Dr. Ellen Toth gave a presentation on diabetes and pregnancy to a group in Maskwacis. She discussed how diabetes, both pre-existing and gestational, can complicate pregnancies by increasing risks for complications like miscarriages, large babies, and birth defects. Babies exposed to high glucose levels in the womb may develop lifelong health consequences like obesity and diabetes themselves. Screening before and during pregnancy is important to detect diabetes early and manage it properly to avoid poor outcomes for both mother and baby.

1. Diabetes
Complicating pregnancies
Presentation to Maskwacis– November 2012
Dr Ellen Toth
University of
Alberta
Diabetes
Specialist
Pregnancy, Maskwacis, 2012

2. The epidemic
Population growth Case finding
Pregnancy:
Diabetes Diabetes
begets
diabetes Behaviours
Genetics
Environment
Modified from Engelgau

3. Plan for this talk
 Introduction
 How does diabetes complicate
pregancy?
 What can be done? (Standing Strong)
Pregnancy, Maskwacis, 2012

4. Pregnancy
Diabetes begets
diabetes?
Pregnancy, Maskwacis, 2012

5. Plan for this talk
 Introduction
 How does diabetes complicate
pregancy?
 What can be done? (Standing Strong)
Pregnancy, Maskwacis, 2012

6. Pregnancy and
Diabetes
 Pre-existing diabetes
OR gestational diabetes both can
have (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. Glucose crosses placenta, Insulin does not
Pregnancy, Maskwacis, 2012

8. Developmental trajectory
Sensitive
phase
Epigenetic
adaptation:
Genetic modification of genes
devlopment Environmental resulting in different
influences: phenotypes
nutrition etc Pregnancy, Maskwacis, 2012

9. The Barker Hypothesis
Also shown for cancer, diabetes, chronic lung disease
Pregnancy, Maskwacis, 2012

10. Prevalence of Gestational Diabetes:
A: Pimas, B: Norway, C: African Americans, D: New York State
Pregnancy, Maskwacis, 2012

11. Consequences of poorly, uncontrolled or
undiagnosed 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. 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. Definitions
 Diabetes before pregnancy
 Diabetes in early pregnancy
 Diabetes in late pregnancy
Pregnancy, Maskwacis, 2012

14. What to do?
 Know whether you have
diabetes 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. 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

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. Gestational Diabetes
 Diabetes during pregnancy.
 Causes: Hormones that help the
baby develop can affect your
own insulin's 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. Questions?
Pregnancy, Maskwacis, 2012