1 / 17

DIABETES AND PREGNANCY 0.5

CLASSIFICATION: . Diabetes mellitus type I --- insulin dependent (Ketosis-prone)Diabetes mellitus type II--- non-insulin dependent (Ketosis-resistant)Impaired Glucose Tolerance and Gestational Diabetes (IGT). Diabetogenic Effects of Pregnancy: . Insulin resistance Increased lipolysis Altere

alcina
Download Presentation

DIABETES AND PREGNANCY 0.5

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. DIABETES AND PREGNANCY (0.5%)

    2. CLASSIFICATION: Diabetes mellitus type I --- insulin dependent (Ketosis-prone) Diabetes mellitus type II--- non-insulin dependent (Ketosis-resistant) Impaired Glucose Tolerance and Gestational Diabetes (IGT)

    3. Diabetogenic Effects of Pregnancy: Insulin resistance Increased lipolysis Altered maternal gluconeogenesis

    4. ** WHITES Classification

    5. DEFINITIONS: DM= Fasting venous glucose concentration > 8.0 mmol/l and 2 hrs (75 gm load ) > 11.0 mmol/l (or) one of the above + Symptoms IGT = Fasting < 8.00 mmol/l, but 2 hr (75 gm load) = (9.0-10.9)

    6. WHO recommended modified GTT ( 75 gm load)

    7. How do diabetic patients present -Symptoms -Risk factors ( history & examination) -Blood tests--screening -Blood test

    8. Screening: WHY ? 30% have none of the Above risk factors Not all DM, IGT, have persistent glucosuria 50% of pregnant women have glucosuria at some time

    9. Risk factors DM, IGT, must be suspected in Pregnant women with Age > 30 Family history of DM Past history of: - Diabetes in a previous pregnancy - Unexplained I.U.F.D., Neonatal death - Congenital abnormalities - Recurrent abortions - Large babies > 90th centile Obesity Hypertension in multipara Polyhydramnios Recurrent infections:Urinary, Fungal Significant Glycosuria

    11. MATERNAL COMPLICATIONS Obstetric - Polyhydramnios - pre-eclampsia (10-15%) Diabetic Emergencies - Hypoglycaemia - Ketoacidosis - Diabetic coma Vascular & End-Organs - Renal - Ophthalmic - Peripheral vascular Neurologic - Peripheral neuropathy - Gastrointestinal disturbance Infections - Urinary

    13. Fetal complications (1) Macrosomia & Traumatic delivery (30% in seemingly controlled) (2) Delayed organ maturity (RDS) 6 times (3) Congenital malformations: Cardiovascular : Transposition of great vessels Ventricular septal defect Aortic coarctation Artial septal defect

    14. Fetal complications (cont) Central Nervous system - Anencephaly - Holoprosencephaly - Encephalocele Skeletal & spinal - Caudal regression Genitourinary - Renal agenesis - ureteral dupliction Gastrointestinal - anal atresia ** Note: when a two-vessel cord is found, suspect a high incidence of congenital anomalies (4) Intrauterine fetal Death (5) Growth restriction (in advanced DM)

    15. NEONATAL complications: Hypoglycaemia RDS Hypocalcaemia Polycythaemia

    16. Principles of management: Start in preconception time Specific during pregnancy

    17. Specific Diet: 16 x Wt. (pounds ) + 300 = CALORIES Carbohydrates 60% Fat 20% Protein 20% Insulin: – Regiment A * 3 times sol.-with meals + lnt. Evening Or - Regiment B * 2 types (short & intermediate) Twice Daily Dose (daily) = wt. (kg) x 0.6 first x 0.7 second x 0.8 third 2/3 in A.M. 2/3 1nt + 1/3 short 1/3 in P.M. 1/2 1nt + ˝ short.

    18. CONTROL Control : Fasting < 5.0 mmol/1 2 hrs P.P. < 7.0 mmol/1 Adjustment when necessary Glycosylated Hb A1c (retrospective) < 6 Fetal well being: AFP 16-18 wks Detailed scan 19-20 wks Biophysical assay from 28 wks Fetal wt. & growth two weekly (3rd) Delivery: - Timing depends on: (Around 38 wks) Maternal factors Biochemical control Fetal status - Method --- LSCS in any medical or obstetric complication. **Insulin dose adjusted on hourly basis with caloric requirements intravenously.

More Related