Transcript Diabetes and Pregnancy

Dr. Miems Kleynhans
Can a “normal” person also become diabetic in
pregnancy?
Gestational Diabetes
 Definition: Diabetes with onset or first recognition in
pregnancy
 Pregestational diabetes: Diabetes diagnosed before
pregnancy, type I or II
 Gestational diabetes : 87% of all diabetes in pregnancy
Who will get gestational diabetes?
 It could happen to anybody
Should we screen and when?
 YES!!!
 Ideal world - between 24-28 weeks gestation
 Glucose tolerance test – 75mg
 In South Africa?
Selective screening : 10 factors
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History of previous gestational diabetes
Certain ethnic groups
Older than 35 years
Weight more than 85 kg
First degree family history of DM
History of typical diabetic symptoms
Previous infant over 4kg
Previous stillbirth
Severe polihydramnios
Repeated glycosuria
Why should we screen
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What are the effects of diabetes on
the pregnancy?
 Antepartum:
Congenital abnormalities
2. Macrosomia
3. Intrauterine death
4. Polyhydramnios – preterm labour
1.
What are the effects of diabetes on
the pregnancy?
 Delivery:
1.
Shoulder dystocia
2. Erb’s palsy
What are the effects of diabetes on
the pregnancy?
 Postpartum:
1. Neonatal hypoglycaemia
2. Polycythaemia
3. Hyperbilirubinaemia
4. Respiratory distress syndrome
Biggest fear?
 Unexplained intrauterine death
 Fetal hyperglycaemia and hyperinsulinemia
 Increased fetal oxygen consumption
 Fetal hypoglycaemia and acidosis
Management
 Confirm diagnosis
 Ophthalmologist
 Kidney function – 24 hour protein clearance
 Blood pressure
 Urine – MCS
 First trimester screening and detailed anatomy sonar
 TSH
 HbA1C
 Fetal monitoring
Treatment
 Control known diabetic patients optimally before
conception
 Diet
 Insulin – gold standard
 Oral hypoglycaemic agents – more studies needed
Delivery : When?
 Often preterm
 Corticosteroids in hospital
 Glucose abnormal up to 5 days
 Multidisciplinary decision
 Mom vs. fetus
Delivery : How?
 The big debate
 Caesarean section vs. normal vaginal delivery
 All factors into consideration – macrosomal, timing,
urgency, maternal choice . . .
Conclusion
 We have to screen
 Increasing problem world wide
 We can improve outcome dramatically
Thank you