemia
Hyperbilirubinaemia
Hypertrophic and congestive cardiomyopathy
RDS
Childhood impaired glucose tolerance
Miscarriage
IUGR
Macrosomia
Birth Injury
Morbidity and Mortality
14. Polycytemia (defination .occurance and pathophysiology)
1. Polycythemia is increased total RBC mass ,Central venous hematocrit >
65% . Above 65% blood viscosity rises exponentially.
2. Polycythemic hyperviscosity is increased viscosity of the blood resulting
from increased numbers of RBCs .Not all polycythemic infants have
symptoms of hyperviscosity .Polycythemia occurs in 2-4% of newborns
.Half of these are symptomatic .Hyperviscosity occurs in 25% of infants
with hematocrit 60-64% .Hyperviscosity without polycythmia occurs in
1% (nonpolycythemic hyperviscosity
Clinical signs result from regional effects of hyperviscosity and from the
formation of microthrombi .Tissue hypoxia , Acidosis ,Hypoglycemia
Organs affected: CNS, kidneys, adrenals, cardiopulmonary system, GI tract
Enhanced fetal erythropoiesis usually related to fetal hypoxia
◦ Placental insufficiency
◦ Maternal hypertension, abruption, post-dates, IUGR, maternal
smoking
◦ Endocrine disorders: due to increased oxygen consumption
◦ IDM (>40% incidence), congenital thyrotoxicosis, CAH, Beckwith-
Wiedemann syndrome (hyperinsulinism)
Increased risk of GI disorders and NEC with
partial exchange transfusion (PET)
Older trials show decreased neurologic
complications from hyperviscosity with PET, but
newer trials show no real benefit
PET is controversial!
Infants with asymptomatic polycythemia have an
increased risk for neurologic sequelae
Normocythemic controls with the same
perinatal history have a similarly increased
risk
15. Effects on the baby after birth
The baby may have low blood sugar (hypoglycaemia) after birth. This is because the baby's pancreas
makes extra insulin in response to the mother's high blood sugar levels. Shortly after birth, the baby
may continue to make extra insulin even though high levels of blood sugar are no longer present. After
a pregnancy affected by gestational diabetes, the newborn baby's blood sugar level is checked regularly.
Sometimes babies are given an early feed of a sugar (glucose) solution through a drip (fed directly into
a vein) to correct low blood sugar.
It is more likely that the newborn baby will develop jaundice . This is not serious and usually fades over
a few weeks, without the need for medical treatment being born very large and with extra fat; this can
make delivery difficult and more dangerous for baby low blood glucose right after birth breathing
problems.There is an increased risk that the baby will be born with congenital problems, such as a heart
defect. Sometimes, infants can be born with respiratory distress syndrome, in which the baby has
problems breathing because his or her lungs have not matured as normal. This usually clears up with
time. There is also a slightly higher chance of stillbirth or death as a newborn, but if detected and the
glucose levels well managed, death is rare. There may be an increased risk of the baby developing type
II diabetes or being overweight later in life. Hypoglycemia ,Hypocalcemia , Hypothermia
,Hypomagnesemia ,Hyperbilirubinemia. Neonatal metabolic complications
Maternal Fetal/Neonatal
Macrosomia
(birth trauma, cesarian)
Macrosomia
(shoulder dystocia)
Preeclampsia RDS
Polyhydramnios Neonatal hypoglycemia
Prenatal mortality (fetus) Neonatal hypocalcemia
Postpartum IFG, IGT, DM
3-6 mos: 16-20 %
Lifetime: 30-50 %
Neonatal jaundice
Obesity later in life?
IGT, IFG, or DM later in
life?
• All women of reproductive age should consume
at least 0.4 mg of folic acid. High risk women
should consume 4 mg/day. This reduces the risk
of neural tube defects. Newer evidence suggests
a lower risk of facial clefting and congenital
heart disease as well
• Macrosomia:(Greater than 90 precentile, 4200
grammes) ,Increased hyperbilirubinaemia
Increased hypoglycemia ,Increased acidosis
Increased birth trauma ,Macrosomnia as a child and
glucose intolerance in adulthood
1.3 3.1 38
145
300
0
50
100
150
200
250
300
Cases
per
100,000
1890 1920 1935 1973 2005
Year
Childhood Diabetes
16. Gestational Diabetes management
Pre-conceptional care
1-Tight glucose control (HbA1c):Aim for HbA1c < 6.1%.Strongly
advise against if HbA1c > 10.0 %
2-Assessment and treatment of associated medical problems -
hypertension, renal, retinal and/or heart disease
3-Folic acid:5 mg/day until 12 weeks gestation
4-Assessment of family. Financial and personal resources to help
achieve a successful pregnancy
5-Educate and empower (hypos, risks, need for structured care etc.)
6-Avoid unplanned pregnancy
7-Retinopathy assessment
8-Dietetic input, advice re obesity
9-Insulin if necessary (Hypoglycemic agents?)
10-weekly visits to Diabetic service/antenatal service & Growth
Monitoring (scan)
11-Delivery based on obstetric issues
12-Delivery gestation depends on insulin usage
1. “Tight” periconceptual control is essential
2. The diabetes should be stable
3. Multidisciplinary team maybe helpful
4. Diabetic education
5. Dietary counseling
6. Assessment of renal function
7. Retinal exam
8. FBS and 2 hour post-prandial levels
9. Pre-meal values if sliding scale short acting insulin coverage
is used
10. Early AM value if hypoglycemia suspected
11. Assure that reflectance meter is calibrated
12. Fasting blood glucose < 100 mg/dl
13. Pre-meal levels <110 mg/dl
14. Post-meal levels <140 – 150 mg/dl
15. Avoid wide swings in control
16. Normalize hemoglobin A1C
17. Maternal Complications
Chronic hypertension:Should be aggressively controlled.ACE inhibitors are
contraindicated.Calcium channel blockers are probably a reasonable alternative and are
safe during pregnancy.Increases the incidence of fetal growth restriction and
superimposed preeclampsia
Pre-eclampsia: BP > 140/90 .Proteinuria > 300 mg/24 hours or increase in baseline
.May be difficult to diagnose in the presence of renal disease and chronic HTN .25%
incidence of superimposed disease with CHTN. Lab: elevated LFT’s.
thrombocytopenia.Sxs: headache, epigastric pain, blurred vision
Oliguria, pulmonary edema, fetal growth restriction
Diabetic ketoacidosis ,Maternal hypoglycemia ,Maternal trauma ,Higher C Section rate
Retinal disease/renal disease not affected significantly by pregnancy: Remains the
leading cause of blindness in women ages 24-64 .Every patient with pre-gestational
diabetes should have a retinal examination in early pregnancy .Laser therapy is safe
and effective during pregnancy .Has a variable course during pregnancy
Nephropathy :Accounts for 1/3 of the deaths in diabetics < 31 .Renal findings are
present as early as 1-2 years after diagnosis
Creatinine clearance may improve in pregnancy due to increased renal blood flow
.Proteinuria may increase substantially. Pregnancy is possible even in patients
requiring hemodialysis .Reliable contraception is advised .Fertility and successful
pregnancy outcomes are reduced with serum Cr > 2.0
Spontaneous abortions:In well controlled patients the rate is similar to the non-diabetic
Higher rates of spontaneous abortion in diabetics with vascular disease
18. GDMTreatment
CBG qid: FBS, 1-2h pc
Dietary: 3 small meals, 3 small snacks
If glycemic targets not met: Insulin
◦ Multiple Daily Injection (MDI) best
◦ Insulin: regular, lispro, aspart ? (still new)
◦ No glargine (stimulates IGF-I receptors)
No OHA’s, not standard of care yet.
Glyburide
◦ Minimal crossing of placenta, 3rd trimester most
organogenesis complete
◦ 1 RCT: 404 women, mild GDM, glyburide vs.
insulin, no difference in outcomes
◦ Further study before safety established
Metformin
◦ Retrospective cohort:
◦ preeclampsia & stillbirth
◦ Bias: DM women older, more obese
NPO during Labour:
Monitor CBG q1h, target BS 4 – 6.5 mM
Hypoglycemia (BS < 4 mM): IV D5W
Hyperglycemia (BS > 6.5 mM): IV D5W & IV insulin gtt
Postpartum:
D/C all insulin (IV and SC)
CBG in recovery:
> 10 mM CBG qid, may need Rx for T2DM
< 10 mM stop CBG monitoring
FBS or 2hPG in 75g OGTT within 6 mos postpartum and prior to any
future planned pregnancies
Encourage: breast feeding, healthy diet, exercise to prevent future Type
2 DM, GDM
Screen for future T2DM (GDM is a risk factor)
GDM: Labour & Postpartum
19. T1DM, T2DM & Pregnancy
Congenital anomalies: 2-3x increased risk
◦ Cardiac malformations
◦ Neural Tube Defects 1 % risk
Folate 1-4 mg/d (Prenatal vitamin 0.4-1.0 mg)
d/c ACE-I and ARBs methyldopa, etc.
Dilated eye exam: preconception & 1st trimester
T2DM: d/c OHA insulin
Good glycemic control prior to conception:
◦ Prevent unplanned pregnancies: OCP or 2x barrier
◦ Initiate MDI and qid (FBS, 2hPC) prior to preg
◦ CSII also another option
T1DM & T2DM: Labour & Postpartum
NPO during Labor:
Monitor CBG q1h, target BS 4.0 – 6.5 mM
IV D5W & IV insulin gtt (Hamilton Health
Sciences Protocol)
Postpartum:
D/C all IV insulin
Insulin resistance/requirements rapidly fall
during & after labor
T2DM: monitor CBG qid
Restart insulin if CBG > 10 mM
T1DM: postpartum honeymoon
CBG q1h x 4h, then q2h x 4h, then
q4h
Restart MDI insulin S.C. when
CBG > 10 mM
No OHA, ACE-I or ARB during breast
feeding!
20.
21. Clinical presentation
Symptoms are non-specific!
CNS: lethargy, hyperirritability, proximal muscle hypotonia,
vasomotor instability, vomiting, seizures, cerebral infarction
(rare)
Cardiopulmonary: respiratory distress, tachycardia, CHF,
pulmonary hypertension
GI: feeding intolerance, sometimes NEC
GU: oliguria, ARF, renal vein thrombosis, priapism
Metabolic: hypo-glycemia/-calcemia/-magnesemia
Heme: hyperbili, thrombocytopenia
Skin: ruddiness
ALWAYS draw a central venous sample if the capillary hematocrit
is > 65% .Warmed capillary hematrocrit > 65% only suggestive of
polycythemia
Diagnosis
Serum glucose
Hypoglycemia is common with polycythemia
Serum bilirubin
Increased bili due to increased RBC turnover
Serum sodium, BUN, urine specific gravity
Usually high if baby is deyhdrated
Blood gas to rule-out inadequate oxygenation as cause of
symptoms
Platelets, as thyrombocytopenia can be present
Serum calcium b/c hypocalcemia can be seen
Other labs to check
22. DETECTION OF FETAL MALFORMATIONS
HBA1C at first visit
1st trimester ultrasound for dating and to exclude anencephaly
Targeted USN at 16 – 20 weeks
Triple or Quad screen at 16 weeks
Fetal echocardiogram at 20 –22 weeks
23. FIRST PRENATAL VISIT
Routine prenatal lab
Baseline 24 hour UA for protein and Cr Clearance
Baseline retinal exam
EKG
Thyroid function tests in Type 1 Diabetics
Hemoglobin A1C
Schedule 10-12 week USN
24. GLYCOSYLATED HGB AND MALFORMATIONS
HBA1C <8.5% , 3.4% malformations
HBA1C > 8.5% , 22.4 % malformations
Reflects glucose control over the preceding 60 – 90 days
Glycosylated albumen reflects more recent level of control
Not as well studied in pregnancy
25. INDICATIONSFOR
HOSPITALIZATION
Persistent nausea and vomiting
Significant maternal infection
DKA
Poor control/compliance
Preterm labor
Well controlled IDDM: at term
Poorly controlled: after documentation of fetal
lung maturity
If fetal surveillance reassuring, delivery before
39 weeks should be unusual
TIMING OF DELIVERY
No breakfast the morning of induction
Establish IV with D5/.45% NaCl at 125 cc/hour
Capillary blood glucose levels every 1 – 2 hours
Begin continuous infusion of insulin with levels
above 120 mg/dl
Avoid fluid boluses with D5
INTRAPARTUM GLUCOSE CONTROL
26. POSTPARTUM GLUCOSE CONTROL
Insulin requirements may fall 50% in the 1st 24 hours
If C/S most will not require insulin until POD 1 or 2
Monitor QID CBG’s
Little need for treatment if under 200 mg/dl
28. ACOG Low Risk
Age < 25
Not a member of an at risk ethnic group (Hispanic, African, Native American, South or East
Asian, Pacific Islanders)
BMI < 25 (non-obese)
No history of abnormal glucose tolerance or FH
No adverse outcomes
29. 2 hour, 75 g CHO
FBS and every 30 minute blood glucose levels x 4
IF FBS > 140 or 2 of the post-prandial blood sugars > 199 = Diabetes
Impaired glucose tolerance if FBS between 115 and 139 or one PP value > 199
30. Normal Maternal Glucose Regulation
Tendency for maternal hypoglycemia between meals - fetal demand
Increasing tissue insulin resistance during pregnancy diabetogenic placental
steroid
Oestrogen, Progesterone,
Chorionic sommatomammotrophin
Increased insulin production (= 30% mean)
31. Congenital Anomalies
Cardiac defects x18 8.5%
CNS defects x16 5.3%
◦ Anencephaly x 13
◦ Spina Bifida x 20
All Anomalies x 8 18.4%
Background major defects 1-2%
32. Congenital Anomalies and Diabetic Control
Maternal HbA1c levels
< 7.2 Nil
7.2-9.1 14%
9.2-11.1 23%
> 11.2 25%
Critical periods - 3-6 weeks post conception
Need pre-conceptional metabolic care
33. Glucose Challenge Test
Non fasting
50g glucose dose
Value > 7.8mmol/l - needs a OGTT
10-15% need a OGTT
20-40% have GDM (2-7% of pop screened)
(Risk factor screening fails to detect 43% of GDM)
34. Management
Multidisciplinary approach
Antenatal visits - 2-weekly after 24 weeks
Diabetic service 2-weekly
Scans - Anomaly scan at 20-weeks
Growth scans from 26-28
weeks
Delivery - around term if insulin dependent
unless complications, diet only control as
normal antenatal patients
Intrapartum management
IV fluids (5% dextrose) + KCl+ insulin
Hourly glucose monitoring
CTG
Manage labor as normal
35. Management - Postpartum
Use pre pregnancy insulin levels
when on diet and monitor. If GDM
monitor sugars only
Breast feeding v Bottle feeding?
GDM - OGTT at 6 weeks
GDM - long term risk of NIDDM
Contraception
Most groups agree that post-partum screening is
advised and that annual assessment is ideal
The best method is controversial but the data
favors a 2 hour, post 75 g CHO approach
36. HYDRAMNIOS
1-2 % in normals and 18% of diabetics
Fetal osmotic diuresis is etiologic
May also be due to fetal cardiac CNS malformations
May be associated with preterm labor
Associated with level of glycemic control